Induction of labor (IOL) means bringing on contractions
through external aids before your body goes into labor
naturally. IOL strengthens the contractions when contraction-inducing
drugs are introduced into the mother's body. When
your labor is induced, it is clear your body is not
prepared to give birth nor is your baby ready to be
born. But for some medical reason labor has to be
induced to avoid dangerous repercussions.
The reasons include:
• When your water breaks and you are still not
in labor and/or infection has set in
• When the mother has preeclampsia
• When there is some uterine infection
• When pregnancy has reached 41-42 weeks (placenta
is at its optimum upto 40 weeks after which it dwindles
• When mother's health can affect the well-being
of the newborn e.g. diabetes or any other pre-existing
• When baby is no longer thriving as he should,
there are placental problems or there is a decrease
in amniotic fluid level
• When there are RH factor complications
• When a stillbirth has occurred (a baby having
died inside mother's womb)
The Risks of induction
of labor (IOL)
• Elective Induction is not without risks. Induction
has been associated with strong frequent contractions
(uterine hyperstimulation); this causes the uterus
to work overtime, cutting off the oxygen supply to
baby. Hyperstimulation is defined as contractions
lasting longer than 90 seconds or having more than
5 contractions in 10 minutes. Hyperstimulation is
caused by strong doses of drugs administered for induction
and can affect your baby's well being.
• Uterine rupture – this is especially true
if you have had a c-section previously. An induction
can cause a tear in the uterus and bleeding which
can be dangerous for both mother and baby. This holds
true for incisions down the center of the uterus.
• A planned induction can result in higher incidence
of cesareans and postpartum hemorrhage, especially
in first-time moms.
• There is a risk of baby being delivered before
time i.e. before he has completely matured, giving
rise to serious physical problems. This is especially
the case if miscalculation of age occurs. ACCG necessitates
that induction should not be done unless the lady
is at least 39 weeks pregnant.
• For elective induction you will need to be
warded one night before labor is induced so that your
cervix can be ripened with the help of medications.
Before inducing labor your cervix must soften and
open. Synthetic forms of prostaglandins which mimic
the natural chemicals to trigger contractions will
be used if the woman's cervix hasn't naturally dilated.
Popular forms include Misoprostol (Cytotec) and prostaglandin
E2 or Dinoprostone (Prepidil, Cervidil), which will
help induction work better. These drugs are taken
orally in tablet form or inserted inside the cervix
as a tablet, gel or suppository. All medications
used to induce labor have one major risk: they might
result in strong forceful contractions that may affect
baby's oxygen supply adversely.
• Apart from prostaglandin treatment, the other
method is to place a catheter with water-filled balloon
into the uterus via the cervix opening. The catheter
will irritate the uterus into action and the balloon
will cause the cervix to soften and open. It can only
be used if the cervix is open wide enough to allow
the insertion of the catheter. After 6-24 hours Oxytocin
will be administered.
• Another way to dilate the cervix is called
laminaria where small reeds or cylinders of dried
leaves of the laminaria plant are placed inside the
cervix; these leaves swell from moisture and cause
the cervix to stretch.
The most common types of induction include medications
given orally, vaginally or intravenously, rupturing
of membranes or both.
• Oxytocin is a hormone naturally produced by
the mother to stimulate contractions. It is usually
administered after your cervix is dilated and thinned
to some extent. Pitocin is the synthetic version of
this hormone which works to cause contractions or
strengthen existing ones.
• Oxytocin is the most commonly used drug to
initiate labor; it is used to speed up contractions
that have stalled. Your contractions and baby's heart
beat will be monitored closely to avoid possible complications.
• An IV catheter is inserted into a vein in
your arm or on the back of your hand. Small, regulated
dose of this drug is delivered into your bloodstream
and the doses are adjusted to either slow down or
speed up the contractions depending on the situation.
• Pitocin should be stopped after five hours
if labor hasn't started. With a meal and rest break
in between, induction is resumed some hours later.
• In the event of Pitocin causing contractions
to hyperstimulate (this in turn affects baby's blood
and oxygen circulation) the dose may be reduced or
stopped totally. If the health status of baby remains
dubious or that of the mother worsens, a c-section
• When the amniotic sac ruptures, prostaglandins
are released in your body causing contractions to
follow. Amniotomy or artificial rupture of the sac
is one way of inducing or speeding up labor. Some
doctors may consider rupturing the membranes to trigger
• Amniotomy or artificial rupture of the membranes
(ARM / AROM) involves the painless insertion of a
long thin plastic hook into the cervix to create a
tear in the membranes. This procedure is comparable
to a vaginal exam, relatively painless and harmless
to both you and baby.
• This procedure causes labor to speed up by
one to two hours.
• Infection can set in if delivery doesn't take
place on time; if baby is showing no signs of distress
it is wiser to leave the sac intact and let nature
take its course.
• For medical reasons doctors sometimes have
to perform an amniotomy to check if baby is passing
meconium, which will mean further monitoring is required.
Again, because of different views, doctors are generally
divided on inducing labor through medical intervention.
Some doctors feel strongly about inducing only when
the mother or baby's health is at risk while others
are comfortable with planned induction for reasons
bordering on theirs or your convenience.