There are many reasons why induction of labor might be needed or wanted at the end of pregnancy. Common medical reasons for induction include diabetes, high blood pressure, and twin pregnancies. There are also many other medical conditions for which advancing pregnancy becomes risky for mom and baby. For any given condition, when the risks of ongoing pregnancy outweigh the benefits of it for the baby, delivery is generally recommended.
In addition to medically indicated inductions, there are also elective inductions. In a large study published in 2018 where low-risk women in their first pregnancy were randomized to a planned induction in their 39th week or “expectant management” (seeing what happens: spontaneous labor, post dates induction, etc.), those that were induced were less likely to have a cesarean delivery or hypertensive problems related to pregnancy. At Kamm McKenzie we will see you frequently as you approach your due date, so we can monitor you and your baby closely. We can also offer membrane sweeping, for those who are good candidates, to promote spontaneous labor. With our model, we give you the best and safest chance to go into labor on your own.
If a formal induction is needed, we use medical interventions to mimic and stimulate the process of natural labor.
The first step in both natural labor and induction is cervical ripening, that is, softening and preparing the cervix for labor. In an induction, this is generally accomplished mechanically with a foley bulb/balloon, and/or with medications. With Kamm McKenzie, your induction will typically begin in the evening (especially if this is your first baby) with foley bulb placement. Overnight the balloon will intensify the pressure exerted on the cervix by your baby’s head, causing natural prostaglandin release. Prostaglandins act on the cervix and uterus to cause softening and opening of the cervix. By morning, your cervix will have dilated to around 3-4 cm!
At this point, we give a synthetic form of the natural contraction-associated hormone, oxytocin through your IV. This stimulates strong, regular contractions that will push the baby down in the pelvis and dilate the cervix. The next step is the rupture of membranes or the breaking of the bag of water. This step continues the natural release of prostaglandins by your body and puts further pressure on the cervix, causing it to thin and dilate more. With these interventions, most women will reach complete cervical dilation (10 cm) and it will be time to push!
Written by Dr. Buckheit
Resources:
https://www.nejm.org/doi/full/10.1056/NEJMoa1800566
https://www.acog.org/womens-health/faqs/labor-induction
