Induction of Labour

When labour is started artificially, it is said to be induced. Labour is induced in between 10-20% of deliveries. To get local figures about induction talk to your LMC or specialist. It is always planned in advance and you will be able to discuss advantages and disadvantages with the your LMC or specialist. In New Zealand maternity system there should be a three way discussion between the woman, the LMC and secondary servicies if labour has to be induced.

Why would it be induced?

Labour is induced when there is danger to you or your baby. It may be induced under the following conditions:

• When you are well past your due date and are either in week 41 or 42. (The hospital policy varies on this as some wait for you to be one week overdue while others wait for two). It is best to check with your LMC or specialist. Postdate pregnancy is the most common indication.
• When you have hypertension or pre-eclampsia and there are complications which will affect you and baby.
• There is placental insufficiency i.e. your placenta is not working as effectively as it should.
• Baby's growth is slowed down or the baby is not moving well.
• Premature rupture of membranes that have been ruptured for more than 18 or 24 hours.
• When there is infection such as Chorioamnionitis - infection of the membranes.
• When you have medical problems, such as diabetes mellitus with pregnancy at term.
• When you have poor obstetric history such as a previous stillbirth.
• When you request induction for social/psychological reasons.

Will I labour quickly as it is induced?

Not necessarily. The labour process can sometimes take several days as you may not be ready to labour. Therefore it is important not to get anxious or frustrated and try not to have any expectation of delivery to occur at a particular time or day. The introduction of prostaglandins administered vaginally have increased the likelihood of a successful induction of labour leading to spontaneous vaginal delivery within 12-24hours.

Is induced labour painful?

Induced labour can be much more painful than the natural one as the strength of the contractions can be strong from the beginning rather than the gradual build up of strength that occurs in natural labour. Some women may need stronger analgesia to cope with induced labour. Discuss this with you LMC or practitioner looking after you.

Natural Methods of Induction

For information on natural methods of induction: Click Here

Medical Methods of Induction.

Prostaglandin pessaries or gel

This method is usually not enough all on its own. It is used in combination by one or both of the other methods below. The cervix - opening to the womb - needs to be favourable for induction of labour to be successful. A pessary/tablet made of prostaglandins (a substance naturally found in womb lining responsible for stimulating uterine contractions to initiate labour) is inserted in your vagina (preferably in the evening or early morning). If cervix is ripe, the pessary stimulates uterine contractions. If the cervix is not ripe, these pessaries will help soften the cervix and open it to the extent that at least ARM can be carried out.

The procedure of placing pessaries in your vagina may be repeated several times during the day till a result is achieved. More often these days prostaglandin gel is used in place of pessaries. The advantage of using pessaries or gel is that you can be mobile while waiting for labour to start.

Aritificial Rupture of Membranes (ARM) or Amniotomy

This is also called breaking of waters. It is an effective way of inducing labour if the cervix is not sufficiently ripe. You will be examined internally by an LMC or a doctor and your waters will then be broken using a long, thin plastic hook (you would have seen one in your ante-natal classes). This hook is brushed against the delicate membranes of the amniotic sac surrounding the baby and they are broken.

Once the membranes are broken, the increased pressure of the head on the cervix causes contractions to become much stronger. This procedure of breaking membranes is painless and is successful in starting labour in majority of the cases.

Once waters are broken, mobility may be restricted especially if the next step is to add syntocinon to your drip. However if you are not going to have syntocinon drip striaight away then you can be mobile while you are waiting for labour to establish.

Syntocinon (oxytocin)

Oxytocin is the drug of choice for labor induction when the cervical examination shows that the cervix is favorable. This is a hormone that is added to your drip to make the contractions stronger and regular. This method is usually combined with ARM. Although very safe, when using syntocinon, contractions may be much more painful, stronger and with shorter intervals between them as compared to those started by natural labour. Mobility is restricted once syntocinon is used as it is added in a drip in your arm and your contractions and your baby's heart rate are monitored continously with a cardiotocograph (CTG) monitor.