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Understanding Medical Labour Induction

Updated: Dec 30, 2022


The most commonly asked questions about pregnancy and birth are the ones related to getting labour started in order to avoid a medical induction. Many pregnant people ask other mothers about their experience with induction. When I read the answers, it is surprising to me how many people have had an induction of labour, but do not actually understand the labour induction process. Myself included! It is a really hot topic with lots of controversy and misinformation.


Earlier this year I read Rachel Reed’s book “Why Induction Matters” in order to help me make informed decisions regarding induction. In the author’s note at the beginning of the book Rachel states “Women regularly contact me to ask questions about induction or to share their experience of induction. Often women are looking for information to help them understand what happened to them during their induction. They are seeking information they should have had before their induction took place”.


I couldn’t agree more! Without proper information one cannot make informed decisions or give informed consent!


Whether you have had an induction before, or you are considering accepting a recommendation to be induced, I highly recommend reading on. The information in this post is mostly taken from Rachel Reed’s book. The book itself is a fairly quick read and if you have the time, I recommend reading it yourself.


WHAT IS THE DIFFERENCE BETWEEN LABOUR INDUCTION AND AUGMENTATION?


The purpose of labour induction is to get your body to go into labour and to establish an acceptable labour pattern according to the medical guidelines and protocols.


Labour augmentation is when the same procedures are used to progress your labour rather than start it. If you have already gone into labour on your own and you receive any of these interventions then your labour has been augmented, not induced.


HOW IS LABOUR INDUCED?


Induction of Labour (IOL) is a 3 step process:

  1. Ripening the cervix

  2. Artificial Rupture of Membranes (ARM/ARoM)

  3. Oxytocin (Pitocin/Syntocinon)


Any one of these steps is capable of inducing labour. If the first step is successful in getting labour going then there is no need for the following steps. If the first 2 steps are not successful then it’s likely all 3 steps will be taken. If your cervix is already ripe, the first step may be skipped, but it is recommended that these steps should be done in this order. Medical labour induction can take 1 to 3 days to work, and it can also fail to get you into labour.


There is something called a Bishop score and it is a tool that can help you to make an informed decision about whether or not to accept an induction of labour. A Bishop score of 6 or lower indicates your body is not ready for an induction. A score of 8 or higher will get a better result with an induction.


According to Dr. Reed, having your water broken is an appropriate step in a medical labour induction, but is not appropriate in a labour augmentation. And a note about oxytocin, according to the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) “once active labor is established, oxytocin rates should be decreased or discontinued to prevent receptor down-regulation”. These are things you might want to consider when creating an induction plan.


But don’t forget, you always have the option to accept or decline any one of these steps at any point in your induction process. You also have the option to decline being induced altogether.


WHAT ARE THE OPTIONS FOR INDUCING LABOUR?


The options for labour induction exist mostly in the first step of ripening the cervix. Ripening the cervix refers to softening and opening up the cervix. This can be done using either a mechanical or medicinal method.


Mechanical methods include things like membrane sweeps and the foley catheter (balloon). Methods which physically open the cervix up. Medicinal methods include things like prostaglandin gel, or Cervidil vaginal insert.


So called “natural” induction methods are also designed to induce labour by ripening, relaxing or irritating the cervix. Midwives brew is an example of this.


Prostaglandins are the key to cervical ripening. The natural methods and mechanical methods are done in an attempt to get your body to naturally release prostaglandins to the cervical area.


In chapter 5 of Rachel Reed’s book it explains that “Prostaglandins are part of the body’s natural inflammatory response. They are responsible for increasing the blood flow to a damaged area, and summoning white blood cells that protect the body against infection”. In a mechanical ripening method, the aim is to damage the area in order to get the body to release prostaglandins to the area.


If you are interested in using a natural induction method and want some real, evidence based information, check out the Natural Labour Induction Series from Evidence Based Birth.


CONCLUSION


Overall, labour induction is more likely to work if your body is already close to going into labour on its own. When considering a labour induction it is important to be informed about all of the potential risks and benefits. Each step of the induction process has its own unique set of risks associated with it. You need to consider your own unique situation and decide for yourself which risks you are willing to take and which you are not. Other people's experience with labour induction might be helpful information for you but it is important to remember that their experience is not your experience.


Regardless of what you decided, it is important that you feel respected and supported in your decision. If you don't feel respected and supported you might need to reconsider who you have on your team.


You are the decision maker and you are the one who has to live with the outcome of these decisions. Knowledge is power. Don't give your power away by letting someone else make these decisions for you. You've got this!


~ This post is for informational purposes only and it is not intended as medical advice. The Birth House Network recommends a healthy working relationship with a healthcare provider who facilitates informed consent and respects and supports your decisions. ~


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