Induction of Labour at Term
As a baby’s due date approaches and then passes the expectant mother may wonder why this has happened. We don’t fully understand what controls the timing of labour (but it’s clearly not us!). It is not uncommon for babies especially those of first time mothers to decide to stay put after their due date. It can be hard waiting longer for your little one to arrive and it is not unusual for discussions with your doctor regarding induction of labour to begin by the 39-40 week mark.
Induction may be indicated for a number of medical reasons for either mother’s or baby’s benefit. Some reasons include.
- If the water has broken but there are no contractions
- More than 10-12 days has past since the due date and labor has not naturally occurred
- Gestational Diabetes or other health issues affecting the mother
- Amniotic fluid is low or depleted
- Issues with the placenta that threaten the baby’s health
In the absence of any medical conditions, one of the of the main reasons for considering an induction of labour after the due date is that unfortunately the rate of stillbirth significantly increases after 2 weeks beyond the due date. The most common timing for an induction of labour for “post dates” is around 10-12 days after the due date. This gives a reasonable amount of time for labour to commence spontaneously, but also gives enough time for baby to be delivered before the risk of adverse outcomes starts to climb.
In considering the timing for an induction, there are a few issues to consider and it is really important that any pregnant woman is fully informed and understands her options regarding the timing and the reason for any planned induction.
One of the concerns in the past has been the thinking that induction of labour increases the risk of caesarean section. There is good evidence now, however, to support induction of labour any time after 39 weeks as it has been shown that induction after 39 weeks compared to expectant management (just waiting for baby to arrive) is associated with lower rates of caesarean section and lower rates of babies being admitted to the nursery.
If you speak to any woman who has had a spontaneous labour and an induction, they will all tell you that the induction contractions are more painful (as the body is playing “catch up”). For this reason the rate of uptake of epidural pain relief is a bit higher in women having an induction. Epidurals do not increase the risk of caesarean section, but are associated with a slightly higher chance of requiring some assistance to deliver baby vaginally.
In order to commence an induction of labour, the membranes need to be ruptured. In order to do this, the cervix needs to be “favourable” (open enough to reach the membranes). Sometimes either hormonal gels or other methods may be needed to “ripen” the cervix prior to the planned day of induction, and this can take some time. Once the membranes are ruptured then the uterus is stimulated by syntocinon to commence contractions.
Some natural ways to try and induce labor include exercising, nipple stimulation, acupuncture, and drinking red raspberry leaf tea. None of these natural options have a lot of strong evidence behind them and should be discussed with your doctor.
If you are considering an induction of labor please consult your doctor and make sure you understand the reasons for and against and the process involved.
The above information does not take the place of a medical consultation and is intended for informational purposes only