When is induction of labor medically warranted, how can labor be induced, and what are the risks? Read on to find out more.
When should labor be induced?
What are some of the reasons to induce labor contractions artificially, rather than waiting for labor to commence naturally? Both the medical induction of labor and its artificial augmentation are fairly common practices on modern maternity wards. Before full-term is reached, labor is sometimes induced when it becomes clear that the risks of continuing a pregnancy are greater than the risks of inducing and the resulting premature birth of a baby.
The pregnancy complication preeclampsia is one example. Preeclampsia is characterized by an extremely high blood pressure, and it can quickly result in maternal and fetal death if it is left untreated. Unfortunately, delivering the baby is the only cure. A partial placental abruption, where the placenta started to separate from the uterine wall before the baby was due, is another good reason to induce labor. Unusually big babies medically referred to as fetal macrosomia are another reason to get labor going, either at term or slightly before. This can be the result of gestational diabetes or maternal obesity, or the cause can be unknown.
Fetal marcosomia is diagnosed through ultrasound. It helps to keep in mind that ultrasound does not always correctly determine a baby's size. Results can be off by up to two pounds. Being overdue is a very common reason for the induction of labor. After 42 weeks gestation, the risk of stillbirth increases significantly. If your bag of waters has been broken for 24 hours and your contractions have not started, your medical team will usually suggest induction, and women whose labors began and then stopped may also be candidates. This is called a stalled labor.
This is not an exhaustive list of sound medical reasons for the induction of labor. If your doctor proposes to induce you, you should always feel free to discuss your situation and the pros and cons of inducing in detail before either consenting to an induction or declining to be induced. Remember that you can always seek a second opinion if you feel the need to.
Induction of labor options
Labor can be induced in a variety of ways, ranging from minimally invasive methods to full-on medical methods that are extremely effective:
- Stripping membranes involves the physical separation of the amniotic sac from the uterine wall. This can induce contractions in women who were already close to labor.
- Artificial rupture of membranes (AROM), also known as breaking your bag of waters. AROM is the point of no return if the procedure does not get contractions going, medical induction will need to follow as ruptured membranes are an infection hazard.
- Intravaginal use of prostaglandins, most commonly misoprostol.
- Pitocin, which is a synthetic version of the hormone oxytocin. This is administred through an IV drip and is extremely effective.
Risks of labor induction
As with all medical procedures, the risks of inducing labor must be weighed against the risks of not doing so in an individual situation. It is up to the doctor and patient to discuss the risks and benefits of all options, and to decide which risk is most acceptable (in other words, most likely to lead to a good outcome). Induction can carry both major risks and minor unpleasant consequences. We will take a look at both, starting with possible major risks:
- Misoprostol is a drug that was developed to treat stomach ulcers, and that is used for early abortions and induction of labor off-label. This prostaglandin is renowned for opening the cervix up very quickly, but it is associated with fetal distress causing the need for a cesarean section. For more info, read: Is misoprostol approved for labor induction?
- The artificial rupture of membranes is again associated with fetal distress, as well as an infection risk.
- Pitocin is without a doubt the most commonly used induction method, as well as the most effective one. The risks are also quite significant: uterine rupture, postpartum hemorrhage, and water intoxication. For the baby, the risks are hypoxic brain damage; neonatal jaundice and neonatal retinal hemorrhage.
All induction methods also have the risk of premature birth and all the consequences, when it is carried out before term. As discussed, this risk is justifiable in some cases, but induction is certainly not something a pregnant woman should ask for without good medical reason. Now, induced labors are well known to be more painful than natural labors. Induction will probably trigger the need for pain relief such as epidural anesthesia, which also carries some risks. Pitocin is linked to nausea, and having an IV drip attached means that the laboring women will not be able to move around freely during her labor.