Induction is a method of artificially or
prematurely stimulating
labour in a
woman.
Common causes for induction include:
- The baby is believed to be getting too big.
- Postdate pregnancy, i.e. if the pregnancy has gone past the 42
week mark.
- Intrauterine
fetal growth retardation (IUGR).
- There are health risks to the woman in continuing the pregnancy
(e.g. she has pre-eclampsia).
- Premature rupture
of the membranes (PROM); this is when the membranes ruptured,
but labour does not start within a specific amount of time.
- Premature termination of the pregnancy (abortion).
- Scheduling concerns.
- Fetal death in utero.
Methods of induction
Methods of inducing labour include:
- "Membrane sweep", also known as membrane stripping, or "stretch
and sweep" in Australia and the UK - during an internal
examination, the midwife moves her finger around the cervix to
stimulate and/or separate the membranes around the baby from the
cervix. This causes a release of prostaglandins which can help to
kick-start labour.
- Artificial rupture of the membranes
(AROM or ARM) ("breaking the waters")
- Cervically-applied prostaglandin,
such as dinoprostone or misoprostol.
- Intravenous administration of
synthetic oxytocin preparations, such as
Pitocin.
- Natural Induction - Many
midwives or other holistic providers practice "natural" induction,
which may include use of herbs, castor oil or other medically
unconventional agents to stimulate or advance a stalled labor.
If an induction causes complications during labor, a
Caesarean section is almost always
conducted. An induction is most likely to result in successful
vaginal delivery when a woman is close to or in the early stages of
labor. Signs of pending labor may include softening of the cervix,
dilation and increasing frequency or intensity of contractions. The
Bishop score may be used to assess the
advisability of induction, and is based on such factors.
When to induce
Until recently, the most common practice has been to induce labor
by the end of the 42nd week of gestation. This practice is still
very common. Recent studies have shown an increasing risk of infant
mortality for births in 41st and particularly 42nd week of
gestation, as well as a higher risk of injury to the mother and
child. The recomended date for induction of labor has therefore
been moved to the end of the 41 week of gestation in many countries
including Sweden and Canada.
Criticisms of induction
- Induced labour tends to be more intense and painful for the
woman, often leading to the increased use of analgesics and other pain-relieving
pharmaceuticals (Vernon, 2005). This cascade of intervention has
been said to lead to an increased likelihood of caesarean section delivery for the baby.
(Roberts 2000). However, studies into this matter indicate that
induction has no effect on the rates of caesarean section. Two more
recent studies have shown that induction may increase the risk of
caesarean section if performed before the 40th week of gestation,
but has no effect or actually lowers the risk if performed after
the 40th week.
- Some feel that doctors show increasing propensity toward
induction simply for personal convenience or to relieve load on
hospital facilities. "[Induction] enables doctors to practice
daylight obstetrics," says Dr. Marsden Wagner, a neonatologist who
served for 15 years as a director of women's and children's health
in industrialized countries for the World Health Organization. "It
means that as a doctor, I can come in at 9 a.m., give you the pill,
and by 6 p.m. I've delivered a baby and am home having dinner."
A growing
number of pregnant women are opting to have induced labor,
according to a 12-year study of women in Illinois
that was
published in the September 2008 issue of the
journal Medical Care. The researchers say that the
consequences are not clear, but some believe that elective
inductions will be done for convenience reasons.
References
- Roberts, Tracy, Peat, 2000 Rates for obstetric intervention
among private and public patients in Australia: population based
descriptive study Christine L Roberts, Sally Tracy, Brian
Peat, "British Medical Journal", v321:140 July 2000
- Vernon, David,
Having a Great
Birth in Australia, Australian College of
Midwives, 2005, ISBN 0-9751674-3-X
- Goodman, David, " Forced Labor", Mother Jones
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