What is Labour Induction: Reasons, Procedure, Risks and Advantages

Table of contents

• What is Labour Induction?

• Different Ways to Induce Labour

• When to Induce Labour?

• The procedure of Inducing Labour

• Risks of Inducing Labour

• Advantages and Disadvantages of Inducing Labour

• Advantages of Inducing Labour

• Disadvantages of Inducing Labour

• What can I expect during Labor Induction?

• How long does a Labour Induction Last?

• Natural Ways to Induce Labour

• Take Home Points

• FAQS on Labour Induction

Introduction

Induce labour or Labour induction is done to avoid maternal and foetal complications during delivery. It is done for vaginal delivery. Spontaneous labour is natural in which labour pains and cervical dilation start on their own.

In labour induction, an obstetrician or healthcare provider artificially induces labour as the name suggests. It can be due to various reasons. In this blog, we’ll cover 

What is Labour Induction?

Induce labour or labour induction is when a Medical practitioner starts the process of labour in a pregnant female. For example, We know a normal pregnancy is almost 9 months 7 days, now suppose a female has completed her pregnancy of 9 months 7 days and still no spontaneous labour pains are noted.

Pregnancy after the due date(given by an obstetrician) is called post-dated pregnancy and there are risks associated with post-dated pregnancy. So to avoid this, Obstetricians may induce labour. In simple words, an Obstetrician can start the process of labour through some medication or techniques to avoid risks to the foetus or mother.

Above is just one scenario in which labour induction may be needed, there are various other indications of labour induction which we’ll cover in other sections.

Different Ways to Induce Labour

After getting through, what is labour induction? you may ask what are different ways of inducing labour? Here are different ways of inducing labour

• Cervical Ripening:

Cervical ripening means making the cervix favourable for the delivery of the baby. This is done using drugs like prostaglandin analogues. Prostaglandins analogues (misoprostol) are usually put into the vagina or given orally to ripen or soften the uterus for labour induction.

• Balloon Dilation:

In this process of labour induction, A catheter is introduced into the cervix with a balloon at the top, Normal saline is filled to inflate the balloon, and inflation of the balloon causes cervical dilation which is important for labour.

• Artificial rupture of Membrane:

In this process of labour induction, Membranes which surround the baby are ruptured using forceps, which release natural prostaglandins present in amniotic fluid(fluid around the baby for cushioning). This causes labour induction to begin.

• Membrane Stripping:

When the Amniotic sac(which covers the baby and amniotic fluid around it) is separated from the uterus, this initiates the process of labour.

• Oxytocin Infusion:

After accessing the cervical status and ripening of the cervix, an IV line is established to start Synthetic oxytocin infusion. Oxytocin is produced naturally by the mother which is responsible for the contraction of the uterus, now that happens in spontaneous labour. Here, we are doing labour induction, therefore we provide synthetic oxytocin.

When to Induce Labour?

What are the conditions in which labour induction is done? Or when to induce labour? There are a lot of conditions in which an Obstetrician decides to induce labour. These conditions can be broadly divided into either mother is at risk baby is at risk or both. Here are the conditions in which labour induction is required:

• Post-dated pregnancy:

The due date or expected date of delivery has been passed

• Pre-labour rupture of membrane or pre-term pre-labour rupture of membranes without contractions:

Rupture of membrane before contraction, whether rupture happened preterm( before 37 weeks of pregnancy) or before spontaneous labour, if membranes are ruptured Labour induction is done to avoid infections p(chorioamnionitis).

• Gestational diabetes 

• Preeclampsia:

Increased Blood pressure with organ damage in pregnancy 

• Eclampsia:

Increased BP with convulsions.

• Placental abruption: Premature separation of the placenta from the uterus.

• Oligohydramnios:

less amniotic fluid

• Intrahepatic cholestasis of pregnancy:

Increased bile acids cause excessive itching on palms, soles or the whole body.

• Infections like chorioamnionitis. 

• Foetal growth restriction

• Heart or Kidney diseases.

• Acute fatty liver of pregnancy, etc.

Note whenever there is foetal distress, this is an indication of C-section, not vaginal delivery. Therefore, Labour induction is not done and a C-section is performed instead.

The procedure of Inducing Labour

After discussing indications of labour induction, the obvious question is How do you induce labour:

• Step 1: Assessing cervical status:

The first step is accessing cervical status. A scoring system is used after evaluation known as Bishop's score. If the score is in the favourable range then labour induction is started.

• Step 2: Cervical ripening if unfavourable score:

If the score is not in favourable range then cervical ripening is initiated as discussed in the above section.

• Step 3: Start of IV oxytocin infusion:

A favourable bishop score is followed by infusion of IV oxytocin. Oxytocin is responsible for uterine contraction.

• Step 4: Further Assessment of the cervix:

After IV infusion, the cervix is assessed further for dilation and effacement.

Although there can be other ways to induce labour, the above-discussed one is commonly used. Other methods like artificial rupture of membranes have a risk of infection

Risks of Inducing Labour

Induce labour is quite safe, but still, there can be a few risks of inducing labour. Here are the risks of inducing labour:

• Preterm Birth:

There are few conditions in which an obstetrician has no option other than labour induction, if the baby is less than 37 weeks old then this can lead to preterm birth. Preterm birth has its complications.

• Failure of Labour induction:

There can be chances of failure to induce labour, in this case, the obstetrician tries to induce it again and if there is foetal distress then a C-section is done.

• Very Strong contractions:

Uterine contractions are Monitored using a CTG(cardiotocography) machine in the labour room. Sometimes if the rate of infusion is fast it can cause very strong contraction which can cause foetal distress. 

• Infection:

Although the usually practised method of labour induction has less risk of infection, methods like stripping of membranes or artificial rupture of membranes have the risk of infections.

• Atonic uterus:

Uterus may not contract at all and may lose its tone, which can cause postpartum haemorrhage or excessive bleeding after birth.

Advantages and Disadvantages of Inducing Labour

Everything has pros and cons. Let's look at the advantages of inducing labour as well as the disadvantages of inducing labour. Keep in mind that, if labour induction is practised so commonly then there are obvious reasons that the advantages of inducing labour outweigh its disadvantages.

Advantages of Inducing Labour

• Avoids complications related to pregnancy as we have discussed in conditions like gestational diabetes, preeclampsia oligohydramnios etc.

• Overcomes the problem of Absence of spontaneous labour.

• Reduces intrauterine foetal death

• Reduces risk of C-section

•  Cheap and Convenient

• Natural and there is no need for general anaesthesia like in C-sec

Disadvantages of Inducing Labour

• Medical admission is required for foetal monitoring 

• Cannot be done in all conditions like in the case of a large baby or small pelvis(Cephalo-pelvic disproportionation), Active Herpes genitals etc.

• Vigorous uterine contraction leads to uterine tachysystole.

• Uterine infections

• Foetal distress

• Uterine rupture 

What can I expect during Labor Induction?

Labour induction is quite a safe process, it usually feels like normal labour. Labour induction involves the ripening of the uterus for delivery of the baby and monitoring of the baby and mother.

Assessment of cervix, foetal heart rate and uterine contractions. Recovery also from induced labour is similar to normal labour. 

Whether labour induction is painful or not depends on the method used to induce labour or whether or not epidural anaesthesia is given.

For instance, in the case of labour induction by medications uterine contractions also start, which can cause labour pains.

If a rupture of the membrane is done there you can feel a popping sensation and feel like water leaking through the vagina.

How long does a Labour Induction Last?

Labour induction can last differently for different individuals depending upon how fast cervical dilation or contractions begin. Typically, women progress to the active stage of labour within 24 hours which is cervical dilation more than or equal to 6 cm.

Natural Ways to Induce Labour

There is no way you can induce labour at home. It is strictly not advisable to do so using medications. It can lead to maternal or foetal death. Therefore, you must never try to induce labour naturally.

It is always advisable to regularly visit your obstetrician for follow-up. A healthcare professional will monitor foetal growth, foetal distress and maternal health based on a detailed assessment. Whether to induce labour is decided. 

Take Home Points

1. Induce labour or labour induction is when a Medical practitioner starts the process of labour in a pregnant female.

2. There are various ways of inducing labour like cervical ripening, balloon dilation, artificial rupture of membranes, membrane stripping, and oxytocin infusion.

3. When to Induce Labour? There are certain indications some of them are oligohydramnios, post-dated pregnancy, preeclampsia, eclampsia, gestational diabetes gestational hypertension etc.

4. We have answered a query about how you induce labour. By assessing cervical status, ripening of cervix, starting IV oxytocin infusion,

5. Risks of inducing labour include preterm birth, infection, vigorous uterine contraction, atonic uterus etc.

6. The advantages of inducing labour are it is cheap, prevents maternal and foetal complications, reduces intrauterine foetal death and distress etc.

7. Disadvantages of inducing labour include uterine rupture, infections, foetal distress, failure of induction, infection etc.