We recommend that you read this handout carefully in order to prepare yourself or family members for the proposed procedure. In doing so, you will benefit both the outcome and safety of the procedure. If you still have any questions or concerns, we strongly encourage you to contact your Doctor prior to your procedure so that we may clarify any pertinent issues. “An educated patient is the best patient.”
INDUCTION OF LABOUR
Labour induction is the process by which your doctor will start uterine contractions that may lead to a vaginal birth of your baby. There are several reasons that your doctor would induce your labour. Some of the more common reasons to induce your labour would be that you are past your due date, your doctor thinks that your baby would be better off born now as opposed to waiting for you to go into spontaneous labour, or your water broke.
Certain medical conditions such as high blood pressure, diabetes, and lung or heart problems in the mother would also cause your doctor to induce your labour. If there is any indication of foetal compromise or foetal death, your doctor may induce the labour. Finally, if you live too far away from the hospital or have a history of fast labours, your doctor may induce the labour. This list is just a few of the more common reasons your doctor would induce the labour.
The success of labour induction in leading to a vaginal delivery depends on many factors, one of which is how far your cervix is dilated and shortened. The more dilated and the more shortened your cervix, the more likely you are to deliver vaginally. Your doctor may give you medicine to ripen your cervix prior to start uterine contractions.
This process is done in the hospital, usually in the Delivery Suite. This will allow your doctor to monitor your baby prior to the start of the induction to make sure the baby is doing well.
Depending on why your doctor is inducing labour, you may already be in the hospital. Your doctor may do an ultrasound to determine how your baby is doing as well as location of the placenta and foetal weight. Your doctor will also determine how far along you are in your pregnancy. After this is done, an intravenous line may be placed for medicine to be given. Your baby may be put on a foetal monitor to record the heart rate and the frequency of uterine contractions.
Your doctor will do an exam of your cervix to determine how dilated it is. Your nurse will take your temperature, heart rate, and blood pressure to make sure that you are doing well.
There are several ways to induce labour. If your doctor needs to ripen (a process to soften) your cervix, then he or she may give you medicine inside your vagina. This medicine will be released into your cervix very slowly. Also, your doctor may give you medicine by mouth that will soften the cervix. These medicines are called prostaglandins and are similar to chemicals that naturally occur in your body. Two of the more common prostaglandins used are PGE1 and PGE2. They come in the form of either a tablet, gel, or vaginal insert.
There are also mechanical ways to dilate and soften the cervix. A Foley balloon catheter can be placed into your cervix to manually dilate it. This is like a balloon of water approximately five to eight centimetres in diameter that will slowly dilate and soften the cervix. Also, there are cervical dilators, called laminaria tents that can be placed into the cervix and will slowly dilate it. These are usually used if you are far from your due date.
Once the cervix is softened, the doctor will give you medicine, intravenously, called oxytocin that causes the uterus to contract in spontaneous labour. This oxytocin will be slowly increased so that the uterine contractions are strong enough to dilate the cervix.
Sometimes, the medicine that softens your cervix will also cause your uterus to contract. Your doctor may not need to give you medicine, intravenously, if your uterus is already contracting and your cervix is dilating.
Also, your doctor may artificially rupture your membranes (break your water) to start contractions. This is an effective way to start contractions. This may be done in conjunction with the other ways already stated above.
Expectations of outcome
As stated above, a labour induction does not always lead to a vaginal delivery. Sometimes, despite the best efforts of your doctor, a caesarean section may have to be done. The success of the labour induction will depend upon the situation in which labour was induced.
Also, a labour induction may lead to an operative delivery such as a forceps delivery or a vacuum delivery.
As for pain with a labour induction, your doctor will provide you with pain relief either intravenously or by an epidural / spinal anaesthesia. This will depend upon how far you are in labour. Your doctor may not be able to take away all of your pain.
After your labour is started, your doctor will be checking to see if your cervix is dilating. A labour induction, if successful, will lead to a vaginal delivery. If it is not successful, it may lead to a caesarean delivery. After you deliver your child by either a caesarean section or vaginal delivery, the labour induction will be stopped.
POSSIBLE COMPLICATIONS OF THE PROCEDURE
All procedures, regardless of complexity or time, can be associated with unforeseen problems. They may be immediate or delayed in presentation. While we have discussed these and possibly others in your visit, we would like you to have a list so that you may ask questions if you are still concerned. There are many different ways to induce your labour or soften your cervix. The complications depend on the way in which it was done. These complications include, but are not limited to:
Complications associated with prostaglandins that can soften or ripen your cervix:
- Hyperstimulation: hyperstimulation usually means that your uterus is having too many contractions in a 10-minute period. This can also include evidence that the foetus may not be tolerating the contraction pattern. The rate of hyperstimulation with PGE2 gel is approximately 1% if placed in the vagina and 5% if placed into the cervix. The risk of hyperstimulation with PGE1 is not known, but is probably slightly higher than PGE2;
- Maternal side effects: since this medicine is absorbed into your blood stream, you may experience diarrhoea, fever or vomiting. This risk is small and your doctor may give you medicine to control some of these side effects;
- Uterine rupture: PGE1 has been associated with uterine rupture in women who have had prior uterine surgery. Also, women who have their labour induced in the second trimester with the use of PGE1 and oxytocin have had uterine rupture. This risk is low and is something your doctor will monitor for very closely;
- Infection: mechanical dilators such as laminaria tents may increase your risk of infection in your uterus when compared with the use of prostaglandins.
Complications associated with other labour induction agents:
- Oxytocin: oxytocin use has been associated with uterine hyperstimulation. This may include evidence that the foetus is not tolerating the contraction pattern. Uterine rupture with hyperstimulation may occur, but this is rare. The risk of this may be related to the dose of oxytocin used. Other rare complications include water intoxication and hypotension (low blood pressure). These risks are small;
- Amniotomy: the risks associated with amniotomy (breaking your water) include prolapse of the umbilical cord (when the umbilical cord comes out of the cervix). This usually will lead to a caesarean delivery. Chorioamnionitis (infection in your uterus and linings of the placenta) and umbilical cord compression are also complications. Your doctor will monitor closely for these complications;
- Stripping of membranes: there is a risk of bleeding after stripping of membranes if there is an undiagnosed placenta previa (when the placenta covers the opening to the cervix). Your doctor may do an ultrasound prior to the labour induction to be certain of where the placenta is located.
The information contained in this medical handout is intended to solely inform and educate and should not be used as a substitute for medical evaluation, advice, diagnosis or treatment by a doctor. Please call your doctor if you have any questions.