What is induction of labor?

Induction of labor is a process by which your health care provider initiates the labor process before it has begun spontaneously.  This is usually done with medications given vaginally or orally but can also be performed by mechanical means. In most cases induction is a two strep process involving cervical ripening followed by augmentation. The medications used by your provider for cervical ripening are varied and may depend on your provider’s preference.  Augmentation may include artificially rupturing your membranes (which is a painless process) and/or the use of oxytocin.

The reasons for considering an elective induction of labor are often personal.  These reasons should be discussed with your healthcare provider. Without a medical indication, elective induction of labor is best reserved for patients who have reached or surpassed 39 weeks gestation. Prior to 39 weeks, although your fetus is considered full term, there may still be adverse fetal outcomes for babies induced between 37 and 39 weeks gestation. For this reason, your physician likely will not offer you an elective induction of labor prior to 39 weeks for the benefit of both you and your developing baby. www.marchofdimes.com/professionals/healthy-babies-are-worth-the-wait.aspx  Furthermore, when considering an elective induction, several factors such as gravidity (number of total pregnancies), parity (number of live born children), and bishop score will be taken into account.  After making a complete assessment, you and your physician may choose to wait for natural labor or up to 41 weeks.  If you have not delivered by 41 weeks, your physician will likely suggest an elective induction.

Medical indications for early induction do exist.  These may include but are not limited to severe preeclampsia, poorly controlled gestational diabetes, intrauterine growth restriction, and complications related to multiple gestations or twin pregnancies.  In cases such as these, your physician may choose delivery prior to 39 weeks gestation for fetal or maternal benefit. Such conditions will be discussed with your physician should they arise.

Unfortunately, inductions are not always successful.  In some cases, patients fail to dilate despite all attempts.  In this case, your physician may choose to discharge you home to wait for the onset of spontaneous labor or schedule you to return again at a later date for a second attempt.  This will only be done if your membranes have not been ruptured and your fetus does not appear to be in any distress.  A second option would be to proceed with cesarean section.  Either option is acceptable and individualized after detailed discussion.  Furthermore, at times fetuses do not respond well to medical induction. The reasons for this are numerous and can also be the case with spontaneous onset of labor. However, in cases where there appears to be fetal stress, you doctor will offer cesarean section for your baby’s benefit.

Remember, if you have not labored or have had previous cesarean sections, an induction of labor will not be offered to you in most private settings.  In cases such as these, your physician will likely schedule a repeat cesarean section at 39 weeks.  If you desire to have a vaginal birth after cesarean delivery (VBAC), you will need to have this discussion with your provider at your first prenatal visit.  Practices surrounding VBAC vary among practitioners and will need to be discussed.

For more information on labor induction please look here. http://m.acog.org/For_Patients/Search_FAQs (keyword: induction)

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