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Labor induction is a method of artificially or prematurely stimulating childbirth in a woman.[1]

Contents

Indications

Common causes for induction include:

Methods of induction

Methods of inducing labour include medication and processes.

If an induction causes complications during labor, a Caesarean section is almost always conducted. An induction is most likely to result in successful vaginal delivery when a woman is close to or in the early stages of labor. Signs of pending labor may include softening of the cervix, dilation and increasing frequency or intensity of contractions. The Bishop score may be used to assess the advisability of induction, and is based on such factors.

Medication

Processes

  • "Membrane sweep", also known as membrane stripping, or "stretch and sweep" in Australia and the UK - during an internal examination, the midwife moves her finger around the cervix to stimulate and/or separate the membranes around the baby from the cervix. This causes a release of prostaglandins which can help to kick-start labour.
  • Artificial rupture of the membranes (AROM or ARM) ("breaking the waters")

When to induce

Until recently, the most common practice has been to induce labor by the end of the 42nd week of gestation. This practice is still very common. Recent studies have shown an increasing risk of infant mortality for births in 41st and particularly 42nd week of gestation, as well as a higher risk of injury to the mother and child [6]. The recomended date for induction of labor has therefore been moved to the end of the 41 week of gestation in many countries including Sweden and Canada.

Criticisms of induction

  • Induced labour tends to be more intense and painful for the woman. This can lead to the increased use of analgesics and other pain-relieving pharmaceuticals.[7] These interventions have been said to lead to an increased likelihood of caesarean section delivery for the baby.[8] However, studies into this matter indicate that induction has no effect on the rates of caesarean section[9]. Two more recent studies have shown that induction may increase the risk of caesarean section if performed before the 40th week of gestation, but has no effect or actually lowers the risk if performed after the 40th week.[10][11]
  • Some feel that doctors show increasing propensity toward induction simply for personal convenience or to relieve load on hospital facilities. "[Induction] enables doctors to practice daylight obstetrics," says Dr. Marsden Wagner, a neonatologist who served for 15 years as a director of women's and children's health in industrialized countries for the World Health Organization. "It means that as a doctor, I can come in at 9 a.m., give you the pill, and by 6 p.m. I've delivered a baby and I'm home having dinner." [12] A growing number of pregnant women are opting to have induced labor, according to a 12-year study of women in Illinois that was published in the September 2008 issue of the journal Medical Care. The researchers say that the consequences are not clear, but some believe that elective inductions will be done for convenience reasons.[13]

See also

References

  1. ^ Houghton Mifflin Company, (2006): The American Heritage Dictionary.
  2. ^ Allahyar,J. & Galan, H. "Premature Rupture of the Membranes."; also American College of Obstetrics and Gynecologists.
  3. ^ Li XM, Wan J, Xu CF, Zhang Y, Fang L, Shi ZJ, Li K (March 2004). "Misoprostol in labour induction of term pregnancy: a meta-analysis". Chin Med J (Engl) 117 (3): 449-52. PMID 15043790. 
  4. ^ Clark K, Ji H, Feltovich H, Janowski J, Carroll C, Chien EK (May 2006). "Mifepristone-induced cervical ripening: structural, biomechanical, and molecular events". Am. J. Obstet. Gynecol. 194 (5): 1391–8. doi:10.1016/j.ajog.2005.11.026. PMID 16647925. 
  5. ^ Kelly AJ, Kavanagh J, Thomas J (2001). "Relaxin for cervical ripening and induction of labour". Cochrane Database Syst Rev (2): CD003103. doi:10.1002/14651858.CD003103. PMID 11406079. 
  6. ^ Tim A. Bruckner et al, Increased neonatal mortality among normal-weight births beyond 41 weeks of gestation in California, October 2008, American Journal of Obstetrics and Gynecology, [1]
  7. ^ Vernon, David, Having a Great Birth in Australia, Australian College of Midwives, 2005, ISBN 0-9751674-3-X
  8. ^ Roberts, Tracy, Peat, 2000 Rates for obstetric intervention among private and public patients in Australia: population based descriptive study Christine L Roberts, Sally Tracy, Brian Peat, "British Medical Journal", v321:140 July 2000
  9. ^ Yeast, John D., Induction of labor and the relationship to caesarean delivery: A review of 7001 consecutive inductions., March 1999, American Journal of Obstetrics and Gynecology, [2]
  10. ^ Caughey AB, Nicholson JM, Cheng YW, Lyell DJ, Washington E. Induction of labor and caesarean delivery by gestational age. Am Journal of Obstetrics and Gynecology . 2006;195:700-5.[3]
  11. ^ A Gülmezoglu et al, Induction of labour for improving birth outcomes for women at or beyond term,2009,The Cochrane Library, [4]
  12. ^ Uterine Ruptures Associated with Prostaglandin Used with RU486 Accessed 20 Feb 2008
  13. ^ Pregnant Illinois Women Increasingly Choosing Induced Labor Newswise, Retrieved on September 18, 2008.

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