Labor Induction and Augmentation
Sometimes labor does not start naturally on its own or does not continue at a normal pace. In these instances, your health-care provider may decide to either begin labor for you or urge it along using medical procedures or medication.
If you go past your due date, experience problems that necessitate delivery, or your water breaks but labor does not begin on its own, you may need to have your labor induced. Most elective inductions of labor are performed for postdatism (usually one or two weeks past your due date), or when continuing the pregnancy may pose an unnecessary risk to the baby or mother (such as preeclampsia, maternal diabetes, or fetal growth restriction).
Your health-care provider will first perform a pelvic examination to determine the ripeness of your cervix. This is determined by evaluating the softness and thickness of the cervix, effacement (thinning) of the cervix, cervical dilation (if any), and station (how high the baby is in the birth canal). A numerical score called a Bishop score is then assigned. The higher the score, the higher the likelihood of a successful induction.
There are several methods your health-care provider may choose from or combine to induce labor:
Stripping the membranes: Your health-care provider separates your membranes from your uterus, which causes the release of hormones that can begin labor. This can be done at your doctor's office and can be uncomfortable.
Breaking your water: Your health-care provider breaks your bag of waters (this is called an amniotomy), causing the release of hormones that will get your labor started. An amniotomy should only be performed in a hospital setting.
Prostaglandin analogues: These are drugs that can be taken orally or intravaginally for both cervical ripening and induction. These drugs can cause excessive contractions (called hyperstimulation) and need to be removed should that occur. Usually, you must remain in the hospital during cervical ripening, and the process may take up to twelve hours.
Pitocin: This is the hormone oxcytocin, which your health-care provider may give you intravenously to stimulate contractions. When Pitocin is used, your contractions and the baby's heart rate will be carefully monitored.
Cervical catheter: Your health-care provider inserts a small catheter with an inflatable bulb on it into your cervix and expands it. This can cause the cervix to ripen and labor to start.
A study in the American Journal of Obstetrics and Gynecology found that as the mother's age increases, so does her risk of needing labor augmentation, having a prolonged labor, and needing a forceps or vacuum extraction. The same study also showed that older mothers are more likely to have babies who experience shoulder dystocia, the shoulders getting stuck during birth. Pushing the baby back in (cephalic replacement) and then performing a cesarean section is a last resort if the shoulders can't be freed.
If your health-care practitioner induces labor, but you don't give birth within 48 hours, she may advise you that you need a C-section. The risk of infection increases the longer you wait to deliver, especially if your water bag has broken.
Labor augmentation is used when your body is in labor but you aren't progressing. If your water has not broken yet, your health-care provider will likely break it for you. If that is not successful or your water has already broken, Pitocin is given by IV to increase your contractions. Because older women tend to have longer labors, they are also more likely to receive labor augmentation to attempt to move things along.