Induced labour : frequently asked questions

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What is induced labour?

When normal labour does not begin on its own naturally and the baby is overdue the labour has to be sometimes initiated with a little help from the doctor. This is called induced labour. Though natural onset of labour and normal delivery is by far the best, medical conditions that may threaten the health of mother and baby may also warrant that labour be induced by external methods.

What is an overdue baby?

If your pregnancy has gone past the 40-41 weeks stage without the onset of labour the baby is considered "overdue".

What are the other reasons for induction of labour?

If your waters have broken but labour has not started even 24 hours after the event you may run the risk of infection and induction of labour may be tried. Other reasons to induce labour are certain medical conditions such as high blood pressure or kidney disease in the mother and diabetes.

How is labour initiated by external means?

There are many ways to do that and your doctor may use one method first and try another later.

What are these methods?

The first one to be tried is the membrane sweep. In this method the cervix is stretched or massaged to dilate it. The membranes surrounding the baby are then gently pulled away from the encircling cervix. This can stimulate the onset of labour. The membrane sweep may have to be tried a number of times for labour to begin.

If the cervix still does not dilate then a prostaglandin pessary or gel is inserted into the vagina to prep it for labour. The prostaglandin hormone will "ripen" the cervix and stimulate uterine contractions to bring on labour. This is the most preferred method to induce labour as it is efficient and has very few side effects.

Very rarely, prostaglandins can cause over stimulation of the uterus causing prolonged contractions and disrupting oxygen supply to the baby. They can also cause a uterine tear or rupture. However, this side effect can be controlled by certain drugs that can counter the contractions.

If the cervix is ripe but labour does not start, an artificial rupture of the membranes is performed to speed things up. This is done through the vagina, by piercing the membranes with a sharp hook or needle. The breaking of the waters can cause the baby to descend further and stimulate uterine contractions. However, because of the risk of infection this is not recommended nowadays.

If the contractions are still not good then a syntocinon or pitocin IV drip may be started. Syntocinon acts like the natural hormone oxytocin that stimulates the uterus to contract. The syntocinon drip has to be monitored very carefully so that the contractions are just good enough for the cervix to dilate and for delivery to happen, and that the uterus is not overstimulated.

The contractions caused by syntocinon are very painful so you may have to opt for an epidural to anaesthetise the pain.

You must be prepared for the likelihood of instruments like forceps and vacuum extractors having to be used during induction of labour. Also in case all methods of induction fail you might need to go in for a Caesarian section.

What factors are important for induced labour to be successful?

The more ripe or ready your cervix is, the further down in the pelvis the baby is the more chances are there for success in induction of labour.

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