Induced childbirth is a practice indicated in certain conditions, including: over-term pregnancies, episodes of early water rupture and the presence of some abnormality in the placenta.
Currently, there are more than one techniques for carrying out induced childbirth available to gynecologists and obstetricians; since in all cases it is a question of procedures that are not completely free of dangers for both the mother and the fetus, before the implementation of one of the the doctor will have to evaluate the risks and benefits of the specific technique chosen.
Typically, induced delivery ends with a vaginal delivery; however, in certain situations, it may happen that it requires the execution of a caesarean section or the use of forceps or a suction cup.
If the premature rupture of the waters occurs several hours before labor, the mother and fetus are at risk of infection; if instead the premature rupture of the waters takes place weeks before the presumed date of birth, the whole situation could evolve in a preterm birth, that is in the premature birth of the baby).
The effects of placental abruption can also be very serious and life-threatening both the mother and the fetus.
The abruption of the placenta is one of the most important causes of bleeding ante-partum (blood loss before childbirth).
Preeclampsia can degenerate into eclampsia, a serious pregnancy pathology that can cause the death of the mother and fetus.
Furthermore, induced delivery is indicated in case of miscarriage in an advanced stage of pregnancy or when the mother suffers from a condition including gestational diabetes, chronic kidney disease and cholestasis of pregnancy or has a high body mass index (in other words, is suffering from obesity).
In-depth study: how do doctors act in the event of a premature rupture of the waters?
If the water breaks before the 34th week, the gynecologist (or the obstetrician) practices induced birth only if it is the only possible solution; if the water breaks between the 34th and 37th week, the doctor illustrates to the mother the dangers and benefits of induced birth and decides with her what to do; finally, if the water break occurs in the 37th week or shortly thereafter, the doctors' strategy is to keep the mother and fetus under continuous observation, in order to artificially induce labor at the most opportune moment.
Other circumstances in which Induced Childbirth may be useful
The indications for induced delivery reported so far are all pathological conditions.
The induction of childbirth, however, can also be used in situations that are not strictly morbid; in fact, it can be useful for:
- Pregnant women who live far from a well-equipped hospital for a birth;
- Pregnant women who need to give birth before a certain time in their life (in such circumstances, induced delivery is a request of the future parturient, rather than a "need of the doctor).
On the basis of the parameters just mentioned, doctors are able to draw up a risk / benefit ratio relating to induced birth, so as to be able to act with the widest safety margin.
Important!
Even when the risk / benefit ratio is largely unbalanced towards the benefits, induced childbirth still remains a delicate practice, which could hide unpleasant drawbacks).
Where is Induced Childbirth practiced?
Induced delivery is a technique practiced in birth centers and hospitals with an obstetrics ward equipped to monitor the mother and the future unborn child even after delivery.
For further information: Gynecologist: Who is he? What does it cure? When to contact him? , as it produces very strong and painful uterine contractions (in general, it is responsible for much more intense pain than natural birth).
Generally, the induction of childbirth ends with vaginal birth; some particular situations, however, require the doctor to resort to other strategies to deliver the baby, such as a caesarean section or the use of forceps or suction cups.
For further information: Epidural Anesthesia: What it is in the detailsTechniques for Performing Induced Childbirth: what are they?
Among the different techniques for performing induced birth, the main ones are:
- The detachment of the membranes;
- The induction of cervical maturation and dilatation;
- L "amniotomy;
- Intravenous administration of oxytocin.
DISCONNECTION OF THE MEMBRANES
The detachment of the membranes is a valid method both to induce childbirth and to speed it up.
In performing it, the gynecologist (or obstetrician) inserts a hand directly into the uterus and practices a series of delicate maneuvers, aimed at separating the amniotic sac from the internal uterine walls.
The effects of membrane detachment are not always immediate.
Warnings and side effects: after the detachment of the membranes (even after several hours), it is possible that a "bleeding, similar to the menstrual one."
INDUCTION OF CERVICAL MATURATION AND EXPANSION
Premise: cervical ripening (or ripening of the uterine cervix) is the process that anticipates the dilation and thinning of the uterus, which, in turn, precede the actual birth.
Currently, to stimulate the maturation of the cervix and consequently dilate the uterus, the gynecologist (or obstetrician) can use:
- Synthetic prostaglandins, administered by mouth (lozenges) or directly into the vagina (gel);
- The pessary, which is a silicone ring made for its placement in the vagina;
- A mechanical dilator, such as a Foley catheter or a derivative of kelp.
Warnings and side effects: The use of synthetic prostaglandins requires continuous monitoring of the patient, because it could induce an alteration of the fetal heart rate.
What is the Foley catheter and how does it work?
The Foley catheter is a thin, flexible rubber tube with an inflatable balloon at one end.
Its use in induced childbirth requires the doctor to insert the end equipped with the balloon into the cervical canal and inject, through the opposite end, a saline solution, in order to inflate the aforementioned balloon and enlarge, thanks to a push mechanism, the walls of the cervix.
What is a derivative of laminaria seaweed and how does it work?
The derivatives of laminaria (digitata and japonica) are none other than the stems of these marine algae, which, once dried, become sticks of ideal size for insertion into the cervical canal.
Once in the cervical canal, laminaria derivatives are able to favor the processes of maturation and dilation of the cervix.
AMNIOTOMY
Amniotomy is the voluntary rupture of the water.
The gynecologist does this by incising the amniotic sac with a small plastic hook; this incision produces leakage of amniotic fluid from the vagina.
Amniotomy is particularly indicated when the cervix is already partially dilated and thinned.
Warnings and side effects: the fetus must be observed both before and after the amniotomy, as variations in its heart rhythm may occur.
INTRAVENOUS ADMINISTRATION OF OXITOCIN
Premise: oxytocin is the hormone that the body of a pregnant woman produces in large quantities at the end of pregnancy, in order to stimulate uterine contractions and labor.
The intravenous administration of synthetic oxytocin allows to induce uterine contractions in an artificial way.
This practice represents the ideal solution when the cervix is already partially dilated and thinned; however it can also have an effect in the cervical ripening process.
Warnings and side effects: as in the previous cases, the administration of oxytocin also requires continuous monitoring of the heart rate of the fetus.
Duration of Induced Childbirth
The duration of induced birth varies from pregnant to pregnant woman and depends mainly on the state of maturation of the uterine cervix at the time of the beginning of the medical practice aimed at inducing labor and, secondarily, on the execution technique used.
In terms of time, the duration of an induced birth can be a few hours, if the maturation of the uterine cervix is already well advanced, or a few days, if the uterine cervix is still very immature.
Frequently Asked Questions about Induced Childbirth
Here is a list of the questions most frequently asked by pregnant women, who are preparing for induced birth:
Q: How long does it take from applying the remedy to the onset of induced labor?
A: It depends on the induction technique and on the state of maturation of the uterine cervix (immature, mature, partially dilated, etc.). For example, in the case of a still immature cervix, it can take up to two days before seeing the first effects; vice versa, in the case of a mature or already partially dilated cervix, the time required is a few hours.
Q: What happens if the induction doesn't work?
A: If the stimulation of birth has not been successful, the doctor may try another attempt, as long as the health of the baby allows it.
If, in fact, it is dangerous to induce labor again, it is advisable to opt for other solutions, such as a caesarean section.
Q: Can several methods be combined to better stimulate labor?
A: Of course, the gynecologist (or obstetrician) can adopt several techniques at the same time, to obtain a better effect. Clearly, the suitable conditions must exist for the practice of induction of childbirth.
Q: Is the use of forceps or a suction cup required?
A: In case of complications, yes.
Q: Are there any natural remedies to stimulate childbirth?
A: There is no evidence that certain natural remedies, such as homeopathy, acupuncture, having sexual intercourse during pregnancy, etc., are capable of stimulating induced delivery. Indeed, it should be remembered that, in some situations, the aforementioned circumstances could prove dangerous.
They represent a contraindication to the practice of induced birth:
- The performance, in the past, of a caesarean section (especially if after the induction of childbirth) or of a surgery on the uterus;
- The presence of the so-called placenta previa (condition in which the placenta develops at the bottom of the uterus);
- The fetus in a transverse position;
- The presence of a "genital herpes simplex infection;
- A small cervical canal (hinders vaginal delivery).
