Induction of labour is a birth option an increasing number of women are facing, with most mums-to-be expecting induction to be the recommended course of action once their pregnancy has reached 40 weeks.
Indeed once a pregnancy has become overdue – generally seven days past your due date – the risks of continuing the pregnancy are considered greater than medically inducing labour, hence the latter is usually recommended.
Aside from overdue pregnancies, there are several other factors that contribute to a recommendation of induction, where the birthing process is started with medical treatment.
Induction of labour is a growing phenomenon, says obstetrician Dr Brad Robinson.
Up until even recently it was believed that induction should be avoided unless medically required.
The overall approach was to induce delivery if the risks of continuing the pregnancy outweighed the risks to the baby and mother of early delivery.
However, this approach is now softening, with a greater awareness of the limitations of our knowledge about these risks, and a greater emphasis on patient choice and non-medical factors such as social circumstances.
The objective of induction is to decrease any risks of complications for both mother and baby. Some of the reasons for labour induction include:
An induced labour experience is usually similar to a natural labour. In other words, pretty unpredictable! Contractions are similarly painful, all the usual pain-relieving options are available and you’ll be able to push when you reach the final stage of labour.
Aside from medical emergencies, the general consensus is that elective induction should not be done prior to 39 weeks gestation for reasons of fetal maturation.
Before induction, your obstetrician will perform a pelvic examination to find out whether the cervix has dilated and by how much. This helps determine which induction method, or combination of methods is most suitable.
All induction methods aim to stimulate the onset of labour and contractions of the uterus.
Like natural labour, you can’t predict the time of onset of labour or the length of time it will take.
The following medical induction methods are available:
Prostaglandin – this is a natural hormone that softens the cervix. Your obstetrician or midwife will perform a vaginal examination and place the prostaglandin around the cervix. It may be inserted as a gel or pessary in the evening to dilate the cervix overnight. Sometimes two or three doses over 24 hours are required.
Stripping of membranes – your obstetrician uses a gloved and lubricated finger to gently separate the amniotic membrane from the cervix. This increases the body’s own prostaglandin levels and may help to dilate and soften the cervix.
Artificial rupture of membranes – your obstetrician uses a slender instrument or a small hook on a gloved finger to break the amniotic membrane. This may trigger the onset of labour.
Oxytocin – during labour, the hormone oxytocin is secreted naturally from the pituitary gland in the brain. Oxytocin causes normal uterine contractions. In hospital, synthetic oxytocin can be administered through an intravenous drip inserted into the woman’s hand or arm. The dose is slowly increased until the uterus contracts efficiently.
Balloon catheter – the doctor inserts a thin catheter into the cervix. Once in place, the little balloon at the end is inflated with water. The constant pressure exerted against the cervix may help it to dilate and soften.
Previously, the risk most commonly highlighted when arguing against induction was that the patient would have a higher risk of requiring caesarean delivery, but according to Dr Robinson, this concern is becoming less relevant.
New data from comprehensive systematic reviews show that in many cases induction at or beyond 39 weeks actually reduces the risk of caesar when compared to expectant management.
Other risks include the induction not working and a slightly increased risk of uterine rupture in women who are trying to give birth vaginally following a previous caesarian section.
It’s important to speak to your obstetrician about any risks associated with induction specific to your situation and pregnancy.
Here are some natural home remedies for inducing labour when you are past your due date. You must know that none of these remedies will start labor unless your cervix has begun to dilate. However, some methods can help you to tone and soften your uterus.