Induction of Labor

What is induction of labor?

Induction of labor means getting the process of childbirth (labor) started before it happens naturally on its own. This is done with the use of medicines or, in some cases, with surgical methods.

When is it used?

Sometimes the mother's health makes it necessary to start the birth process early. Examples include:

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

Sometimes there are problems with the pregnancy itself, such as:

• infection in the sac that holds the baby
• early breaking of the membrane that holds the sac without the start of labor
• poor growth of the baby
• abnormal fetal heart rate
• the placenta is pulling away from the wall of the uterus (abruption)
• 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.

Before starting 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 if the induction will work. Your provider will also check the baby's position. In some cases, your provider may check the baby's lungs by testing a sample of amniotic fluid.

When is induction not used?

Induction of labor is not done in the following situations:

• Placenta previa (the placenta located low in the uterus, possibly covering the cervix).
• When the baby is lying transverse (sideways) in the uterus.
• Prolapsed umbilical cord which comes through the cervix before the baby.
• Previous surgery on the top or the body of the uterus (fundal area)
• Previous C-section with vertical incision.

How do I prepare for this procedure?

Follow your healthcare provider's instructions.

What happens during the procedure?

Labor is induced at the hospital. The most common ways to induce labor are amniotomy, stripping the membranes, oxytocin, and prostaglandin gel.

Amniotomy is the term used for breaking the bag of waters that holds the baby. It is often the easiest way to start labor. This procedure is no more painful than a normal vaginal exam. Your provider uses a tool to make a hole in the amniotic membrane. This membrane holds back the bag of waters, called the amniotic sac. When it is torn and the amniotic fluids start coming out, uterine contractions usually start within 1 to 2 hours.

Instead of tearing the bag of waters, your provider may use a finger to separate the bag of waters from your cervix. This is called stripping the membranes. It releases hormones that start the contractions.

Your provider may decide to start labor by giving you oxytocin intravenously (IV). Oxytocin is a natural 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 until the contractions reach the desired strength and frequency. Your provider will adjust and continue the oxytocin until the baby is born. If you start contracting well enough on your own, the medicine may be decreased or shut off.

Your provider may put a medicine in the vagina to help the cervix soften and open, called ripening of the cervix. For example, your provider may put a hormone ointment called prostaglandin gel in the vagina. Often the gel is used with oxytocin to help the oxytocin work faster. Prostaglandins should not be used to open the cervix with vaginal birth after cesarean (VBAC) due to the increased risk of rupture or the uterus. Only oxytocin alone may be used to induce labor with VBAC.

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 associated with this procedure?

The risks of induction of labor with oxytocin can almost always be prevented with close monitoring and a gradual increase of the dose. There remains a small risk of:

• abnormal fetal heart rate from contractions that are too strong or frequent, or from a squeezing (compression) of the umbilical cord
• separation of the placenta from the uterus (abruption) if contractions are too strong
• too much water in your body if the wrong IV solutions are used
• prolapsed umbilical cord (the umbilical cord falls into the birth canal ahead of the baby's head or other parts of the baby's body) or infection as a result of amniotomy
• damage to the uterus or cervix (for example, a tear of the uterus or cervix)
• a cesarean delivery if induction of labor does not work.
• infection from the breaking of the bag of waters with amniotomy.

When such problems occur, your provider will stop giving oxytocin and may 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.