If in the case of cesarean operations, the birth depends especially on the medical act, in natural births the evolution is unpredictable. For various reasons, labor induction is needed.
A natural phenomenon, labor usually occurs between 37 and 40 weeks of pregnancy, but the term can be extended up to 42 weeks, provided that the fetus is strictly monitored.
Hastening labor is a necessary intervention when there are health risks for the mother and the fetus, if it remains in the womb. But labor can also be induced at the request of the mother, for various reasons. In this case, the parents are made aware of the risks related to induced birth. Although natural birth is the best option, in certain situations specialized help is needed for labor to begin.
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Thus, birth can be induced if 41 weeks of pregnancy have passed. Labor must be accelerated in case of preeclampsia, a situation that describes high blood pressure accompanied by the presence of protein in the urine and edema. Labor can be induced when the doctor finds a growth restriction of the fetus in the uterus during the ultrasound. It is also necessary to induce labor when the spontaneous rupture of the membranes has occurred for more than 24 hours, without specific uterine contractions occurring. Gestational diabetes, which causes fetal macrosomia, i.e. the birth of a fetus weighing more than 3,800 g, is another situation that can cause premature delivery. Uterine infections, such as chorioamniotitis, can also favor the medical decision to hasten labor.
How the birth is hastened
Rupture of membranes – The removal of the membranes can be done by the midwife or the obstetrician. By breaking the membranes, the sac in which the baby is located is separated from the cervix. This maneuver can cause the secretion of prostaglandin, which stimulates contractions and labor. The method is applied if the birth takes place at term. If the water has broken and labor has not started, avoid removing the membranes to prevent infections.
Administration of prostaglandins – hormonal substances that cause dilation of the cervix, prostaglandins have the effect of stimulating contractions. It should be known that, before using the substance, the doctor must analyze the Bishop score (system used by doctors to estimate the probability of going into labor) and monitor the child’s pulse for at least 30 minutes.
Artificial rupture of membranes – this procedure involves making an incision in the membranes where the baby is. A long, thin probe or a medical glove, equipped with a hook at the tip of the finger, is used. The procedure may cause discomfort and may not always induce labor. Moreover, the child is exposed to the risk of infection.
Administration of oxytocin – the synthetic form of the hormone oxytocin is administered intravenously. This is synthesized by the body to stimulate labor. This solution is used when the removal of the membranes and the administration of prostaglandins do not have the expected effect or when the labor does not progress
Good to know! The contractions caused by the synthetic substance oxytocin can be more intense than the natural ones.
When hastening birth is NOT indicated
Induction of labor cannot be performed if the pregnant woman has previously undergone a cesarean section or a major operation on the uterus. Likewise, birth cannot be hastened in this way, in the case of placenta praevia, when the placenta blocks the cervix. The doctor will not induce labor when the fetus does not have a normal position, but is transversally in the uterus. Last but not least, the procedure cannot be performed if the pregnant woman suffers from an active genital herpes infection. Hastening the birth is prohibited if the woman has a narrow vaginal canal and does not allow a normal labor to take place, so neither does natural birth.
Statistically, in 25% of cases, induced labor does not work, and the doctor opts for a caesarean section for the birth of the child.
Good to know! Induction of labor can last from a few hours to 2 days
Dr. Livia Manta, gynecologist-obstetrician, “Alfred Rusescu” Mother and Child Protection Institute, Bucharest
Induction of labor is required when: pregnancy is over 41 weeks, hypertension is induced by pregnancy at over 34 weeks, premature rupture of membranes has occurred, the woman wants this – but at over 39 weeks, there is gestational diabetes at over 36 weeks – to prevent macrosomia, there is a suspicion of growth restriction beyond 34 weeks. Growth restriction occurs when a fetus is smaller by more than 2 weeks at the ultrasound estimate, compared to the chronological one. It should be remembered that artificial induction of labor increases the risk of cesarean delivery.