Nature typically prepares and control labor. However, sometimes nature needs a push to prepare the cervix for an efficient and comfortable delivery. Inducing labor is that push. Yet, inducing labor is not always safe. Scroll down to understand 7 risks of inducing labor you must know about.
Studies show that the rate of labor induction is alarmingly increasing. Almost 50% of the women who participated in the survey, who give birth vaginally, had labor induction
If labor induction is scheduled because of a medical reason, it will be the best thing for a mother or her child’s well-being. On the other hand, if it is elective, which means if it has opted for some sort of convenience and preferences, it is always better to avoid it as the final gestation week is very important for the baby.
There are some prominent risks of inducing labor that in this article, we intend you to be aware of the same.
What Is The Significance Of Final Gestational Weeks?
The final weeks of gestation are very important as it is during these days that the mother’s antibodies pass to the baby in the womb. It is very important for immunity. Also, it is during the last days of gestation baby’s lungs get developed enough to breathe.
It is also during the final weeks of pregnancy the baby attains more coordinated sucking and swallowing skills. Moreover, it is during the final weeks of pregnancy, more fats get deposited under the baby’s skin. This is very important for maintaining body temperature during the initial few weeks of the newborn.
Our panel gynaecologist Dr Ankita Patel Tayal says that according to ACOG recommendation, when a woman and her fetus are healthy, induction should not be done before 39 weeks. Babies born at or after 39 weeks have the best chance at healthy outcomes compared with babies born before 39 weeks. When the health of a woman or her fetus is at risk, induction before 39 weeks may be recommended.
The baby’s maturity and the mother’s readiness for labor are two factors that should not be avoided when it comes to vaginal delivery.
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What Is Meant By Inducing Labor?
Labor induction is a process that stimulates uterine contractions artificially before the labor begins naturally. Labor is usually induced when it is found that the baby has to be delivered vaginally before the labor starts naturally. The doctors prefer this only if there is a strong medical need.
Moreover, inducing labor is not meant for all women. If the woman had a C-section in the previous delivery, she could not undergo labor induction in the subsequent pregnancies. Similarly, inducing labor will not be initiated if the woman had major uterine surgery.
Also, labor induction will not be initiated if the mother is experiencing placenta previa or if the baby is in a breech or transverse lie position.
When Does A Doctor Opt For Inducing Labor?
Usually, the doctor decides on inducing labor when it is found that setting off labor fast is safer for the baby or mother, or both, than waiting for the labor to start naturally. The doctor goes for inducing labor after evaluating several factors.
Labor induction will be necessary if there is no enough amniotic fluid around the baby. The condition is called Oligohydramnios. Studies show Oligohydramnios increases the risk of stillbirth.
The doctor chooses to go ahead with inducing labor in case of premature rupture of membrane. No other way other than inducing labor as the water is broken, and yet labor is not starting naturally. High blood pressure and issues associated with it and gestational diabetes are the other two issues that may necessitate labor induction.
If the pregnancy is overdue for more than a week or two, or if the doctor detects fetal growth restriction, the doctor may induce labor. Similarly, uterus infections like chorioamnionitis, conditions like placental abruption also necessitate labor induction.
How Long Does It Take To Go In Labor After Being Induced?
Are you wondering how long it will take Inducing labor and labor to start? Well, it depends on how ripe the cervix is when the induction starts. Cervical ripening means the cervix becomes soft and expanded.
If the cervix already starts ripening and all it needs is a little push to ripe completely, the labor will start within hours after labor induction. On the other hand, if the cervix is intact and shows no signs of ripening, the women might have to wait for days after labor induction to begin the labor.
How Induced Labor Differ From Natural Labor?
Induced labor can be more excruciating than natural labor. This is because unlike natural labor, where the frequency and strength of the contractions gradually increase, they can start more quickly in induced labor and become stronger at a fast pace.
The intensity of the pain depends on the type of labor induction. It could range from mere discomfort to more intense, especially if the medication is taken results in long-lasting contractions.
Therefore, in induced labor, the woman might need pain killers or even ask for an epidural. Besides, as the baby is closely monitored in induced labor, it will be hard for the mother to move around as in natural labor.
Also, in induced labor, the requirement of assisted delivery is more when compared to natural labor. Assisted delivery is delivery in which the doctor needs to use instruments like forceps and vacuum extractors to deliver the baby.
How Is Labor Induced?
There are more than a few methods of inducing labor. The doctor may try the labor induction process that suits the mother. Sometimes doctors may even opt for a combination of methods. Here are four main ways to induce labor.
1. Stripping or sweeping the membrane
A membrane sweep is a technique that helps to stimulate the cervix and start the labor. The procedure is performed by gently inserting a gloved finger through the cervix and moves it back and forth in a rotating manner. It is not a painful procedure. The procedure, however, may not be comfortable as well.
The discomfort will be more or less similar to discomfort during a smear test or vaginal examination. The whole procedure will be over within five to ten minutes. Studies prove that membrane sweeping is advantageous in bringing about spontaneous labor.
If the membrane sweep is successful, the labor starts within 48 hours. However, giving two or even three membrane sweeps 48 hours apart is found to increase labor chances, thereby increasing the success rate. A midwife or doctor can perform it at home or prenatal clinics.
2. Amniotomy
Rupturing the membranes, alias, amniotomy is another means to induce labor. In this method, the doctor or nurse breaks the amniotic sac using amnihook, a small hook similar to a knitting needle. This procedure will be initiated only if the cervix is somewhat dilated.
This is not a painful procedure. If the cervix is favorable, the rupturing of the membrane helps to start the labor in a matter of hours. The mother may feel a warm gush of fluid once the sac opens. Rupturing of the membrane set off the release of hormone prostaglandins that kick start the labor.
3. Inducing labor with medicines
Giving you medicines to ripen the cervix and start contractions is another method of inducing labor. Oxytocin is the medicine widely used to induce labor. It is a synthetic form of a hormone that triggers contractions.
Pitocin is a drug that contains this hormone. This drug is usually administered slowly and continuously through an IV. It could potentially generate really strong contractions. Therefore, after administrating, the fetus and uterus need to be closely monitored.
Pitocin is more of use at speeding up labor that’s going slowly or has stalled after starting. Another important thing is inducing Pitocin cannot dilate the cervix, even though it could generate strong contractions. Therefore it will not be administrated if the cervix is not ripening.
Pitocin carries some risks. One of the important Pitocin side effects is the over-stimulation of the uterus. Rupture of the uterus, fetal distress, and fetal death are other potential risks.
4. Ripening the cervix
Cervical ripening involves encouraging the cervix that fails to erode and dilate naturally to become softer, thinner, and wider. This will help to induce labor in case the labor is not happening as the cervix fails to dilate. The ripening of the cervix can be done in various ways.
Medicines are used to soften and thin the cervix. A medicine called laminaria is inserted into the vagina. It absorbs moisture and expands, which helps to open the cervix. Catheter dilation is another technique used to dilate the cervix.
Here, the doctor inserts a Foley catheter, a narrow latex tube with a balloon tip, through the vagina into the cervical canal. The balloon will then slowly be inflated to 2 to 3 inches in diameter. This will boost the dilation of the cervix.
7 Risks Of Inducing Labor You Must Know About
1. Uterine hyperstimulation
Many agents that are used to induce labor can bring about uterus hyperstimulation. This is a condition in which the uterus is overstimulated, and as a result, there will be more than five strong contractions in 10 minutes. Having more frequent strong contractions that exceed two minutes duration is also a sigh of the hyper-stimulated uterus.
As the hyper-stimulated uterus’ contractions will be more intense – stronger and faster, it could hamper the oxygen supply to the fetus. This can lead to changes in fetal heart rate changes and fetal distress.
2. Failed induction increases the need for C section
Dr Ankita Patel Tayal, MD OBGYN, says that sometimes labor induction does not work. Early labor is the time when a woman’s contractions start and her cervix begins to open. Women who have induction at 39 weeks should be allowed up to 24 hours or longer for the early phase of labor. They also should be given oxytocin at least 12–18 hours after stripping of the membranes. If a woman’s labor does not progress, it may be considered a failed attempt at induction.
An induction will be counted as failed when there is no sign of labor after one round of the labor induction process. One round of labor induction process consists of placing of PGE2 tablets inside the vagina at an interval of 6 hours.
A failed induction may mean that you will need to try another induction or have a cesarean delivery. Which the doctor chooses depends on why the induction of labor failed in the first attempt.
It is found that around 75% of labor induction ends in successful vaginal delivery. This implies around 25% of the women fail to deliver vaginally after labor induction, mainly due to the unripened cervix. This section of women necessitates a C section.
Many studies show the relationship between induced labor and cesarean rates. When the water breaks as a result of the labor induction procedure, no other way than go ahead with a c section. This is because, without amniotic fluid around it, the baby in the womb will be prone to infections.
It is the first time mother more often have to undergo a C-section after the failure of labor induction. Fetal distress and poor position of baby are other reasons that necessitate c-section after labor induction.
3. Increased chances of infection and complications
Some processes of labor induction, such as rupturing the membranes with a hook, carry an increased risk of infection for both mother and child. Another common complication associated with labor induction process like amniotomy is cord collapse.
The sudden and fast gush of amniotic fluid after the rupturing of the membrane leads to cord collapse. Also, prolonged (more than 18 hours) rupture of membranes and delaying onset of labor increases the risk of intra-amniotic infection.
4. Uterine rupture
This is a rare but serious complication of induced labor. Uterine rupture happens whether the uterus rips apart along the scar line from a prior C-section or major uterine surgery. Strong, frequent, and prolonged contraction of the hyper-stimulated uterus as a result of medicated labor induction can cause uterine rupture.
Studies show that the risk of uterine rupture is very high with labor induction. However, women with previous c sections or those who underwent any sort of uterus surgery are more at risk.
However, when it comes to risks associated with labor induction, we cannot ignore the relatively high risk of uterine rupture regardless of all precautions taken. Uterine rupture is a life-threatening condition that necessitates an emergency C-section. However, in the worst scenario, the uterus might need to be removed.
5. Increased need for medical interventions
Induction of labor involves an increased need for medical intervention. First of all, as induced labor contractions are more intense and painful, the need for pain-relieving techniques like epidural will be initiated.
Other than this, while the labor is induced, more often, the baby tends to be in positions that will not allow the baby to move easily through the birth canal. Both of these scenarios get in the way of effective pushing during active labor.
Therefore, it can become necessary for the doctor to rely on instruments like forceps or vacuum extraction to help deliver the baby. Assisted delivery increases the risk of birth injuries.
6. Increases the chances of postpartum hemorrhage
Labor induction increases the risk of heavy bleeding after delivery. Studies show that even among women who are out of the dangerous zone of postpartum hemorrhage (PPH), if go for labor induction, no matter what technique is used, the risk of PPH increases.
This is because, due to all medicines and techniques used to induce the labor artificially, the uterine muscles fail to contract as in normal delivery. This could lead to serious bleeding after delivery.
7. It is more painful than normal labor
Induced labors are usually more painful owing to the intense and more frequent and prolonged contractions. This can negatively affect the mother as she becomes tired and/or disillusioned fast than in normal labor.
The painful labor also increases the need for epidural analgesia, which, in turn, can increase the need for assisted vaginal delivery. Also, labor induction necessitates more vaginal examinations and monitoring other interventions that can be discomfort for the mother.
Risks Of Inducing Labor- Conclusion
The decision to go with the labor induction process should be taken after weighing the pros against the cons. It is a serious decision. Go for labor induction only if you are convinced about the medical reasons for it. If your pregnancy is healthy, avoid elective labor induction. It is always best to wait for labor to start naturally.
If your doctor recommends inducing labor earlier, enquire about the possibility of waiting for completing 39 weeks. It is always important to weigh the pros and cons of induced labor if you are intended to go for elective labor induction.
After all, no machine can provide the atmosphere your womb provides when it comes to the growth and development of the baby.