Induction of Labor
Inducing labor is starting the labor, with medicine, before nature starts the labor. We induce labor for many reasons. The big categories are: pregnancy complications for the mother, pregnancy complications for the baby, and because the pregnancy has gone past the due date – enough to be a safety issue for the baby. Many times we induce labor to Prevent something bad from happening to the mother or baby.
Alternative to Induction
If induction of labor is requested, the alternative is either to wait for natural labor OR to delivery by cesarean section. When there is a compelling safety reason for mom or baby, then waiting is not a good idea. There are certain medical situations where cesarean section is better than induction of labor.
Risks of Induction
We prevent most risks to the baby during induction by very closely monitoring the fetal heartbeat. If the heartbeat suggests a problem for the baby, we deliver by cesarean section. As a result of induction, there is a higher chance of cesarean section, compared to regular labor. How much higher depends on LOTS of things.
How We Induce Labor
Induction of labor is done in the hospital. After arriving at the hospital, patients meet the labor floor staff, including the nurse, resident, the attending, and sometimes a medical student. The staff must first review the course of the pregnancy, your medical history, and document things in the electronic health record.
After we have confirmed that the baby’s head is down with a brief ultrasound done right at the bedside, we start an intravenous line (IV), and begin monitoring the uterus with two hockey-puck sized devices. One puck is a microphone, to listen to the baby, and the other puck is a used to measure contractions.
Next we start intravenous pitocin (oxytocin). We start at a low dose, and adjust the dose to make contractions come every 2-3 minutes. The dose of pitocin depends upon how sensitive your uterus is to the medicine at any moment during the labor. We monitor the frequency of contractions, and the baby’s heart rate pattern, to guide the dosing. You should expect to have the pitocin medicine until the baby is delivered.
At some point in the induction process, it may be medically necessary to break the water bag. The medical term for this is called an amniotomy. Reasons to break the water bag may include to help make the induction/pitocin work, and to confirm baby well being. Meconium stained fluid is a marking of potential baby problems during labor. We manage the labor and delivery differently if we know the baby is under extra stress, or if there is meconium. The only way to diagnose meconium in the fluid is to see the fluid.
Pain and Induction of Labor
Contraction pain is the same for regular labor and induced labor. The experience of induced labor is not as natural is regular labor…so the experience can be different. We often use pitocin during induction of labor. True, contractions are stronger with pitocin. But we give only enough pitocin to start and maintain labor progress. Without contractions there is no pain, and there is no labor…[read more]
Treating labor pain is the same, during induction or natural labor. Women may elect to use intravenous medication or epidural, for all the same reasons…[read more]
As a general rule, women who are planning to have an epidural, and who have already had one or more vaginal deliveries, should get their epidural early in the labor process. A second labor, once it gets going, can progress quickly. Once the labor gets going, there may not be time to get good pain relief from an epidural before its time to push.
The actual delivery part of the induction should be the same as for a regular labor.
What if the cervix is not ready?
The cervix should be 2-3 cm dilated, and mostly thinned out, to use pitocin for induction.
If the cervix is not ready, not dilated or thinned enough, we can use a different medicine to start the induction. The category of medicine is called Prostaglandin (PG). These medicines come in various forms; pill, gel and on the end of a string. The PG medicine is stronger than pitocin, and is more difficult to adjust, so we only use it early, to get things started. It can take 4 or 12 or 24 hours to get the cervix ready. It takes longest to prepare a closed, long cervix in a first mom. Induction, and cervix preparation, is easier in a second labor, a dilated cervix, and a thinned out cervix. Sometimes we use other things to physically dilate the cervix, like a balloon. How we prepare a cervix depends upon lots of factors.
Some women choose to treat labor pain with medication. There are two choices to manage pain: intravenous medication and epidural…[read more]
A cesarean section is an alternative to a vaginal delivery. It is a surgical procedure done in the hospital OB operating room…[read more]