An induction of labour is when a doctor or midwife uses various methods to artificially initiate or accelerate labour. such as:
A membrane stretch and sweep is when a doctor or midwife sweeps their finger around the opening of the cervix to stimulate labour. A sweep is when the doctor or midwife carefully separates the membranes that surround the baby from their cervical attachment. It is not recommended to perform a stretch and sweep before 40+ weeks and if the cervix is unfavourable . This method of induction is not always effective in starting spontaneous labour so it may be offered again or it may lead to the choice of having a pessary (or gel) containing prostaglandin inserted into the vagina to help ripen the cervix and stimulate contractions.
A pessary or gel containing prostaglandin may be offered if a membrane stretch and sweep is not effective at initiating spontaneous labour. This method of induction is when a tampon shaped pessary or tablet or gel is inserted vaginally in an attempt to ripen the cervix and to stimulate contractions. This is one of the most commonly recommended ways to induce labour.
The artificial rupture of membranes, also known as ARM or breaking the waters, is often used to accelerate labour after other induction methods have initiated contractions or after spontaneous labour has begun. Note: waters do not always break, as is often shown on film and tv, to signify the beginning of labour. Many women reach full dilation before they have a Spontaneous Rupture of Membranes (SROM) with some even birthing the baby in ‘the caul’ (the amniotic sac).
A hormone drip containing synthetic oxytocin (Syntocinon®) should only be offered if the membrane sweep or prostaglandins have not been effective in starting labour. It is also offered to women who may have been induced by membrane sweep or prostaglandins but whose contractions and cervical dilation have slowed completely or appear to have stopped. It is not recommended for use until at least 6 hours after receiving prostaglandin gel or 12 hours after removal of the prostaglandin pessary.
Whether to consent to induction of labour, or not, is a choice that at least 1 out of 3 women will have to make in her maternity care in Ireland. If an induction is clinically indicated, in the case of fetal and maternal risk such as: pre-eclampsia, fetal growth restriction, diabetes or problems with the placenta – then a woman may have less difficulty in agreeing with her maternity care provider that it is in her and her baby’s best interest to undergo an induction to minimise risk. Induction for serious medical conditions can be life saving.
For most other pregnant women, an induction may be suggested because there is a belief that the baby is too big or too small (known respectively as ‘large for dates’ or ‘small for dates’) OR clinical policy states that a woman must be induced after a certain number of days over their 40 week Estimated Due Date (EDD). The consensus on the window of normal gestation is that it can be anywhere from 37 to 42 weeks; however, some hospital policies will suggest induction of labour from 40 weeks, or earlier, depending on the perceived complication. In these cases the research shows that taking a ‘wait and see’ approach more often leads to spontaneous onset of labour, less interventions and a healthy outcome for both mother and baby. The difficulty is knowing when to consent to an induction or when to ‘wait and see’.
The following list of advantages and disadvantages to the various methods of induction of labour may be helpful in balancing the risks and making a choice whether to consent to the procedure, or to ‘wait and see’:
Note: One of the main reasons for an oxytocin drip is slow progression of labour, sometimes referred to as dystocia or ‘failure to progress’. This is controversial as there are no definitive studies that accurately describe the length of ‘normal’ labour. Recent research does not support the original clinical indication for oxytocin augmentation of labour, namely that it was believed the need for operative delivery (either c-section, forceps or ventouse) is reduced by administering oxytocin drip. This is not supported by Cochrane Reviews
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The following research links were used to compile the information in this article:
Bugg et al. Oxytocin versus no treatment or delayed treatment for slow progress in the first stage of spontaneous labour. Cochrane Pregnancy and Childbirth Group – Intervention Review. July 6, 2011. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007123.pub2/full
Kelly et al. Vaginal prostaglandin (PGE2 and PGF2a) for induction of labour at term. Cochrane Summaries. May 16, 2012. http://summaries.cochrane.org/CD003101/vaginal-prostaglandin-pge2-and-pgf2a-for-induction-of-labour-at-term
Mozurkewich et al. Methods of induction of labour: Systematic review. BMC Pregnancy and Childbirth 2011, 11:84. http://www.biomedcentral.com/content/pdf/1471-2393-11-84.pdf
National Collaborating Centre for Women’s and Children’s Health. Induction of labour. 2nd edition. London: RCOG Press; 2008. http://www.nice.org.uk/nicemedia/live/12012/41260/41260.pdf
Smyth et al. Amniotomy for shortening spontaneous labour. Cochrane Summaries. June 18, 2013. http://summaries.cochrane.org/CD006167/amniotomy-for-shortening-spontaneous-labour