Induced childbirth: when it is practiced, and what are the induction methods

What is induced birth

Induced birth is an obstetric technique which, when the baby is late in coming out, or when there are risks to its health or to the health of the mother, allows the baby to be born quickly: for example, when the mother has blood pressure high, or when the child is not growing or developing properly.

In some cases, hospitalization for induced birth and therefore induced labor avoids having to resort to  caesarean section , even if – it must be said – not all induced births end with a vaginal birth.

Where possible, labor induction is always planned in advance, so that the woman can first discuss its advantages and disadvantages with the doctor or midwife, and also get their opinion on her specific case.

On the occasion of the birth, in order to make the pain feel less, epidural anesthesia could also be proposed (loco-regional anesthesia in which anesthetic drugs are administered), given that generally the contractions and labor in the case of an induced birth they can be more painful than a natural birth.

When practicing an induced birth

Induced birth is generally practiced when the following conditions are met.

in cases of a late pregnancy

Most women spontaneously go into labor by the end of the pregnancy.

The date is calculated by adding 40 weeks from the start date of the last menstrual period or it is obtained through the data collected with the dating ultrasound.

We speak of a pregnancy beyond the term when 42 weeks have passed and the birth has not taken place.

In general, the need for hospitalization begins to be assessed to proceed with induction of labor already at week 41 and 2 days.

In fact, when the due date is passed, the risks connected with the continuation of the pregnancy are higher (both for the mother and for the child) than those of proceeding with the induction of the birth.

At present, there is no way of knowing which babies could be affected by this delay, so induction of labor is “offered” to all women who do not enter it themselves, by the 42nd week.

in the case of pre-eclampsia

But an induced birth is also taken into consideration in cases of malfunctioning of the placenta, and in the case of   pre-eclampsia which is a typical disease of pregnancy.

in the presence of oligohydramnios

Labor is induced less frequently in the case of  oligohydramnios –  a condition characterized by a small amount of amniotic fluid that can put the baby at risk – or in the case of an early break of the waters in the absence of contractions.

in cases of early breakage of the water

Induction can also be practiced in the event of early rupture of the waters in the absence of contractions.

Methods of inducing childbirth

Induction can take place by means of special drugs or by non-pharmacological methods, especially mechanical.

pharmacological

The pharmacological ones consist in the administration of :

• of prostaglandins , through the introduction of vaginal candles inside the uterus; although sometimes this practice does not trigger the onset of labor, it allows the softening of a still tightly closed cervix, facilitating dilation with the use of oxytocin;
• of oxytocin, a synthetic version of the hormone that initiates contractions by means of an injection: in practice, oxytocin stimulates the tonic and phasic activity of the myometrium;
• of misoprostol, a prostaglandin analogue drug; it has the advantage of being administered via different routes and of being cheap.

non-pharmacological

Among the non-pharmacological methods instead we have:

• amniorexi : a technique which by artificially breaking the membranes causes a release of prostaglandins, at a local level;
• mechanical methods  including introduction of laminaria into the cervical canal, intracervical insertion of a Foley catheter, and detachment of the membranes, detachment which causes an increase in phospholipase and prostaglandin activity (in itself the detachment of the membranes does not appears to produce clinically important benefits, but is used as an adjunct to other methods);
• the use of castor oil
• acupuncture ,

• manual nipple stimulation : stimulation that causes uterine contractions.

Induction is performed in the maternity wards of hospitals by midwives, but if necessary, doctors will also be available if they are needed.

Labor induction can take some time.

But once labor sets in, it should then proceed as normal. However, it may take up to 24-48 hours for it to trigger.

If the induction does not work, the doctor or midwife will evaluate the woman and the baby’s condition. You may be offered to try another induction or caesarean section.

The possible risks of an induction to childbirth

The risks of induced childbirth are as follows,

• that the baby is premature, if the induction is started before the 39th week of pregnancy;
• hemorrhages after childbirth;
• abnormal heart rhythms in the baby (caused by medicines that may be used for induction),
• having to resort to a caesarean section, as we mentioned above.

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