Induction of Labor: Understanding Your Options & What to Expect

Question
Hi Brenda

Once again, I need your advice.

This is my first pregnancy. I am 39 years old and had IUI on 3/17 and 3/18 and so 12/8 is my due date. Today, my total weight gain is 14 pounds(before pregnancy was 107) only and now is 122 and the baby is around 6 pounds. I am GBS +ve.

In the past weeks, I had only had mild contractions and not dilated yet. Today, my doctor told me that if the baby is not born naturally within this week, he is going to send me to hospital on 12/10 to induce labour. I asked the reason and why don't wait after 41 or 42 weeks, he just said for the benefit of my baby.

So can you explain to me under what situations doctor will induce labour?

What procedures would include?
What drugs would they use? HOw about epidural?
Any harmful effect to the baby and to the mother? short term and long term?
Usually how many hours for the induction and the baby to be delivered?
C-section is necessary?
Anything I should pay attention to?

Thanks

Answer
Dear Jennifer,

Labor is typically induced if the health of the mother or the baby is at risk. Doctors make a determination about whether to induce labor based on:
- the condition of the woman
- the condition of the baby
- how far along the pregnancy is
- whether your cervix is dilating/effacing on its own

Certain health conditions will also prompt the induction of labor. They would include:
- A pregnancy beyond 42 weeks
- Pregnancy-induced hypertension (PIH)  
- An infection of the uterus (chorio-amnionitis)
- Placental abruption  
- Premature rupture of membranes (water has broken too early).
- Any health condition which poses a threat to the mother or baby.
- Miscellaneous reasons at the discretion of the doctor, such as living a long way from the hospital

There are a couple different methods of trying to induce labor. One is to strip the membranes. Stripping the membranes can be done in the doctor's office and involves checking your cervix with a gloved finger. Your doctor will then sweep the finger over the very thin membranes that attach the amniotic sac to the wall of the uterus. There is sometimes cramping and/or spotting after this procedure.

Another way of inducing labor is to artificially break the water by making a small opening in the amniotic sac with a small instrument. Very often labor will begin within several hours of this being done.

Most commonly when we speak of inductions we are referring to the use of a medication called oxytocin to induce labor. Oxytocin is a man-made hormone which causes uterine contractions and is given intravenously. Usually a pump is used to deliver the appropriate amount of medication to you. Your contractions are monitored closely to make sure they do not get too strong as your labor progresses. If your labor proceeds and gets going really well, sometimes a determination is made that oxytocin can be weaned down to see if labor will continue without it.

Complications from induction are rare, but they can include:
- Changes in the fetal heart rate
- An increased risk of infection for mother and/or baby
- The umbilical cord can prolapse (slip out before the baby) or get compressed
- Uterine rupture if contractions would get too intense or strong without any relief

Again - you are monitored closely with any labor induction and these complications are not common.

Having an epidural is typically not an issue with a labor induction. There would have to be another reason besides the induction to  contraindicate an epidural.

There is no way to determine a number of hours or a length of time to give you for an induction vs. a non-induced labor. Every woman and every pregnancy is different. Every induction is also different. Some women will dilate/efface quite easily once an induction is started; others will not.
Your doctor will assess how you progress with the induction. If water has been broken and there is no significant progress in 24 hours, your doctor will usually recommend a C-section. Otherwise, if your labor progresses after induction is started, there should be no need for a C-section unless there is another cause.

I hope that all of this information has helped you and answered your questions. I wish you well and a blessed delivery.

Brenda