Labor Induction - How and Why
Often, by the time a woman gets to the last few weeks of her pregnancy, she feels like she's been pregnant for at least two years. The weight, the waddle, the pressure on the bladder - when will it end? When is this baby going to come? Actually, all of these feelings and questions are quite normal.
Labor Induction - Why?
However, there is a point in time when the waiting needs to be brought to an end and labor has to be induced because it isn't happening on its own. The foundational reason that labor will be induced is because the risks of waiting for it to start on its own outweigh the risks of getting it going medically. There are several instances when your healthcare provider may decide that inducing is the best route.
· Your due date was two weeks ago and you're still pregnant. The experts agree that waiting longer than two weeks past the due date puts both you and your baby at risk for all sorts of problems. The placenta may begin to deteriorate and baby won't get what is necessary to sustain life properly. This increases the chances of stillbirth or serious difficulties for your newborn baby. Additionally, the baby will continue to grow and may become too large to deliver vaginally, making a c-section necessary. If you do start to deliver vaginally, it could be damaging to you both.
· Your water has broken and you're not in labor. In order to lessen the chances of infection to either your uterus or your baby (or both), the doctor will induce labor unless the baby is seriously premature.
· Too little amniotic fluid is in the sac to provide for the baby because the placenta isn't functioning properly.
· You develop the serious complication pre-eclampsia that restricts blood flow to the baby.
· You have high blood pressure, diabetes, or kidney disease that will be detrimental to the health of both you and your baby.
· You have had a full term stillbirth before.
Then there are the logistical reasons for inducing labor: You live a million miles away from the hospital or you have a history of two contractions and voila - baby arrives. Unless there is evidence of fetal lung immaturity, diagnosed with an amniocentesis, your doctor probably will not induce before 39 weeks - no matter how far away you live.
Depending upon the condition of your cervix at the point when induction is going to be performed, your practitioner has a variety of choices for induction. If your cervix is unripe, that is it hasn't softened or opened up, then it isn't ready for labor. In this case s/he will use hormones to ripen the cervix and prepare it for induction. Sometimes the procedure for preparing the cervix can kick-start the labor. If, after mechanically preparing the cervix labor doesn't start, then a synthetic form of the hormone oxytocin will be administered by IV.
Labor Induction - How?
There is a variety of ways the doctor can ripen the cervix and induce labor:
· Prostaglandins. Typically, the first way your caregiver will try to get labor going if your cervix hasn't thinned out and begun to dilate is to start the induction by inserting a medication containing prostaglandins into the vagina. This medication ripens the cervix and can get labor moving.
· Using a Foley catheter. Rather than using medication, your practitioner may decide to insert a Foley catheter which is a very small, uninflated balloon, at the end of your cervix. When the balloon is filled with water it puts pressure on the cervix which, in turn, causes a release of prostaglandins. The release causes the cervix to soften and dilate, the balloon falls out and the catheter is removed.
· Sweeping or stripping the membranes. This can only be done if your cervix is dilated somewhat. Your practitioner inserts a finger into your uterus and manually separates the amniotic sac from the lower part of the uterus. This also causes a release of prostaglandins and helps to get things going. Often, this procedure is done during an office visit and then you're sent home to wait for labor to start. That usually occurs within a few days.
· Rupturing the membranes. This procedure, called an amniotomy, is no more uncomfortable than a vaginal exam. You have to be dilated somewhat and your practitioner inserts a plastic hooked instrument that looks like a crochet hook through the cervix and breaks the amniotic fluid sac. If the cervix is really ripe, this alone can trigger labor.
Once the membranes are ruptured, delivery should happen within 12 to 24 hours because of the risk of infection to your uterus and your baby.
There are many aspects to labor and delivery. You can learn more about the entire process by checking out our articles in this section.