Induction of Labour
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Extracted from Survival Guide to Midwifery, 2nd Edition (2012) Diane M. Fraser and Margaret A. Cooper, Oxford; Churchill Livingstone: 2012. Courtesy Elsevier
Induction of labour is an intervention to stimulate uterine contractions before the onset of spontaneous labour.
Induction is indicated when the benefits to the mother or the fetus outweigh those of continuing the pregnancy. These include:
If delivery is imperative, it should be effected by caesarean section.
Methods of inducing labour
Before prescribing prostaglandin, assess cervix using the Bishop's score (See Bishop's score). Prostaglandin preparations are available as gels, tablets or controlled-release pessaries. They are inserted close to the cervix, within the posterior fornix of the vagina. Fetal heart and uterine contractions should be monitored for 30-60 minutes thereafter.
Sweeping or stripping of membrane
Sweeping the membranes can be an effective method of inducing labour in an uncomplicated pregnancy. During a vaginal examination, the clinician inserts a finger through the cervical os, and using a sweeping or circular movement, releases the fetal membranes from the lower uterine segment. The woman should be made aware that this procedure may cause some discomfort and bleeding.
Anmionotomy is the artificial rupture of the fetal membranes (ARM) resulting in drainage of liquor. It is performed to induce labour when the cervix is favourable, or during labour to augment contractions. Amniotomy is also carried out to visualise the colour of the liquor or to attach a fetal scalp electrode for continuous electronic monitoring of the fetal heart rate.
Oxytocin is used in conjunction with ARM and may be commenced at the same time or after a delay of several hours. It is administered intravenously via a pump. The aim should be to use the lowest dose required to maintain effective, well-spaced contractions (maximum 3 - 4 contractions every 10 minutes). Oxytocins should not be started within 6 hours of administration of prostaglandins. Side effects include hyperstimulation of the uterus, which could cause fetal hypoxia and uterine rupture; water retention; prolonged use may contribute to uterine atony postpartum.
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National Institute for Health and Care Excellence. (2008) Inducing labour. Clinical guideline 70. Available at: https://www.nice.org.uk/guidance/CG70
World Health Organization (2011). WHO recommendations for induction of labour: RHL review. The WHO Reproductive Health Library; Geneva: World Health Organization. Available at: http://apps.who.int/rhl/pregnancy_childbirth/induction/guidelines_goonewardeneme_com/en/