There has been A LOT of discussion about elective induction of labor. The hospital that I work at passed a policy that states no elective inductions can be performed before 40 weeks gestation. All of this in an attempt to reduce the cesarean section rate.
Imagine the smile that came across my face when I FINALLY had an opportunity to peruse the magazines and journals that had accumulated in my magazine rack.
I came across good ole OB.GYN. News. I like this publication as it is easy for me to scan, and the articles are current and informative. Click here to read the article that I was super excited to share with my colleagues and get their take on.
In a nutshell, the article basically states that elective induction of labor at 39 weeks was not only safe for the newborn but also provided a few benefits to first-time moms.
Some benefits include a 16% reduction in cesarean section as well as a 36% reduction in hypertensive disorders as relates to pregnancy. This, all in comparison to pregnant moms who were managed expectantly.
ACOG, the American College of Obstetrics and Gynecology, has historically taken a more hands-off approach where inductions are concerned in that they don’t recommend induction of labor unless it’s medically indicated.
What is Induction of Labor?
Labor induction is when uterine contractions are stimulated to hopefully result in a vaginal birth.
There are numerous reasons induction of labor may occur. It could range from maternal indications such as gestational diabetes and hypertensive disorders to fetal indications such as IUGR (Intrauterine Growth Restriction).
It could also be a result of oligohydramnios (low fluid around the baby in the uterus), social indications such as living a great distance from the hospital or having a history of sudden labor and delivery.
Having practiced Obstetrics for 16 years, I find myself in the middle. On one hand, I do tend to favor a more hands-off approach. It’s the midwife in me. Midwives certainly played a large role in my training and I happen to come from a long line of midwives.
On the other hand, if a cervix is deemed “favorable” as denoted by their bishop score, I see nothing wrong with inducing a “mom to be” at 39 weeks.
I do, however, know that I’m not a HUGE fan of inducing labors that aren’t medically indicated when cervices are not favorable. Sometimes at 39 weeks, they just aren’t.
Then we get into inductions that last for days, and what could eventually seem like an eternity. Dare I mention the “C” word? Cesarean section?
What do I mean by if the cervix is deemed favorable or not?
Let me explain briefly.
A cervix’s favorability has to do with its dilation, consistency, position, effacement, and baby’s station in the pelvis. Taking all of these measures into account, a Bishop score is assigned.
The Bishop score is a scoring system that determines the “readiness” of a cervix for labor.
Typically speaking, the aforementioned components are scored and a number from 0-13 is given to rate the cervix. A composite score of < 6 is deemed unfavorable; i.e, the induction is not likely to result in a vaginal delivery.
When the Cervix is not Favorable
If, for example, a cervix is not deemed favorable, and the induction is being done for a medical indication, the cervix may undergo “cervical ripening.” This can be achieved either mechanically or medically.
Mechanical cervical dilation involves inserting a foley bulb into the cervix. The bulb is inflated with sterile saline/water.
This puts the cervix under pressure causing the cervix to release chemicals called prostaglandins. These prostaglandins in turn cause the cervix to soften, and become more effaced, or thinned out.
Medical induction involves the use of certain medications that contain prostaglandins. These medicines can be taken orally or placed inside the vagina to cause the cervix to soften or thin out, and thus become more favorable for induction.
Stripping the Membranes
Stripping the membranes is a technique done in your obstetrician and gynecologist’s office.
If your cervix is dilated, your Ob-Gyn, with a gloved hand, will be able to insert a finger or two between the thin membranes that connect the amniotic sac to the wall of the uterus.
Sweeping or stripping these membranes will cause the release of the previously mentioned prostaglandins, which in turn, will cause the cervix to either further soften and dilate, or, in some cases, cause the onset of labor.
When the Cervix is Favorable
Oxytocin is a chemical given to cause uterine contractions. This is where the induction part comes in. Once a cervix is deemed “favorable,” oxytocin is given through an IV to cause the uterus to contract.
Uterine contractions typically begin within 30 minutes of starting oxytocin. Oxytocin can be given either to induce or augment (speed up) labor that has already begun.
Women who have induction of labor at 39 weeks gestation should be allowed 24 hours or longer for the early or latent phase of labor. Remember that labor and delivery are a process. Induction of labor can take anywhere from hours to days.
When an Amniotomy Has to be Performed
If your water doesn’t break spontaneously, an amniotomy may be performed at some point during your labor induction.
This is typically done by your ob-gyn using a special instrument to put a small hole in your amniotic sac (the fluid-filled sac that contains the baby inside the uterus). Once this is done, your contractions are likely to become more intense, and sometimes more frequent.
If you are considering an induction, or it is something that has been suggested to you by your ob-gyn, have a frank discussion about the pros/cons and whether this is something that you feel is right for you. This post certainly should put you on the road to making a more informed decision.
I’m hopeful that this article/blog post will serve to make women more informed and empowered. We as women deserve to be an intricate part of our pregnancies/management. As GI Joe always says, “knowing is half the battle.”
Until next time,