Induction of Labor

What is induction of labor?

Induction of labor refers to the process of getting childbirth labor started before it starts on its own.

When is it used?

Sometimes healthcare providers need to get labor started because of problems with the mother's health. A few examples are:

• The mother has high blood pressure caused by the pregnancy (preeclampsia).
• The mother has diabetes.
• The mother has chronic medical problems, such as kidney, lung, or heart disease.

Sometimes there are problems with the pregnancy, such as:

• breaking of the membrane that holds the sac without the start of labor
• infection in the sac that holds the baby
• growth of the baby that is too slow
• abnormal fetal heart rate
• problems with the placenta or amniotic fluid around the baby
• death of the baby before birth

Sometimes there are issues of timing, such as:

• The pregnancy has gone at least 1 to 2 weeks past the due date.
• You live too far from a hospital and you have a history of fast labor.

Inducing labor can help keep the mother and baby healthy and may limit or avoid problems.

Labor is not induced if there is a reason to avoid a vaginal delivery such as:

• The placenta or umbilical cord is too low in the uterus, possibly covering the cervix.
• The baby is not positioned so that the head or bottom will come out first. If the baby is breech (bottom first), there may be reasons to perform a C-section rather than induce labor. Your provider will discuss this with you.
• You have an active infection in the vaginal area, such as herpes.
• You have had previous surgery to remove large fibroids from the uterus.
• You have had a C-section for a past delivery with a vertical cut in your uterus.
• Monitor or ultrasound tests show that the baby may not be able to tolerate labor well.

How do I prepare for this procedure?

Before inducing labor, your healthcare provider will check the opening of your uterus (the cervix) to see if it is getting ready to allow the baby to go through. This helps your provider know how easy or difficult induction might be. Your provider will also check the baby's position. In some cases, especially if it is before your 39^th week of pregnancy, your provider may want to check your baby's lungs to make sure they are developed enough for the baby to breathe normally after birth. This can be done by testing a sample of amniotic fluid with a procedure called amniocentesis.

Follow your healthcare provider's instructions. You may be asked to avoid eating or drinking for some period of time before being admitted to the hospital. Tell your provider about any recent illnesses you might have had or have been exposed to.

What happens during the procedure?

Labor is usually induced at the hospital. Procedures that may be done to induce labor are amniotomy, oxytocin, a balloon catheter put in your cervix, and prostaglandin agents.

• Amniotomy is the term used for breaking the membrane of the bag of water that holds the baby (the amniotic sac). This may be done if the cervix has already started to soften and open. This procedure is no more uncomfortable than when you have a pelvic exam. Your healthcare provider uses a small thin plastic rod to make a hole in the membrane. Uterine contractions usually start within 1 to 2 hours after the membrane is torn and the amniotic fluids start coming out.
• Your provider may decide to start labor by giving you oxytocin in a vein (IV). Oxytocin is a hormone that makes the uterus contract. At first you will get a very low dose. A monitor will measure your contractions. The dose will be increased slowly to make the contractions stronger and more frequent. If you start contracting well on your own, your provider may stop giving you the medicine.
• If your cervix is not quite ready for labor, your provider may put a thin tube with a small balloon through your cervix. The tube is called a balloon catheter. Your provider will inflate the balloon. Pressure from the balloon can help your cervix gradually start softening and opening. The balloon usually stays in place for a number of hours to prepare the cervix for labor while you are given a low dose of oxytocin to start contractions.
• If your cervix is not quite ready, your provider also may choose to put a medicine in the vagina to help the cervix soften and open. This is called ripening of the cervix. For example, your provider may put a gel or tablet containing a medicine called prostaglandin in the vagina.

  If you have had a C-section for a previous birth, your healthcare provider will not use prostaglandin medicine to help with labor. The medicine would increase the chance that the scar on the uterus will open (rupture).

During the induction of labor, your contractions, your blood pressure, dilation of your cervix, and your baby's heart rate will be monitored.

What are the risks of this procedure?

Breaking the bag of water (amniotomy) early could increase the chance of an infection around the baby.

If labor is induced with oxytocin, there is a small risk that:

• The baby will have start having an abnormal heart rate pattern because the contractions are too strong or frequent, the umbilical cord is being squeezed, or there are problems with the placenta.
• The umbilical cord will fall into the birth canal ahead of the baby's head.

Most risks can be prevented with close monitoring and just a gradual increase of the dose of oxytocin. If any of these problems happen, your provider will stop giving oxytocin and may decide to deliver the baby by C-section. If the baby is very far down the birth canal and the cervix is wide open, your provider may use forceps or vacuum extraction to deliver the baby vaginally.