Generality
One speaks of induced childbirth when labor is stimulated by artificial methods.
Induction of childbirth is advisable under certain conditions, such as an over-term pregnancy, an early rupture of the water or an abnormality of the placenta.
In most cases, stimulation interventions end in a vaginal delivery, however, in some cases, a caesarean section may be necessary.
What is induced birth?
Induced labor (or induction of childbirth ) is the medical procedure, carried out during pregnancy, which serves to stimulate the onset of uterine contractions, typical of labor, when these are late.
Said in simpler words, induced childbirth consists in the stimulation, with artificial methods, of labor.
Its execution, as we shall see, is required in particular situations and is not without risks. However, if the benefits that can be obtained are greater than the possible dangers, then it is advisable to intervene.
HOW MANY INDUCED PARTS ARE PERFORMED IN ITALY?
In Italy, according to some statistical data, the induction of childbirth is practiced in 20-25% of pregnancies and represents one of the most implemented obstetrics interventions.
Usually, when we talk about induced childbirth, the cesarean section of electri, for which no labor is foreseen, is excluded from the calculation of total pregnancies.
When you run
Before determining if it is essential to stimulate childbirth, the gynecologist must examine different aspects: from the state of health of the mother to that of the fetus, from the gestational age of the child to its size, from the position of the baby in the uterus to the state of the uterine cervix maternal.
But when exactly is induced childbirth required?
The most common situations are the following:
- Continued pregnancy beyond the time limit . Generally, if one or two weeks have passed from the expiration date, it is necessary to give birth to the child with induced birth. If you do not act, the risk is that the fetus grows too much, that the placenta no longer performs its functions properly and that the birth is extremely dangerous for the mother.
- Premature breakage of water . Water rupture is one of the initial signs of labor; however, in some situations, it can occur without being accompanied by uterine contractions or well in advance of the expiry date of the pregnancy.
Breaking without contraction exposes the mother and the fetus to infections . Early breakage, on the other hand, could result in a premature birth of the child, with all the consequences of the case. If it occurs before the 34th week, induced childbirth is practiced only if it is the only possible solution; if it occurs between the 34th and 37th week, the gynecologist explains the dangers and benefits of induced labor to the mother and decides with her what to do; if it occurs at the 37th week or soon after, mother and fetus are placed under continuous observation and, at the appropriate time, labor is induced.
- Infection of the uterus .
- Low fluid content in the amniotic sac . This condition, also known as oligohydramnios, usually does not create any disturbance, but in some cases it can be a source of danger to the child and require an induced birth.
- Deteriorated placenta .
- Placental detachment . It occurs when the placenta separates from the inner wall of the uterus. The effects can also be very serious and endanger both the mother and the fetus. It represents one of the most important causes of ante-partum hemorrhage .
- Pathological conditions, such as diabetes, pregnancy cholestasis and hypertension, which afflict the mother during pregnancy.
INDUCED PART AS A PRACTICAL SOLUTION
Sometimes, induced birth can be a practical solution to certain situations.
For example, if a pregnant woman lives very far from a hospital or has been the protagonist in the past of an imminent birth, the induction of childbirth can be an excellent remedy, regardless of whether the pregnancy is at risk or not.
In general, in such conditions, at least the 39th week of gestation is expected before proceeding.
OTHER SITUATIONS IN WHICH THE INDUCED PART IS ACTIVATED
There are women who require induced childbirth for fear that labor may arise at an unwanted time. Faced with such situations, gynecologist and attending physician tend to dissuade the expectant mother from her intentions, since the induction of childbirth is not a risk-free procedure.
risks
Induced birth is a procedure that can expose the pregnant woman and / or the fetus to different dangers. This explains why, before proceeding, it is necessary to make an assessment of the risk / benefit ratio and, only at the end of this, decide what to do.
Here is a list of possible dangers:
- Need for a cesarean section . The ideal situation, when labor is induced artificially, is to have a vaginal birth; however, in some cases, this is not feasible, therefore a cesarean section is needed. Cesarean section, like any surgical operation, is not without risks.
- Premature birth . It is the risk that one runs with the parts induced in the non-term pregnancy. As mentioned, before stimulating labor, it is necessary to make the appropriate assessments and ask what is best for the mother and the child. One of the most common disorders among premature babies is respiratory distress.
- A reduction in heart rate in the child . Some medicines, used to stimulate childbirth, have as a possible side effect a reduction in the fetal heart rate and a decrease in the flow of oxygen coming from the mother and directed to the fetus.
- Infections . The risk of developing infections increases both in the mother and in the fetus.
- Prolapse of the umbilical cord . This situation occurs when the umbilical cord descends into the cervical canal before the baby's head. This results in a reduction of the oxygen destined for the fetus.
- Rupture of the uterus . It is a very rare complication, however possible.
- Postpartum hemorrhages . These are caused by the failed spontaneous contraction of the muscular walls of the uterus (uterine atony). Blood loss can also be very copious.
WHEN IS THE INDUCTED PART NOT APPROPRIATE?
There are people for whom the induction of childbirth is not recommended.
Classic situations, not suitable for induced childbirth, are represented by: a previous cesarean section (especially if induced) or a previous uterine surgery; placenta previa, in which the placenta is formed at the bottom of the uterus; transverse position of the fetus ; genital herpes simplex infections in progress; birth canal (or cervical canal) too small to allow vaginal delivery.
Preparation
Induced childbirth is almost always performed in the hospital, precisely in the delivery rooms of obstetrics. Here, in fact, there are all the equipment suitable for the situation and possible complications.
WHEN THE INDUCED PART IS PLANNED
The induced birth can be, depending on the circumstances, an emergency procedure or a planned procedure. When it is a long-planned procedure, the expectant mother is subjected to all the clinical controls necessary to ensure that there are all the ideal conditions for an artificial induction of labor.
GENERAL WARNINGS: PAIN IN THE INDUCED PART
The uterine contractions of induced labor are much stronger and more painful than those that occur during natural labor.
Therefore, pregnant women are prepared for this aspect and subjected to epidural anesthesia, which makes them (insofar as possible) insensitive to pain.
Procedure
Induced birth can be performed in various ways. The choice of the most appropriate method is up to the doctor and depends on the circumstances. Therefore, every pregnant woman represents a case in itself.
The main techniques for inducing labor are:
- The separation of the membranes
- Induced cervical maturation and dilatation.
- Amniotomy, or the voluntary rupture of water
- Intravenous administration of oxytocin
DISCONNECTION OF MEMBRANES
The separation of the membranes is a valid method both to stimulate delivery and to speed it up. It is performed by the gynecologist (or even by the obstetrician), who, inserting a hand directly into the uterus, performs delicate maneuvers, aimed at separating the amniotic sac from the internal uterine walls.
The effects of the detachment are not always immediate and, due to its simplicity of execution, the intervention can also be ambulatory
Warnings and unwanted effects: after the dissolution of the membranes (even after several hours), a hemorrhage may occur, similar to the menstrual one. If this is copious, it is good to alert your gynecologist.
INDUCED CERVICAL MATURATION AND EXPANSION
Premise: the cervical maturation (or maturation of the cervix ) is the process that anticipates the dilation and the thinning of the uterus, which, in turn, precede the actual birth.
To stimulate the maturation of the cervix and consequently dilate the uterus, one can use: synthetic prostaglandins, administered by mouth (tablets) or directly in the vagina (gel); a pessary, which is a silicone ring placed in the vagina; or mechanical dilators, such as a Foley catheter or laminaria algae derivatives.
Both cervical maturation procedures take place in a hospital ward.
How does a Foley catheter work?
The Foley catheter is a thin tube of flexible rubber, equipped, at one end, with an inflatable balloon.
Once the catheter is positioned at the level of the cervical canal, a saline solution is injected through it, which inflates the balloon. The inflated balloon pushes on the walls of the cervix, widening them.
What is and how does a derivative of alga laminaria work?
The derivatives of laminaria (digitata and japonica) are nothing more than the stems of these marine algae, which, once dried, become sticks of the ideal size for insertion into the cervical canal. Here, they favor the processes of maturation and dilation of the cervix.
Laminar algae are also used for the stimulation of childbirth in the case of endouterine fetal death.
Warnings and side effects: the use of synthetic prostaglandins should be monitored step by step, as these could alter the fetal heart rate .
amniotomy
Amniotomy is the voluntary rupture of water.
The gynecologist performs this operation by incising the amniotic sac with a small plastic hook. As soon as the bag breaks, amniotic fluid is lost from the vagina.
Amniotomy takes place in the hospital and is particularly indicated when the cervix is already partially dilated and thinned.
Warnings and unwanted effects: the fetus must be put under observation both before and after amniotomy, as changes in its heart rate may occur.
INTRAVENOUS ADMINISTRATION OF OXYTOCIN
Intravenous administration of synthetic oxytocin takes place in the hospital and serves to stimulate uterine contractions. It is the ideal solution when the cervix is already partially dilated and thinned, but it can also have an effect on the cervical maturation process.
Warnings and undesirable effects: as in the previous cases, the administration of oxytocin also requires continuous monitoring of the fetal heart rate.
FREQUENT QUESTIONS
Here are the questions most frequently asked by pregnant women, who are preparing for induced childbirth:
How much time passes from the application of the remedy to the beginning of induced labor?
It depends on the treatment and the state of the 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 dilated cervix, the time required is a few hours.
What happens if the induction doesn't work?
If the stimulation of the birth has not been successful, you can proceed with another attempt, provided that the child's health conditions allow it.
If, in fact, it was considered dangerous to induce labor again, it is advisable to opt for other solutions, such as cesarean section.
Can multiple methods be combined to better stimulate labor?
Of course, the gynecologist can adopt several techniques at the same time, to get a better effect. Obviously, as mentioned in the beginning of the chapter, there must be the appropriate conditions.
Should I use forceps or a suction cup?
In some cases, yes. If there are complications, in fact, it could be useful to use forceps or suction cup.
Are there any natural remedies to stimulate childbirth?
There is no evidence that certain natural remedies you hear about (homeopathy, acupuncture, having sex during pregnancy, etc.) can stimulate induced childbirth. Indeed, in some situations, they are also potentially dangerous circumstances.
Results
Most of the induced parts (according to an English statistic, just under 2/3) does not require other interventions and ends, favorably, with a simple vaginal birth .
About 15%, on the other hand, requires the use of forceps or suction cups, while almost 20% require cesarean section . A cesarean section, performed in such circumstances, does not prohibit subsequent pregnancies, however it advises against any further induced childbirth.
