What is induction of labour?

Induction of labour is a procedure done to end a pregnancy after 20 completed weeks with the goal being a normal vaginal delivery.

When is induction of labour considered?

Induction is considered when there are complications of pregnancy which means there is excessive risk to the mother or baby's well being in continuing the pregnancy. The most common indications include high blood pressure (including preeclampsia), diabetes, cholestatic jaundice of pregnancy, PUPPPS, intrauterine foetal growth retardation, postdates pregnancy, unstable foetal lie, twins in very advanced pregnancy, a history of very rapid labour, planned trial of scar going overdue and to avoid a baby getting too big for an uncomplicated vaginal birth, foetal demise. Sometimes induction is done because of maternal request such as family commitments, husband / partner work commitments, to time arrival of relatives from overseas, excessive pregnancy discomfort, etc.

How is induction done?

Prior to the induction being arranged I will do a vaginal examination to assess your suitability. In this examination the dilatation of your cervix, the length of your cervix, how soft your cervix is ('ripeness'), how low in the pelvis is you baby's head is (engagement or how far off being engaged) and how well applied your baby's head is to your cervix.

• If the findings are favourable then you are suitable for induction.
• If the findings are not favourable but induction is technically possible then with ripening of the cervix prior induction can be attempted.
• Sometimes you will be advised because the findings are very unfavourable that it is unlikely the induction process would work and if attempted even with repeated ripening attempts is likely to be associated with a long protracted time induction period before labour is established, if it did establish. This would be not only physically and emotionally very draining for you, but also can put your bay at increased risk of foetal dilates. As well especially if you are past your EDC the question needs to be asked why the findings are so unfavourable. Is this an omen of challenges in labour this would mean a Caesarean section because of induction. Careful assessment, discussion and alternatives of management should then be considered.

When is induction done?

This depends on the state of your cervix.

If your cervix not very favourable but induction is possible then Prostin prostaglandin vaginal gel is used to ripen your cervix. A labour ward / birth unit midwife will introduce the gel high into your vagina usually the night prior to the planned induction. You would then stay in labour ward / birth unit. Your husband / partner is welcome to stay with you. There would be foetal heart rate monitoring prior to and after the gel is introduced for a short period.

Sometimes there is onset of labour after the gel. If this happened there is the possibility you may not need any further intervention.

If your cervix is very favourable or if your baby's head is very high in your pelvis and is poorly applied to your cervix, or you have an unstable lie then artificial rupture of your membranes (the amniotic sac) (ARM) and sometimes a Syntocinon infusion drip is safest and most effective option. This will also be required after Prostin ripening of the cervix if you have not gone into labour  

Is induction more painful and quicker?

There are stories that induced labours are more painful and too fast. This is not necessarily the case. Everyone's response is different. Every labour is different. Even every labour for the same person will be different. So to anticipate how a labour would have gone without being induced is impossible to know. Pain thresholds are different. Someone will cope better in one labour than an other , and so on. Sometimes it can take hours between the use of Prostin and even an ARM and start of Syntocinon infusion before there is established labour. Sometimes it is quick with there being uterine response sooner. If a Syntocinon infusion is used then the rate is regulated to be optimal for your uterine activity.

Spontaneous labour experiences are also very variable. Many spontaneous labours can be very painful without any intervention in the labour process being done. Some labours are very slow and need help of an ARM and sometimes a Syntocinon infusion.

After Prostin gel and before onset of labour there can be Prostin induction pains as uterine activity increases. Analgesics can be given by labour ward / birth unit staff if needed

What are the risks of induction?

• Failed induction. This is where induction is attempted and doesn't work and labour does not establish. This is much more like if induction is attempted when there are very unfavourable findings at vaginal examination. Some pregnant with other doctors have been subjected to repeat attends at induction over many hours which creates significant anxiety and frustration and increased risk to their bay and is an omen of a difficult labour and birth. A failed induction will result in a Caesarean section. If very unfavourable then there should be discussion about the necessity for induction on the planned date or whether it can be deferred and other alternatives if delivery is necessary.

• Newborn problems. There has an association between Syntocinon infusion use and new born jaundice in some studies though in my experience this is not the case. There are also reports about increased incidence of immature lungs and newborn breathing problems. These can usually be avoided if induction is deferred until EDC or later.