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Inducing labour

Sanjeevani was due a week ago. The baby is doing well and the water around the baby is adequate. She has advised Sanjeevani to get admitted for induction of labour. Sania, on the other hand is 37 weeks pregnant. She has high blood pressure, which dev eloped in pregnancy. It is best to induce labour and deliver the baby before the high blood pressure can affect the mother or foetus.

Induction of labour is the use of artificial means, such as a medication, to start the process of childbirth. Contrary to popular belief, induced labour is not more painful than natural labour.

Reasons for inducing labour

• Postdated pregnancy i.e. pregnancy that has continued 7 to 10 days past the due date

• Rupture of the membranes before labour has started

• Pregnancy induced hypertension (PIH)

• Diabetes in pregnancy

• If the baby is small

• Separation of the placenta from the inner lining of the uterus

• Logistical reasons (for example, the pregnant woman lives far from a hospital or there is a history of fast labour)

• Death of the baby before birth (intrauterine foetal demise).

Methods of inducing labour

Amniotomy If the cervix is favourable (thinned out and dilated), an amniotomy is often resorted to. Amniotomy is the process of rupturing the amniotic membranes and letting out the amniotic fluid. method for labour induction works well in combination with medications .

Oxytocin It is the drug used for the induction, the world over. It makes the uterus contract. For induction, a synthetic form of the drug is given intravenously (IV). The contractions are monitored carefully to make sure that they are not stronger than what is safe for the mother and baby. As with any procedure, induction of labour with oxytocin must be done according to standard protocols.

Prostaglandin tablets Prostaglandin tablets may be given orally. The dose is increased gradually till contractions start. Prostaglandin tablets or gel are best avoided if the woman has had a previous caesarean section. Their usage may sometimes result in the previous scar giving way.

Risks of labour induction When monitored properly, induction of labour is very safe. As with any procedure, induction of labour carries some risk for the mother and baby. In some cases, there is a small risk of complications such as

• foetal distress where the baby is not tolerating labour well

• a Caesarean section which may need to be done if the induction is not successful

• a tear or rupture of the uterus (rare)

When should labour not be induced? Induction of labour is not attempted when the placental position is abnormal, if the foetus is in an abnormal position or if there is a deep scar on the uterus because of a prior surgery.

(The author is a Chennai-based obstetrician and gynaecologist with a special interest in women’s health issues.)

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