When should labour be induced?
Labour will be induced if there is a medical reason to do so, e.g., if your water has broken but you’re not having contractions yet, or if you are past 41 weeks of pregnancy. In other rare situations the health of the mother or baby may justify inducing labour. Talk to your health professional about the reasons for induction and its potential effects.
Methods used to induce labour
There are several different ways to induce labour, and the method chosen will depend on many factors, like how ripe the cervix is and whether or not it is your first delivery. There may be several steps involved.
First the ripeness of the cervix is evaluated. If your cervix is still closed or only slightly effaced (meaning it is still thick), you may be given hormones vaginally (via tampon or gel) or orally (via a pill). This will soften the cervix and it will begin to efface (thin). The cervix will then dilate, or open, a few centimetres.
Sometimes a catheter with a small balloon attached is inserted into the cervix. The balloon can then be inflated inside the cervix to open it. These methods may sometimes cause discomfort but they help prepare your cervix for the next stage of the induction process.
Contractions may be induced or intensified—if you are already having them—using the drug oxytocin, administered intravenously.
Also your amniotic membranes can be artificially ruptured (breaking your water). This intervention is generally no more painful than a cervical examination and does not harm your baby.
Once labour has begun, either naturally or by induction, your health professional may suggest stimulating labour if your cervix is not dilating and your contractions are too far apart or not strong enough.
The frequency and strength of contractions are increased using intravenously administered oxytocin. Once the oxytocin starts to take effect, you may need to continue taking it until your baby is born.
Monitoring the baby’s health
During the active phase of labour, your baby’s well-being is checked by listening to his heart with a fetal stethoscope or portable ultrasound machine. During this phase your baby will be monitored every 15 to 30 minutes.
If your baby needs to be watched more closely, continuous electronic fetal monitoring will be done. This means you will be connected to an electronic fetal monitor for a prolonged period. Two sensors are strapped to your abdomen and connected to a machine that produces a monitoring strip. One sensor tracks your baby’s heartbeat and the other records your contractions and the baby’s movements.
If the monitor bothers you or you would like to move around more, ask if you can take monitoring breaks to allow you more freedom of movement.
The staff can explain what the tracing means. There’s no need to worry if you stop hearing your baby’s heartbeat. Most of the time it’s because the baby or mother has moved and the sensor is no longer in the right place. Tell the staff so they can readjust it.
When and why is monitoring used?
During the last trimester
To make sure your baby is doing well if:
- You have health problems (diabetes, hypertension);
- There are concerns about your baby (reduced movement, underweight, insufficient amniotic fluid).
When inducing or stimulating labour with drugs
To make sure your baby is doing well and to determine the frequency of contractions. Monitoring continues until the baby is born.
To make sure your baby is doing well, to determine the frequency of contractions, and to see how your baby is handling them, if:
- You had a pregnancy without complications and you’re having a normal labour. Many hospitals suggest you be monitored for 20 minutes when you arrive and then every 15 to 30 minutes thereafter, based on the intensity of the contractions and how dilation is progressing (intermittent electronic monitoring);
- There is any doubt about your baby’s well-being, or if the situation requires more in-depth evaluation;
- You request an epidural during labour, in which case you will probably be connected to a monitoring device until the baby is born;
- You are planning for a vaginal birth after caesarean (VBAC);
- You have had a high-risk pregnancy.
In hospitals, certain drugs can be administered to ease birthing pains. The options available are the epidural, narcotics, and nitrous oxide gas.
Epidural anaesthesia, often referred to as an epidural, involves injecting a local anaesthetic through a flexible tube (catheter) inserted between two vertebrae in the lower back. The drug numbs the nerves in the abdominal area and partially numbs the leg nerves.
The epidural diminishes the pain of labour, but does not stop the contractions. This drug is administered and managed by an anaesthesiologist. If you want to have the option of having an epidural, find out ahead of time if it is available where you plan to give birth.
If you decide to have an epidural, an evaluation will first be done to ensure, among other things, that this type of anaesthesia is not contraindicated for you. Once the epidural is in place, its effects can be adjusted to suit your needs by varying the amount of drug administered through the epidural catheter. This catheter will be removed after delivery.
Once under the effects of the epidural, you will no longer be able to move around, but you will be able to move your legs. You must stay in bed, lying down or sitting up.
You will be connected to an intravenous solution until after the birth of your child. You will probably be connected to a continuous fetal monitor, especially if you are to be given drugs that stimulate contractions. If you have problems urinating during labour, you may need a urinary catheter.
Epidural anaesthesia is the most effective way to relieve labour pain. However it can slow the progression of labour because it may diminish uterine contractions and prevent you from moving about as you did before. For these reasons it is not usually administered until labour is well underway.
The effects of the epidural may make it more difficult to know how to push when the time comes for your baby to be born. This is why vacuum extractors or forceps are more often used to deliver a baby when the mother has an epidural. Epidurals do not increase the risk of having a caesarean.
Other drugs are also used, but less often than an epidural.
Narcotics are administered as injections. They decrease the sensation of pain without eliminating it completely. They can make you sleepy and nauseous and have the same effect on the baby. Sometimes the baby requires medical monitoring for a few hours after birth until the drugs are eliminated from his system. These drugs have no long-term effects on the mother or baby.
Nitrous oxide is not widely used. It is a gas administered through a mask that partially relieves pain during labour or delivery.
An episiotomy is a cut (incision) in the perineum that is made just as the baby is about to be delivered. It may occasionally be used in situations where the baby needs help to exit more quickly. The cut is then sutured under local anaesthesia.
Episiotomies are no longer done routinely because they have been shown to increase the risk of deep tears to the perineum.
Urinary catheter: A flexible tube that allows urine to drain freely from the bladder. The catheter is inserted into the bladder through the urethra.
Perinerum : The part of the body between the vagina and the anus.