Induction of Labor: Everything You Need to Know
There are different reasons why health professionals proceed with induction of labor, a practice that consists of artificially triggering the natural birth process.
Such a strategy isn’t necessary in all pregnancies, nor is it appropriate in all cases. However, nowadays, it’s become quite frequent and this has generated controversy.
Let’s find out what it is, when it’s necessary to practice it, and what international scientific societies think about it. Keep reading!
What does induction of labor mean?
Labor induction is based on using different medical strategies to initiate labor. More specifically, triggering contractions and stimulating dilation of the cervix, in order to achieve vaginal birth.
There are different methods to induce labor:
- Mechanical: this is performed by artificially rupturing the membranes covering the amniotic sac. To perform this procedure, the cervix must be dilated and the baby’s head must be wedged in the pelvis. As the fluid comes out, the baby exerts pressure on the pelvic floor to stimulate labor.
- Pharmacological: based on the use of drugs that stimulate contractions (such as oxytocin) and promote dilation of the cervix (such as prostaglandins).
It’s worth noting that this procedure is reserved for specific cases, in order to obtain benefits that outweigh the risks to the health of the mother or baby.
When is the induction of labor necessary?
According to the Spanish Society of Gynecology and Obstetrics (SEGO), induction of labor is indicated when the risks of continuing the pregnancy outweigh the risks of accelerating the birth.
In its action protocol, this entity suggests induction only in the following situations:
- Post-term pregnancy: when a pregnancy lasts longer than 42 weeks, there’s a risk that the baby won’t be well-nourished and oxygenated due to the aging of the placenta
- Premature rupture of membranes: due to the risk of infections inside the amniotic sac and other complications
- Hypertensive states of pregnancy (preeclampsia, eclampsia, and HELLP syndrome)
- Gestational diabetes
- Intrauterine growth restriction
- Twin pregnancy
- Chorioamnionitis (infection of the amniotic membranes)
- Premature placental abruption
- Intrauterine fetal death
In addition to this, these guidelines refer to elective induction, which is unrelated to clinical reasons, and should only be practiced if the gestation is more than 39 weeks.
Risks associated with induction of labor
Although in the aforementioned cases, induction is a way to avoid a cesarean section, there are risks inherent to the practice that you should be aware of:
- Failed induction: after implementing pharmacological and mechanical methods, labor doesn’t progress
- Maternal bradycardia: the drugs administered can lower the mother’s heart rate and decrease fetal oxygenation
- Uterine rupture: although rare, it’s serious and occurs due to tearing of the uterus
- Uterine bleeding due to the following reasons: During labor, the uterus doesn’t contract properly and the hemorrhage doesn’t stop
For all of the above reasons, there are some contraindications to performing induction of labor. Among them, having had previous and close cesarean sections, when the fetus is in a transverse position, a history of uterine rupture, an active herpes infection, umbilical cord prolapse, or cervical cancer, among others.
What position do health agencies adopt on labor induction?
The current controversy surrounding this procedure is closely related to its high frequency in health centers around the world. Even without any medical cause to justify it.
The reason is thought to be the choice of the moment of birth and the lack of respect for childbirth as a natural event. Let’s see how the various scientific societies express themselves in this regard.
World Health Organization (WHO)
In 2015, the WHO published a series of recommendations on labor stimulation, suggesting avoiding the use of oxytocin, misoprostol, and sac rupture (amniotomy). These recommendations have to do with the risks that such strategies involve.
In 2018, these guidelines were expanded in the Intrapartum care for a positive childbirth experience. Those guidelines sought to optimize the birth experience from a holistic, human rights-based approach.
With respect to induction of labor, the authors discourage early amniotomy along with oxytocin administration to accelerate birth. Finally, they highlight the need to reduce unnecessary medical interventions in low-risk pregnancies.
Argentine Federation of Gynecology and Obstetrics Societies (FASGO)
In an update published in 2019, this body highlighted a series of conditions to be taken into account when carrying out labor induction. In relation to them, the experts state the following:
“The indications for induction of labor are not absolute; maternal (cervical status, ovarian membranes and gestational age) and fetal conditions, among other factors, should be taken into account.”
Likewise, the authors emphasize that labor can be induced for logistical reasons that justify it (such as the distance between home and hospital or certain psychosocial indications).
It should be noted that pregnant women should be aware of the induction method, the place where it’s performed, the details, and the options for support and pain relief.
Induction of labor, a strategy to reduce the number of cesarean sections
A timely and justified induction of labor is a favorable option for the well-being of mother and baby, as it limits the need to resort to a cesarean section.
It has been determined that the benefits of labor induction may outweigh the risks. Especially in the case of prolonged pregnancies (more than 41 weeks), in which perinatal deaths and cesarean section rates tend to balance the scales.
Before the specialist performs the procedure, the mother should know what it is and endorse its performance. It’s her right to choose how to give birth.
All cited sources were thoroughly reviewed by our team to ensure their quality, reliability, currency, and validity. The bibliography of this article was considered reliable and of academic or scientific accuracy.
- Federación Argentina de Sociedades de Ginecología y Obstetricia FASGO (2019). Inducción al trabajo de parto. Actualización del Consenso de Obstetricia FASGO 2019. Recuperado de: http://www.fasgo.org.ar/archivos/consensos/Actualizacion_Consenso_2019_Trabajo_de_Parto.pdf
- MayoClinic (2021). Inducción del trabajo de parto. Recuperado de: https://www.mayoclinic.org/es-es/tests-procedures/labor-induction/about/pac-20385141#:~:text=La%20inducci%C3%B3n%20del%20trabajo%20de,para%20lograr%20un%20parto%20vaginal.
- MedlinePlus (2021). Inducción del trabajo de parto. Recuperado de: https://medlineplus.gov/spanish/ency/patientinstructions/000625.htm
- Ministerio de sanidad, política social e igualdad de España (2011). Estrategia Nacional de Salud Sexual y Reproductiva. Recuperado de: https://www.sanidad.gob.es/organizacion/sns/planCalidadSNS/pdf/equidad/ENSSR.pdf
- Organización mundial de la Salud OMS (2015) Recomendaciones para la estimulación del trabajo de parto. Recuperado de: http://apps.who.int/iris/bitstream/handle/10665/200213/WHO_RHR_15.05_spa.pdf?sequence=1
- Organización mundial de la Salud OMS (2018) Recomendaciones de la OMS Para los cuidados durante el parto, para una experiencia de parto positiva. Recuperado de: https://apps.who.int/iris/bitstream/handle/10665/272435/WHO-RHR-18.12-spa.pdf
- Sociedad española de ginecología y obstetricia SEGO (2015). Protocolo SEGO para la inducción del parto. Progresos de ginecología y obstetricia Vol 58. N°1. Pp: 54-64. Recuperado de: http://ginecologiayobstetriciaucc.blogspot.com/2017/03/induccion-del-parto-sego-2013.html