In most healthy pregnancies, labor usually starts spontaneously between 37 and 42 weeks of pregnancy. The onset of labor is characterized by softening and opening of the cervix, following which the uterus starts contracting and the water breaks. Labor induction or inducing labor is the process of artificially initiating labor by stimulating uterine contractions during pregnancy before labor begins on its own or if it fails to begin spontaneously by the due date to achieve vaginal delivery.
The time taken to go into labor after being induced varies and can take anywhere between a few hours up to two to three days. The time taken depends on
- How the body responds to the treatment used to induce labor.
- Whether it’s the woman’s first pregnancy (labor induction usually takes longer if it’s the first pregnancy).
- The gestational age (labor induction usually takes longer if the woman is less than 37 weeks pregnant).
- How ripe the cervix is when the induction begins (if the cervix needs time to ripen, it takes longer for labor to begin).
Induction of labor is usually elective (planned in advance); hence, the patients can discuss the pros, cons, and risks with the doctor. The benefits of induction of labor usually outweigh the risks. Induction of labor typically involves rupturing the membranes (breaking the waters) or administering medication to ripen the cervix and/or stimulate uterine contractions.
Why is labor induced?
Labor induction may be indicated in the following:
- Post-term pregnancy: If the process of labor hasn’t begun two weeks beyond the due date (usually over 39-41 weeks), the doctor may suggest inducing labor.
- Rupture of the membranes before labor: The membranes rupture (water breaks), but labor has not begun.
- Gestational diabetes: This is diabetes in the mother that develops during pregnancy.
- High blood pressure disorders of pregnancy: This involves hypertension (high blood pressure) that develops during pregnancy.
- Chorioamnionitis: It is an infection of the uterus.
- Intrauterine fetal growth restriction (IUGR): The weight of the fetus is below average.
- Oligohydramnios: It is reduced amniotic fluid in the uterus surrounding the baby.
- Placental abruption: The placenta detaches partially or completely from the inner wall of the uterus before delivery.
- Systemic medical conditions: Certain systemic medical conditions such as kidney disease or obesity.
How is labor induced?
Induction of labor is usually performed in a labor and delivery unit, with an operating room and resources available to perform an emergency cesarean delivery if necessary and induction fail. If induction is successful, women may be able to deliver vaginally. The fetal and maternal status are continuously monitored. Induced labor is usually more painful than natural labor because uterine contractions are quicker and much stronger. Hence, women may need an epidural (regional anesthesia) to manage pain.
There are various techniques to induce labor:
- Ripen your cervix: Medications called prostaglandins are usually placed inside the vagina to cause thinning or ripening (softening) of the cervix. Another technique that may be used to ripen the cervix is filling a balloon catheter with saline and placing it in the cervix.
- Amniotomy: This involves rupturing the amniotic sac, also referred to as rupturing the membranes or breaking of water. A small opening in the amniotic sac is made using a surgical instrument resulting in the gushing of flush, also known as “water breaking.” An amniotomy is done only if the cervix is partially dilated and thinned.
- Intravenous medication: Medication such as the synthetic version of the hormone oxytocin is administered intravenously (IV). Oxytocin is a naturally occurring hormone in women that causes the uterus to contract. IV oxytocin augments labor that has already begun.
What are the complications of labor induction?
Some common risks that may be associated with induction of labor include:
- Failed induction: About 25% of induced women may need cesarean delivery due to failed induction. Women who are pregnant for the first time have a higher risk of failure of induction.
- Infection: Some methods of induction of labor, such as rupturing the membranes (especially if there is prolonged membrane rupture), may increase the risk of infection in the mother and/or baby.
- Fetal distress: Medications used to induce labor can cause abnormal or excessive contractions, which reduce the baby's heart rate and oxygen supply resulting in fetal distress.
- Uterine rupture: It is a life-threatening complication in which the uterus ruptures the scar from previous surgery. Rarely, the uterus may rupture in women who have never had previous uterine surgery. An emergency cesarean delivery with or without a hysterectomy (uterus removal) is required.
- Postpartum hemorrhage: Labor induction increases the risk of uterine atony (the uterine muscles don’t contract properly) that can cause severe bleeding after delivery.
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