Labor induction is the use of medications of various types to produce uterine contractions and delivery. Inductions are broadly of two types- medically indicated and elective.
Induction may be medically indicated if you or your baby are sick. This can occur with many types of pregnancy complications- diabetes, high blood pressure, growth restriction, auto-immune problems.
Induction is elective if it is done at the choice and desire of the mother, without a pressing medical need. There can be many factors which lead to the choice of induction- availability of a desired physician, care for other children, availability of parents or other family members, work schedules, scheduled time off from a job.
Elective induction can be done only after 39 weeks. Many patients would love to be delivered before that, but there is more risk to the fetus below 39 weeks.
Suitability for induction is not an issue if it is medically indicated. We must simply do what conditions require. If induction is elective, I will assess your cervix with what is called a Bishop Score. This is an assessment of 5 characteristics of the cervix- dilatation, length, consistency, position and station. These are combined into a numerical score that ranges from 0 to 14. Anything 7 or better is favorable for delivery.
Induction is done fundamentally in two ways- with pitocin or with cytotec and pitocin. If you cervix is favorable, only pitocin is needed. You will come to the labor floor at 5:30 AM, be admitted to the hospital, and get an IV. I will break your water (rupture your membranes), insert special monitoring equipment in the uterus, and begin pitocin.
If your cervix is unfavorable, you will come to the labor floor the night before the delivery day, at 11:30 PM. Again you will get an IV, but then will be given a medication called cytotec to soften and prepare your cervix for delivery, called cervical ripening. You will then have procedures just like for the pitocin induction.
Cervical ripening has been done in many ways. A foley catheter balloon can be used very well. Prostin
suppositories are an older and quite unpleasant option I have not used in years. They are associated with vomiting, diarrhea, fever, pain and the tumultuous onset of labor.
Cytotec is much more pleasant. If used in higher doses, it can lead to fetal distress, uterine damage and emergent delivery. Obviously we do not use it in those doses. In small amounts it is quite effective and gentle in ripening the cervix. It is used with careful fetal monitoring, and there are strict rules about when it can be given. You will usually be scheduled to get three doses, but rarely are that many given. Usually two or sometimes even one dose are enough to start ripening the cervix.
Induction does not make labor more painful, contractions more frequent or stronger than a normal labor. All those ideas are based on much older usage of pitocin and prostins. Laos, delivery outcomes are actually better with carefully selected induction. Cesarean section rates are lower, and fetal complications are lower as well. The reason is that patients having elective inductions are already selected for a favorable cervix, and have extra monitoring as well.
What induction does do is shorten the time spent in the earliest part of labor. This phase can be up to 20 hours long. In an induction, it is usually 2-3 hours long. The length and intensity of active labor are not changed, and delivery is the same as well.
Many women choose elective induction for their deliveries. Induction is a useful medical tool, and a great blessing for those who qualify for it electively.
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