Induction Of Labor (IOL)

Induction of labor (IOL) means bringing on contractions through external aids before your body goes into labor naturally. IOL strengthens the contractions when contraction-inducing drugs are introduced into the mother's body. When your labor is induced, it is clear your body is not prepared to give birth nor is your baby ready to be born. But for some medical reason labor has to be induced to avoid dangerous repercussions.

The reasons include:

• When your water breaks and you are still not in labor and/or infection has set in
• When the mother has preeclampsia
• When there is some uterine infection
• When pregnancy has reached 41-42 weeks (placenta is at its optimum upto 40 weeks after which it dwindles in performance)
• When mother's health can affect the well-being of the newborn e.g. diabetes or any other pre-existing medical condition
• When baby is no longer thriving as he should, there are placental problems or there is a decrease in amniotic fluid level
• When there are RH factor complications
• When a stillbirth has occurred (a baby having died inside mother's womb)

The Risks of induction of labor (IOL)

• Elective Induction is not without risks. Induction has been associated with strong frequent contractions (uterine hyperstimulation); this causes the uterus to work overtime, cutting off the oxygen supply to baby. Hyperstimulation is defined as contractions lasting longer than 90 seconds or having more than 5 contractions in 10 minutes. Hyperstimulation is caused by strong doses of drugs administered for induction and can affect your baby's well being.
• Uterine rupture – this is especially true if you have had a c-section previously. An induction can cause a tear in the uterus and bleeding which can be dangerous for both mother and baby. This holds true for incisions down the center of the uterus.
• A planned induction can result in higher incidence of cesareans and postpartum hemorrhage, especially in first-time moms.
• There is a risk of baby being delivered before time i.e. before he has completely matured, giving rise to serious physical problems. This is especially the case if miscalculation of age occurs. ACCG necessitates that induction should not be done unless the lady is at least 39 weeks pregnant.

Pre-induction

• For elective induction you will need to be warded one night before labor is induced so that your cervix can be ripened with the help of medications. Before inducing labor your cervix must soften and open. Synthetic forms of prostaglandins which mimic the natural chemicals to trigger contractions will be used if the woman's cervix hasn't naturally dilated. Popular forms include Misoprostol (Cytotec) and prostaglandin E2 or Dinoprostone (Prepidil, Cervidil), which will help induction work better. These drugs are taken orally in tablet form or inserted inside the cervix as a tablet, gel or suppository. All medications used to induce labor have one major risk: they might result in strong forceful contractions that may affect baby's oxygen supply adversely.
• Apart from prostaglandin treatment, the other method is to place a catheter with water-filled balloon into the uterus via the cervix opening. The catheter will irritate the uterus into action and the balloon will cause the cervix to soften and open. It can only be used if the cervix is open wide enough to allow the insertion of the catheter. After 6-24 hours Oxytocin will be administered.
• Another way to dilate the cervix is called laminaria where small reeds or cylinders of dried leaves of the laminaria plant are placed inside the cervix; these leaves swell from moisture and cause the cervix to stretch.

Induction Methods

The most common types of induction include medications given orally, vaginally or intravenously, rupturing of membranes or both.

Oxytocin

• Oxytocin is a hormone naturally produced by the mother to stimulate contractions. It is usually administered after your cervix is dilated and thinned to some extent. Pitocin is the synthetic version of this hormone which works to cause contractions or strengthen existing ones.
• Oxytocin is the most commonly used drug to initiate labor; it is used to speed up contractions that have stalled. Your contractions and baby's heart beat will be monitored closely to avoid possible complications.
• An IV catheter is inserted into a vein in your arm or on the back of your hand. Small, regulated dose of this drug is delivered into your bloodstream and the doses are adjusted to either slow down or speed up the contractions depending on the situation.
• Pitocin should be stopped after five hours if labor hasn't started. With a meal and rest break in between, induction is resumed some hours later.
• In the event of Pitocin causing contractions to hyperstimulate (this in turn affects baby's blood and oxygen circulation) the dose may be reduced or stopped totally. If the health status of baby remains dubious or that of the mother worsens, a c-section will follow.

Amniotomy

• When the amniotic sac ruptures, prostaglandins are released in your body causing contractions to follow. Amniotomy or artificial rupture of the sac is one way of inducing or speeding up labor. Some doctors may consider rupturing the membranes to trigger labor.
• Amniotomy or artificial rupture of the membranes (ARM / AROM) involves the painless insertion of a long thin plastic hook into the cervix to create a tear in the membranes. This procedure is comparable to a vaginal exam, relatively painless and harmless to both you and baby.
• This procedure causes labor to speed up by one to two hours.
• Infection can set in if delivery doesn't take place on time; if baby is showing no signs of distress it is wiser to leave the sac intact and let nature take its course.
• For medical reasons doctors sometimes have to perform an amniotomy to check if baby is passing meconium, which will mean further monitoring is required.

Again, because of different views, doctors are generally divided on inducing labor through medical intervention. Some doctors feel strongly about inducing only when the mother or baby's health is at risk while others are comfortable with planned induction for reasons bordering on theirs or your convenience.