Induction (birth)

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Induction is a method of artificially or prematurely stimulating labour in a woman.

Common causes for induction include:

• The baby is believed to be getting too big.
• Postdate pregnancy, i.e. if the pregnancy has gone past the 42 week mark.
• Intrauterine fetal growth retardation (IUGR).
• There are health risks to the woman in continuing the pregnancy (e.g. she has pre-eclampsia).
• Premature rupture of the membranes (PROM); this is when the membranes rupture, but labour does not start within a specific amount of time.
• Premature termination of the pregnancy (abortion).
• Scheduling concerns.
• Fetal death in utero.

Criticisms of induction

Induced labour tends to be more intense and painful for the woman, often leading to the increased use of analgesics and other pain-relieving pharmaceuticals (Vernon, 2005). This cascade of intervention has been shown to lead to an increased likelihood of caesarean section delivery for the baby. (Roberts 2000). Inductions should only be undertaken for significant medical reasons, but some feel that doctors show increasing propensity toward induction simply for personal convenience or to relieve load on hospital facilities. "[Induction] enables doctors to practice daylight obstetrics," says Dr. Marsden Wagner, a neonatologist who served for 15 years as a director of women's and children's health in industrialized countries for the World Health Organization. "It means that as a doctor, I can come in at 9 a.m., give you the pill, and by 6 p.m. I've delivered a baby and am home having dinner."

Methods of induction

Methods of inducing labour include:

• "Membrane Sweep" (aka "Stretch and Sweep" in Australia and the UK) - during an internal examination, the midwife moves her finger around the cervix to stimulate and/or separate the membranes around the baby from the cervix. This causes a release of prostaglandins which can help to kick-start labour.
• Artificial rupture of the membranes (AROM or ARM) ("breaking the waters")
• Cervically-applied prostaglandin, such as dinoprostone (Cervidil) or misoprostol.
• Intravenous administration of synthetic oxytocin preparations, such as Pitocin.
• Natural Induction - Many midwives or other holistic providers practice "natural" induction, which may include use of herbs, castor oil or other agents to stimulate or advance a stalled labor. The safety of such practices is undetermined. Women should not try to induce labor without talking with their physician or other healthcare provider, and certainly not before 37 weeks gestation.

If an induction causes complications during labor, a Caesarean section is almost always conducted. An induction is most likely to result in successful vaginal delivery when a woman is close to or in the early stages of labor. Signs of pending labor may include softening of the cervix, dilation and increasing frequency or intensity of contractions.

References

• Roberts, Tracy, Peat, 2000 Rates for obstetric intervention among private and public patients in Australia: population based descriptive study Christine L Roberts, Sally Tracy, Brian Peat, "British Medical Journal", v321:140 July 2000
• Vernon, David, Having a Great Birth in Australia, Australian College of Midwives, 2005, ISBN 0-9751674-3-X
• Goodman, David, "Forced Labor", Mother Jones

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