A Closer Look at Labor Induction

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Prof. Abd SalmanWhile many pregnant women go into labor naturally, some women need a little push. It could be they are overdue or have a medical issue that requires giving birth soon. Whatever the reason, HEALTH looks at what really happens during an induction and how it works…

Labor induction, explains Prof. Mawahib Abd Salman, Consultant, Professor Obstetrics and Gynecology at Gulf Medical University in Ajman is the artificial stimulation of uterine contractions to help in childbirth. “Induction of labor has the advantage when given in true medical reasons and it may be done potentially to save the life of a mother and her baby,” she tells and is a relatively common procedure but also may be associated with implications on fetal and maternal condition. “In a life threatening situation, induction of labor may be the best choice,” she says, however in a case of labor induction for social reasons or convenience, this may have an impact on the mother and baby.


The Commonly Accepted Medical Reasons for Induction include:

  • Post term pregnancy, for instance in the case of a pregnancy overdue the 41st week.
  • Intrauterine Fetal Growth Retardation (IUGR).
  • There are health risks to the woman in continuing the pregnancy (for instance if she has pre-eclampsia).
  • Premature Rupture of the Membranes (PROM); this is when the membranes have ruptured, but labor does not start within a specific amount of time.

Disadvantages

According to Prof. Abd Salman, the procedure has an impact on birth experience of women. “It may be less efficient and is usually more painful than spontaneous labor,” she tells and also epidural analgesia and assisted delivery are more likely to be required. Another disadvantage is that induction of labor can cause more strain than spontaneous labor. With induction of labor, Prof. Abd Salman indicates that it is reported that less than two thirds of women gave birth without further intervention, 15 percent required in instrumental birth, and 22 percent required undergoing emergency Caesarean section.** (**Nice Guidelines) Also there is a higher risk of maternal and neonatal infection with more preterm deliveries, she points out. “The main neonatal impacts on the baby include; a higher rate of neonatal infection,
hyperbilirubinemia, with premature delivery due to wrong date, with a higher rate of admission in neonatal intensive baby care unit (NICU),”
she says.

The Methods:

Sweeping membrane / stretch and sweep If the patient have a favorable cervix this may be offered first as a “drug –free” induction with fewer side effects and risks compared with other methods. It’s not usually painful but may be uncomfortable and result in some bleeding afterward. Sweeping the membranes involves a vaginal examination.

Artificial Rupture of Membrane (ARM) If the cervix is favorable and the baby is in the pelvis, this choice may be given for an induction. The waters are broken in the hope this leads to labor, however, it may give a short time for contractions to be established sometimes only an hour or two – before being put on an intravenous Oxytocin drip. “It is important that the baby is in good position before the membranes are ruptured – if the baby is too high, there is a risk of cord prolapse, where the baby’s umbilical cord slips through the cervix before the baby, putting pressure on the cord,” says Prof. Abd Salman. “This can be a very serious situation as the baby’s blood and oxygen supply becomes compressed.”

If the labor is not progressing after the membrane rupture, this is probably going to have a Syntocinon drip put up.

Artificial Oxytocinon (Pitocin, Syntocinon) Syntocinon is administered through an intravenous drip with oxytocin titration method and Prof. Abd Salman explains that this may be used if waters have broken but there are no contractions or if contractions don’t start on their
own. “When the patient will use this drug, she must be monitored continually as the doctors need to know what effect this is having on
the baby,” she explains.

Prostaglandins If the cervix is not ripe or favourable, Prof. Abd Salman says then prostaglandins are likely to be used to soften and open the
cervix. “Should this be effective and the cervix becomes at least slightly open, the waters can then be broken,” she says, however  prostaglandin may need several doses to work, so the patient may be asked to come in for extra doses.

Prostin Gel Prostin Gel is placed in the vagina near the cervix during a vaginal examination. “It works by softening and dilating the neck
of the womb and stimulating contractions,” indicates Prof. Abd Salman. A second vaginal examination is performed to check the cervix.

Methods of Induction
Labor can be induced in several ways, dependent upon the cervix and if it is favorable or ripe (a slightly open cervix), or unfavorable or unripe (a closed long cervix). Prof. Abd Salman notes that the doctor may not tell the patient about some risks listed and it may seem worrying or disturbing, however drug information should be given about its use and effects. “It is not intended to frighten anyone, but to help make the patient to make a balanced, informed decision based on the risks or benefits,” she says.

Final Words
Essentially, Prof. Abd Salman tells that in spite of the benefits and major clinical indication of induction labor, it is still associated with a large impact on health of women and their babies so the process needs to be clearly justified before starting.

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