Vaginal birth

• Most women give birth through the vagina (birth canal)
• Labor occurs in three stages and feels unique to everyone.
• If you need an induction, have it when you’re full term.

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For some women, labor is slow to begin. In these cases, health care providers may give the woman medications or use other methods to bring on labor. This is called "inducing labor" or "labor induction."

What is labor?
A woman is in labor when she has short, regular contractions of the uterus. These contractions lead to changes in her cervix. The cervix is the narrow, outer end of the uterus. During labor, the cervix becomes softer and shorter, thins out, and then opens before birth. During delivery, the baby comes through the cervix into the vagina (birth canal).

Why is labor induced?
Here are some common reasons for inducing labor:

• The pregnancy has lasted more than 42 weeks. The placenta usually stops functioning well enough after 42 weeks for the baby to get adequate nutrition and oxygen. The placenta is the baby's lifeline. It transfers oxygen and nutrients from the pregnant woman to the fetus.
• The pregnant woman has high blood pressure caused by pregnancy.
• The woman has an infection in her uterus (womb).
• The woman's water has broken, but contractions haven't begun.
• The woman has health problems, such as diabetes, that could harm her or her baby.
• A growth problem is causing the baby to be small.

How Is labor induced?
Here are four ways used to induce labor.

Separating the amniotic sac from the wall of the uterus (also called "stripping the membranes"): The amniotic sac is the lining inside the uterus (womb) that contains the baby. The health care provider gently puts a gloved finger through the woman's cervix. Using the same gloved finger, the provider then separates the sac from the uterine wall. When this is done, the woman may feel some cramping or have some spotting. This procedure may be done in the provider's office.

Ripening the cervix: The provider places a small tablet or suppository in the vagina up against the cervix. (A suppository is a medication that melts once it is in place). This helps to soften and thin the cervix. After receiving the medication, the woman may start to have gentle labor contractions.

Giving the woman a drug to start contractions: A commonly used drug is oxytocin (Pitocin). It has been available since the 1940s. A woman's body makes oxytocin naturally. The synthetic form (Pitocin) may be given through a small tube in the woman's arm called an IV tube. (The initials IV stand for "intravenous," which means "within a vein.") The drug may make the woman's contractions very strong.

Breaking the woman's water (also called "rupturing the membranes"): The health care provider uses a small instrument to break the sac that contains the baby. The woman usually doesn't feel pain. But she may feel a warm gush of fluid.

The health care provider may use one or more of these techniques to induce labor.

What can the pregnant woman expect
In most cases, induction goes well, and the woman delivers her baby through the birth canal (vaginally). An induction can take a few hours or as long as two or three days. It depends on how the woman's body responds to the treatment she receives. Typically, induction takes longer when:

• The woman is pregnant for the first time.
• The baby is not full term.

Remember:

• Every pregnancy is different. Having an induction isn't a sign of failure. It may be the best thing for your health and the health of your baby.
• Before you go to the hospital, eat only light foods. Examples: Soup, Jell-O. The medicines used for inducing labor may upset your stomach.
• The medicines you receive might cause very strong contractions.
• Ask the medical staff if you need help for pain.

Side effects and risks
Like any medical procedure, induction has side effects and risks. Some of them are described here.

• Oxytocin can make labor contractions very strong and lower the baby's heart rate. Throughout an induction, medical staff carefully monitor the baby's heart rate. Adjusting the dosage of the drug can decrease the strength of the contractions and reduce the effect on the baby's heart.
• Women who have inductions and their babies are at increased risk of infection.
• The baby may have problems with the umbilical cord. For example, the cord may slip into the vagina before the baby does. This is more likely to occur if the baby is breech (feet or bottom first, instead of head first). Also, the cord may be compressed, decreasing the baby's oxygen supply. These problems can be serious for the baby.
• Sometimes treatment doesn't work, and the woman has to have a cesarean delivery.
• Uterine rupture is a rare complication of induction. A rupture is a tear in the uterus. This can cause serious bleeding. Women who have previously had a cesarean section are at increased risk of uterine rupture; c-sections leave a scar in the uterus.

The risk of late preterm birth
Inductions may contribute to the growing number of babies who are born "late preterm," between 34 and 36 weeks gestation. While babies born at this time are usually considered healthy, they are more likely to have medical problems than babies born a few weeks later at full term (37-42 weeks).

A baby's lungs and brain mature late in pregnancy. Compared to a full-term baby, an infant born between 34 and 36 weeks gestation is more likely to have problems with:

• Breathing
• Feeding
• Maintaining his or her temperature
• Jaundice 

It can be hard to pinpoint the date your baby was conceived. Being off by just a week or two can result in a premature birth. This may make a difference in your baby's health. Keep this in mind when scheduling an induction.

The bottom line
Induction is sometimes needed to protect the health of both the mother and the baby. But it also has risks. The pregnant woman needs to understand both the benefits and risks. These questions may be useful when you talk to your provider:

If your provider recommends induction before 39 weeks:

• Is there a problem with my health or the health of my baby that may make me need to have my baby early?
• Can I wait to have my baby closer to 40 weeks?

About induction:

• Why do you need to induce my labor?
• How will you induce my labor?
• Will inducing labor increase the chance that I'll need a c-section?

July 2008