It is possible to overdo this, however, and cause too-frequent contractions. Your healthcare provider can guide you through cycles of stimulation and rest periods. Your practitioner can also try to get your labor going more quickly by rupturing the membranes the "bag of waters" that surround your baby, if your water hasn't already broken on its own. She can do this by inserting a slim, plastic hooked instrument through your vagina and dilated cervix to rupture your amniotic sac.
This should cause no more discomfort than a regular vaginal exam. While this procedure, known as amniotomy, has been used for a long time to augment labor, experts continue to debate its risks and benefits. Having an amniotomy may mean a somewhat shorter labor and less chance that you'll need oxytocin. On the other hand, keeping your amniotic sac intact until it breaks on its own offers greater protection against infection and umbilical cord compression during contractions. Your practitioner will consider whether amniotomy is a good choice for you based on factors such as how far your cervix is dilated, how low the baby is in your pelvis, whether you need internal fetal monitoring, and your risk of infection.
Until you're experienced it, labor and birth can be hard to imagine! Here's a video showing the process, including how contractions work to slowly open the cervix. BabyCenter's editorial team is committed to providing the most helpful and trustworthy pregnancy and parenting information in the world.
When creating and updating content, we rely on credible sources: respected health organizations, professional groups of doctors and other experts, and published studies in peer-reviewed journals.
We believe you should always know the source of the information you're seeing. Learn more about our editorial and medical review policies. Committee opinion Approaches to limit intervention during labor and birth. American College of Obstetricians and Gynecologists. Fetal heart rate monitoring during labor. Mott Children's Hospital. Labor induction and augmentation. Gulbahtivar D et al. The effect of uterine and nipple stimulation on induction with oxytocin and the labor process.
Worldviews on Evidence-Based Nursing 12 5 : Kernberg a et al. Augmentation of labor: A review of oxytocin augmentation and active management of labor. Jump to content. As the end of pregnancy nears, the cervix normally becomes soft ripe and begins to open dilate and thin efface , preparing for labor and delivery.
When labor does not naturally start on its own and vaginal delivery needs to happen soon, labor may be started artificially induced. Even though inducing labor is a fairly common practice, childbirth educators encourage women to learn about it and about the medicine for stimulating a stalled labor augmentation so that the women can help decide what is right for them. When labor is induced for medical reasons, it is usually because it's safer for you to have the baby now rather than risk further problems from staying pregnant.
Some women ask to have their labor induced when there isn't a medical reason for it elective induction. And sometimes doctors will induce labor for nonmedical reasons, such as if you live far away from the hospital and may not make it to the hospital if you go into labor.
In these situations, your doctor will wait until you are at least 39 weeks, because this is safest for your baby. When labor does not happen as expected or as needed, inducing labor is preferred over delivering by cesarean section.
If labor induction isn't successful, another attempt may be possible. In some cases, a cesarean delivery is best for the mother and baby, depending on their conditions. The cervix is thought to be ripe and ready for active labor when it is soft, well dilated, and effaced, and when the cervix and baby are positioned low in the pelvis.
If the cervix is not ripe enough, medicines may be continued until it is. A balloon catheter, such as a Foley catheter, is a narrow tube with a small balloon on the end. The doctor inserts it into the cervix and inflates the balloon.
This helps the cervix open dilate. The catheter is left in place until the cervix has opened enough for the balloon to fall out about 3 cm. Sweeping, or stripping, of the amniotic membranes is a simple first step used to try to start labor. Sweeping of the membranes separates the amniotic membrane from the uterus enough so that the uterus starts making prostaglandins. This type of chemical helps trigger contractions and labor. After the cervix is open a little, this step can easily be done in your doctor's or nurse-midwife's office.
Sweeping the membranes works in 1 out of 8 women. This means that it starts labor without needing to use oxytocin or artificially rupture the membranes. Print entire guide. Home Health and wellbeing Children's health, parenting and pregnancy Pregnancy and family planning Antenatal information Induction of labour and augmentation Augmentation of labour. The rates of induction of labor have been progressively increasing over past decades, especially in developed countries.
This is the result of better diagnostic tools and understanding of maternal and fetal medical complications. There is still a significant difference in the rates of induction of labor between countries.
As a general rule, induction of labor is indicated when the benefits of delivery to the mother or the fetus outweigh the risks associated with induction of labor. However, more recently, the indications have been continuously increasing due to a better understanding of the pathophysiology and of maternal and fetal conditions such as intrahepatic cholestasis of pregnancy ICP , fetal growth restriction and placental insufficiency.
Furthermore, there has been an increase in the number of women with pre-existing chronic medical problems including maternal cardiac disease and autoimmune amongst others, who are now supported through pregnancy, but may previously have been advised to avoid pregnancy or even to terminate. The indications for induction of labor are summarized in Table 1. Maternal considerations when inducing labor are mostly the risk of failure of induction, the need for operative delivery and the length of the process requiring more analgesia and more medical intervention.
One of the most important fetal considerations is that of prematurity. In these cases, it has to be clear that the benefits outweigh the risks as the fetuses will be at increased risk of neonatal complications including, but not limited to, respiratory distress syndrome, jaundice and feeding difficulties.
Maternal request induction of labor after 39 weeks most commonly due to the discomfort of pregnancy or social reasons is increasing and still controversial. These cases need to be discussed on a case-by-case basis considering the specific circumstances. The main relative contraindications to induction of labor are previous cesarean section, breech presentation, grand multiparity, unstable lie, polyhydramnios, twin pregnancy and non-reassuring cardiotocography not requiring emergency delivery.
In these cases, senior input with consideration to the specific clinical circumstances should be sought. Absolute contraindications are detailed in Table 2. The success of induction of labor is related to the state of the cervix prior to induction, 4 parity, 5 , 6 body mass index BMI 7 and position of the vertex occipito-anterior higher success compared to occipito-posterior.
In , Bishop 9 described a method to assess the cervix in multiparous women prior to the start of induction of labor through a digital vaginal examination. The length of the cervix, consistency, position and dilatation are considered, and a score is given depending on each parameter.
He concluded that a score of 9 or more resulted in a success rate of induction of labor similar to that in women with spontaneous onset of labor. The Bishop score used currently is similar to the one described in the s, but it is now applied to nulliparous women as well. Nulliparous women with a Bishop score of 3 or less have a fold increased risk of induction of labor failure and multiparous women a 6-fold increase risk. Some studies 11 , 12 have evaluated the use of ultrasound to assess the cervix prior to induction, however, the last systematic review concluded that ultrasound assessment of cervical length was not an effective predictor of successful induction of labor.
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