Labour may need to be induced for various reasons:
- If the pregnancy has gone two weeks past the due date. It is inadvisable to wait beyond that time as the danger of stillbirth can go up.
- Intrauterine foetal growth restriction (IUGR) or if tests show that the placenta is no longer functioning properly, there is too little amniotic fluid or the baby isn’t thriving or growing as he should.
- If the mother has pre-eclampsia which can endanger both mother and baby by waiting for labour to begin naturally.
- If the membranes have ruptured, but labour has not started within a certain amount of time.
- Premature termination of the pregnancy (abortion).
- Foetal death in utero and previous history of stillbirth.
- Multiple pregnancies continuing beyond 38 weeks.
- A high-risk pregnancy that puts the woman and/or her child at risk, such as diabetes, high blood pressure or chronic kidney disease.
Methods of induction of labour can be both pharmacological, that is, with medicines or mechanical/physical approaches. Physical approaches include artificial rupture of membranes or membrane sweeping. In pharmacological approaches certain drugs like oxytocin or prostaglandins are administered that start off the labour process.
If the cervix has not softened and effaced(ripened), then the practitioner will use mechanical methods or medicines to ripen the cervix. This may kick start the labour and also shorten the labour period.
Risks of induction of labour:
While the induction of labour is considered generally safe when monitored by trained personnel it may carry certain risks. Oxytocin or prostaglandins, can occasionally cause contractions to come too frequently or that are abnormally long and strong. This, in turn, may stress the baby. In rare cases, these drugs may also cause placental abruption or uterine rupture. Some experts caution about using these drugs on women who have a VBAC (Vaginal birth after caesarean) as ruptures have been known to happen in such cases.
Continuous foetal monitoring is done during induction of labour to monitor the baby’s heart rate and the strength and frequency of the contractions. If the hospital has a cordless monitor then walking around may be possible, else you will have to be in bed at this time.
If the cervix is unripe, induction of labour can take a long time. However, waiting for labour to start on its own after the due date may be even more frustrating.
There are certain situations in which labour should not be induced.
- When tests indicate that your baby needs to be delivered immediately and cannot tolerate contractions.
- Placenta previa is present (when the placenta is low in the uterus, either next to or covering the cervix).
- If the baby is in a breech position, i.e. not in the head first position.
- In case of more than one c-sec delivery earlier.
- A previous c-sec delivery with a vertical uterine incision or other uterine surgery.
- In case of multiple pregnancy where the first baby is in breech presentation.