We have reached the 40th week, the estimated due date has passed and the baby has no intention of being born, what happens? Normally they let a week and a half pass, a maximum of two, before proceeding to what is called induction of labor and childbirth. It is a real forcing of labor for the baby to be born. Before understanding what are the methods and indications for which an induction is carried out, let's understand what is fundamental or why. Because in the event of a late delivery, don't let nature take its course and the baby is born when it's ready.
If we talk about physiology, a woman's pelvis has a certain size determined by the shape of her bones. A baby who stays inside the belly beyond a certain period of time risks becoming too big, exposing himself and his mother to the risks deriving from a physical inability to pass through bones that cannot be enlarged that much. If we look into the world of pathology, on the other hand, there are many reasons why induction of childbirth may be necessary: latent infections, failure of the baby to grow in the last period of gestation. Even if in cases of important pathologies and emergencies we proceed directly with the caesarean section.Read also: Childbirth: the stages of labor
Labor induction techniques
We have therefore understood that often if a labor does not start spontaneously within two weeks from the presumed date of delivery, an attempt is made to intervene. But how? Here we must distinguish two main lines of intervention: the pharmacological / invasive practices and non-pharmacological practices. Within the traditional induction techniques and therefore the pharmacological ones we can find a further subdivision. A test is carried out to choose which methodology to apply, Bishop's score, which assigns scores according to the characteristics that the cervix may present at the end of pregnancy (for example, position, consistency, dilation, etc.).
- If this score is higher than a threshold value of 7 then labor will be promoted which would soon begin through the use of synthetic oxytocin administered intravenously, associated with amnioresis or the manual rupture of the amniotic sac. However, this practice is also very contrasted in the scientific literature and, in some structures, a non-invasive method is preferred: the internal application of a small strip soaked in prostaglandins. These hormones seem to have a decidedly accelerating effect on the changes in the cervix that lead to labor, without presenting the bloody factor for mother and baby due to the rupture of the membranes.
- If, on the other hand, Bishop's score is not favorable and therefore is less than 7, a different technique, included among the non-pharmacological ones, can be used, i.e. the introduction of a catheter that begins the changes necessary for the onset of labor, a sort of gentle mechanical expansion by inflating the balloon present in the catheter. In addition to this technique, it is also possible detachment of the membranes, which does not imply their rupture with the leakage of amniotic fluid. They are simply manually detached from the cervix to try to induce their rupture and the departure of labor.
- Among the non-pharmacological methods there are also i "Grandmother's remedies" (castor oil and the like) which, however, I strongly advise against using unless under strict supervision of a health professional. The onset of labor is a very delicate phase and it is not the case to risk remedies never tried before without even knowing what are the effects they can have on the mother and the baby.
How long does an induction last?
The answer to the question how long it lasts is very simple: until labor begins. Having said this, however, we must consider the fact that there is the possibility of a failure of induction techniques whatever they may be. That is, there are cases, and unfortunately they are not foreseeable, in which neither pharmacological nor non-pharmacological methods have an effect and therefore it is necessary to proceed with a caesarean section.
- Let's consider drug induction. Oxytocin is a very powerful drug that must be administered with caution so we start from a minimum dosage that will be gradually increased until the result is obtained, obviously leaving time for the uterus to react. Indicatively we can say that on average for this technique it can take from 2 to 4 hours for it to initiate labor. If there are no effects or symptoms, stop. The sling or gel instead of prostaglandin is left inside the cervix for 12 hours (even if recent studies do not show problems in leaving it in place even 24 hours) and it is expected to take effect. Also in this case, if it does not work, we suspend and change the method.
- Clearly mechanical methods such as amniorexes and membrane detachment or inserting the catheter they are snapshots, but here too we observe for 12 hours and then decide how to proceed. So it can be quite a lengthy procedure.
Is induction of labor painful?
On the painful depends a lot on the local conditions and the technique used. Clearly everything that is manual implies that the doctor with his hands and / or tools forces the local situation, and therefore the pain in this sense can be caused by the invasiveness of the procedure. Pharmacological techniques, on the other hand, are painful in the sense that they induce the reaction of the uterus triggering contractions, sometimes quite strong and not always effective. Nausea and vomiting may occur due to the pain of contractions, and there is the drawback that it is not possible to move too much due to the drip, or the gel placed in the cervix.
The risks of induction
If there were high risks it is evident that these procedures would not be applied. However, it must be considered a certain one percentage of women in whom induction should be avoided. How to understand what they are? First of all, based on clinical history, histories of haemorrhages or precipitating births lead, for example, to opt for non-pharmacological methods. The drugs, even if in minimal quantities, pass through the placenta and reach the baby, therefore, to avoid risks to both, both the baby's heartbeat and vital functions and maternal contractions are constantly monitored. Finally, there are conditions in which induction is absolutely contraindicated and are as follows:
- labor is already in progress
- the baby is breech
- there are any type of changes in the baby's heartbeat or in the type of uterine contraction
- the placenta is not positioned in such a way as to allow vaginal delivery and very invasive surgery on the uterus.
The guidelines on induction, when should it be performed?
According to recent data collected by the Lombard Society of Gynecology and Obstetrics the inductions of labor in conditions of physiological pregnancy they are increasing to even 1 in 5, and this does not always seem to be associated with a real need for induction, but rather with techniques of "voluntary anticipation without cause" and not adhering to national and international guidelines. The guidelines are very precise but also admit intermediate situations, in which it is not known whether or not to wait for labor to arise spontaneously as long as these cases are discussed within a team of professionals.
When to induce labor?
We see when it is recommended to induce labor:
- pregnancy protracted beyond 41 weeks and 5 days
- rupture of membranes and loss of amniotic fluid before the onset of labor (only if no signs of labor appear within 12 hours of the rupture and in this case hospitalization is required)
- absence of amniotic fluid or very little quantity in a pregnancy that is now over 37 weeks.
Concluding the theme ofinduction of labor it is very complex, discussed and constantly evolving in terms of parameters, techniques and timing. What I recommend to do is to definitely rely on the gynecologist / obstetrician who follows you during pregnancy and decide together, by reading the protocols of the various hospitals, which could be right for you if you happen to have to resort to induction.