Medical Induction of Labor
Sometimes it is preferable to use medical techniques to begin labor rather than wait for the body to begin labor naturally. In the US, nearly one in five labors is induced.
Reasons for Procedure
The most common reason for labor induction is that the pregnancy has gone two or more weeks past the due date. In this situation, the baby may get too large for a vaginal delivery or may not be able to receive enough oxygen through the placenta (the organ that links the mother and the baby). Other reasons for induction include the following:
- “Water breaks” (the amniotic fluid that surrounds the baby in the uterus leaks out through the mother’s vagina) and contractions do not begin
- High blood pressure]]> or diabetes
- Infection in the uterus
- Low amniotic fluid level
- Problems with the placenta
Risk Factors for Complications During the Procedure
The risk factors are the same as those for a labor that begins on its own. Risk factors that likely will rule out an induction and result in a cesarean birth]]> include the following:
- Placenta or vasa previa (placenta positioned over the cervical opening)
- Baby is lying horizontal in the uterus
- Prolapsed umbilical cord (umbilical cord slips out of the cervical opening)
- Prior high, vertical uterine incision or surgery to remove a ]]>fibroid]]> that entered the uterine cavity
- Pelvic structure abnormality
- Active ]]>genital herpes]]> infection
- Invasive ]]>cervical cancer]]>
What to Expect
Prior to Procedure
The same general guidelines and recommendations apply for an induction as for a spontaneous birth]]> . However, there are some differences:
- Do not eat too much before arriving at the hospital for your induction. The medicines given to induce labor can create very strong contractions and could upset your stomach. Labor contractions slow the digestive process, so your stomach will remain full. This can cause a problem if you need ]]>general anesthesia]]> .
- Your doctor may give you medicine to begin the labor process on the night before your induction is scheduled.
Description of the Procedure
To deliver your baby vaginally, the cervix needs to “ripen” or efface. When effaced, the cervix softens, thins, and opens to prepare for delivery. If your cervix is not doing this already, your doctor may give you a medicine to aid this process. The medicine could be a gel that is applied to the cervix, a suppository put in the vagina, or a pill taken by mouth.
There are also procedures that your doctor can do to aid this process. Your doctor could:
- “Strip the membranes” or separate your cervix from the tissues around the baby’s head with his finger
- “Break your water” with a thin, plastic hook
- Expand a small balloon-tipped catheter in the uterus
- Place small cylinders that contain a type of seaweed into the uterus
Changes in the Cervix During Pregnancy
If contractions have not started once your cervix is ripe, your doctor will give you a drug that causes contractions. The drug is a man-made version of a hormone called oxytocin, which is produced by your body during active labor. The drug can be adjusted throughout labor to strengthen or weaken the contractions as needed. Once contractions begin, the labor and birth process mirrors that of a spontaneous delivery.
The same pain medications are available for an induced labor as for a spontaneous delivery. Most women opt for an ]]>epidural or spinal block]]> .
Just like in a spontaneous birth, the following may occur:
- If your perineum has torn or if you've had an ]]>episiotomy]]> , this will be closed with stitches.
- A nurse may massage your abdomen to help your uterus clamp down and decrease bleeding.
- Your vaginal area, perineum, and rectum will be washed to remove all of the birth fluids and blood.
- You may be given an ice pack to apply to your perineum to soothe it and to decrease swelling.
- You may require a shot of ]]>oxytocin]]> (Pitocin) to help your uterus contract to help decrease bleeding.
- You may be given pain medications, either by mouth, injection, or intravenous (IV).
How Long Will It Take?
It can be hours to several days from the time you are induced until you deliver your baby. If your cervix is not ripe when you are scheduled for the induction, labor and delivery could take 2-3 days. Inductions for first-time mothers and those taking place preterm generally take more time.
In some cases, your doctor may give you medications, such as glyceryl trinitrate and dinoprostone, to reduce the time from induction to delivery. ]]>*¹]]>
Will It Hurt?
Yes, labor is painful, but you can learn various techniques to try to lessen the pain. You should learn as much as possible about childbirth ahead of time so that you can decide if you want to use an epidural or other pain medication.
The same possible complications that may occur from a spontaneous delivery also apply to inductions. In addition, inductions carry the following risks:
- Stalled labor—If the medicine does not trigger labor, you may need a cesarean section.
- Strong contractions—The medicine that causes contractions could make them too strong. Although rare, this can lead to fetal distress and uterine rupture. In the event that your contractions are too strong, your doctor will lower the dose or stop the medicine.
Average Hospital Stay
The average length of stay for all births is 2.4 days.
Postoperative care following an induced labor is the same as for a spontaneous birth.
Call Your Doctor If Any of the Following Occurs
After you leave the hospital, call your doctor if any of the following occurs:
- Fever of 100.4°F
- Soak more than one sanitary napkin an hour or if the bleeding level increases
- Incisions from C-section or episiotomy]]> become more red or swollen or drains pus
- New pain, swelling, or tenderness in your legs
- Have hot-to-the-touch, significantly reddened, sore breasts, or any cracking or bleeding from the nipple or areola (the dark-colored area of the breast)
- Foul-smelling vaginal discharge
- Painful urination or a sudden urge to urinate or inability to control urination
- Increasing pain in the vaginal area
- Develop a cough or chest pain, nausea, or vomiting
- Become ]]>depressed]]> or experience hallucinations, suicidal thoughts, or any thoughts of harming your baby
American Academy of Family Physicians
Women's Health Matters
Harman JH, Kim A. Current trends in cervical ripening and labor induction. Am Fam Physician . 1999;60:477-484.
Inducing Labor: your questions answered. MayoClinic.com website. Available at http://www.mayoclinic.com/invoke.cfm?ID=PR00117 . Accessed August 29, 2005.
Labor and delivery procedures. The Merck Manual website. Available at http://www.merck.com/mmhe/sec22/ch261/ch261e.html . Accessed August 30, 2005.
Labor induction. American Academy of Family Physicians website. Available at: http://www.aafp.org/afp/990800ap/990800a.html . Accessed August 29, 2005.
Longer hospital stays for childbirth. National Center for Health Statistics website. Available at http://www.cdc.gov/nchs/products/pubs/pubd/hestats/hospbirth.htm . Accessed August 30, 2005.
Morey SS. ACOG develops guidelines for induction of labor. American Academy of Family Physicians website. Available at: http://www.aafp.org/afp/20000715/practice.html . Accessed August 29, 2005.
*8/8/2006 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Nunes FP, Campos AP, Pedroso SR, et al. Intravaginal glyceryl trinitrate and dinoprostone for cervical ripening and induction of labor. Am J Obstet Gynecol . 2006;194:1022-1026.
Last reviewed February 2009 by ]]>Ganson Purcell Jr., MD, FACOG, FACPE]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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