Paula Barry, Practice Development Co-ordinator at the Coombe Women & Infants University Hospital explains some of the reasons for induction of labour.
Sometimes labour needs to be started artificially; this is called induction of labour. The following are some of the reasons why you may be offered induction, but you should ask your hospital what their policy is.
Reasons for inducing labour
1. If your waters have broken, but labour hasn’t started. If you don’t go into labour within a day or so, there is an increased risk that you or your baby could develop an infection. So you’ll probably be offered an induction 24 hours after your waters break.
2. If you have diabetes. Each mother is assessed individually. If your baby is growing normally, in some hospitals you are offered an induction after 38 weeks of pregnancy.
3. If you have a chronic or acute condition, such as preeclampsia or kidney disease, that threatens your wellbeing, or the health of your baby.
4. If your pregnancy is overdue.
Methods of induction
There are a few methods your doctor can use to try to get your labour started. Some may need to be repeated, or you may need to try more than one before your labour begins. There are three main methods used to induce labour:
- Syntocinon drip
Propess and Prostaglandin are drugs to help soften, or ripen, the neck of the womb. This may stimulate contractions. Your midwife or doctor will insert a tablet, pessary or gel containing one or other of these drugs into your vagina. While you wait for prostaglandins to work you can usually go for a walk around. However, in some hospitals, this is not an option. How you are given prostaglandin depends on whether this is your first or second baby. If this is your first baby, you may need further help to assist induction.
When your cervix is open enough, your waters will be broken using a small plastic instrument, somewhat like a crochet hook. This is known as artificial rupture of the membranes (ARM).
Oxytocin is a hormone that is released by your body when you start labour naturally yourself. It causes contractions, which open your cervix and push the baby out. If your labour is being induced you may be offered a synthetic (man‑made) form of oxytocin known as syntocinon. It is given intravenously (into a vein) as a drip in your arm.
The contractions brought on by syntocinon encourage dilatation of the cervix – you may ask for an epidural for pain relief if required. Syntocinon may cause your uterus to become overstimulated or hyperstimulated. You will be given medication to slow your contractions if stopping syntocinon isn’t enough. There are other methods of pain relief, which can be used before an epidural should this happen to you.
Your baby’s heartbeat is monitored closely using a cardiotocography machine (CTG machine), which is a monitor with two small discs placed on your abdomen, as some babies may not tolerate medications used to induce labour. If it is still not possible to break your waters or you are on the syntocinon drip but your cervix is not opening you may be offered a Caesarean section, as induction of labour has not worked for you (depending on the reason for the induction).
The risk of you requiring a Caesarean section, or other medical interventions with induction of labour is higher than when labour is spontaneous. If you have concerns, discuss them with your doctor/midwife.
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