Induction of labor is sometimes necessary if the continuation of pregnancy poses a threat to the he alth of the mother or baby, or when the due date has passed and the baby is still not going to be born. Labor induction is effective and safe, it enables natural delivery. What are the methods of induction of labor?
Induction of labor( induction of laboror induction of uterine contraction by artificial means) was used already in antiquity. Women who reported pregnancy, but still could not wait for a baby, were advised, inter alia, sex. It induced not only the desired contractions (during caresses, oxytocin is secreted, a hormone necessary for the contraction of the uterine muscle), but also accelerated - thanks to substances contained in the semen - the opening of the cervix. It was not until the beginning of the 20th century that the role of oxytocin in childbirth was discovered. And the role of prostaglandins, contained in male sperm, to which the cervix becomes sensitized after the 38th week of pregnancy - even later. Today we are able to obtain these compounds in optimal quantity, chemical composition and concentration in laboratory conditions. This makes it possible to use oxytocin and prostaglandins in the delivery room. With their help, effective induction is also carried out before the planned delivery date, when early termination is necessary for the he alth of the mother or child.
Indications for induction of labor
The main indications for inducing labor are:
- transferred pregnancy (lasting more than 42 weeks)
- future mom's hypertension
- chronic kidney disease in pregnant women
- diabetes
- premature drainage of amniotic fluid,
- inhibition of intrauterine growth of the fetus
Sometimes doctors also decide to use induction at the time of delivery, in the absence of pregnancy complications and the correct structure of the pelvis, and with the correct positioning of the fetus.
Labor induction: pros and cons
Its supporters argue that it is better to terminate a pregnancy on an optimal date than wait for the appearance of any risk features, the risk of which increases over time. Opponents emphasize, however, that inducing labor is an activity that carries a certain risk and that it does not make sense to help nature, and that it increases the risk of complications and pregnancy termination with caesarean section. The decision to induce laboror shortening its duration, as well as the choice of method, the doctor should discuss with the patient. It is worth asking the obstetrician about this before you find yourself in the delivery room. Then you will be able to evaluate the pros and cons of induction. Remember, however, that during childbirth sometimes everything happens very quickly and the situation changes (including indications on how to terminate the pregnancy). It is best to rely on the doctor's knowledge and experience. Importantly, it may be necessary to accelerate the maturation of the cervix before labor is induced.
Induction of labor: oxytocin
Since the beginning of the 20th century, when the importance of oxytocin was discovered in labor, it has been widely used in obstetrics. It helps not only to strengthen the contractile action during labor, but also to induce it. Appropriately diluted hormone is administered in a drip or a special infusion pump at a rate that allows for the safe development of labor. A significant disadvantage of this method is the possibility of causing strong and painful contractions, and an advantage: a significant shortening of the labor time. It must be remembered that pain resistance is an individual matter and natural, spontaneous contractions are also perceived by many women as unbearable pain. These ailments can be significantly alleviated by anesthesia, and induction is not a contraindication to its use. Sometimes, before the actual induction of labor, the so-called oxytocin test. It consists in the administration of a low dose of oxytocin, which induces uterine contractions, while at the same time controlling the child's condition (using CTG). This test allows you to assess the condition of the fetus and its safety during labor, response to contractions and oxytocin itself. The purpose of the test is not to induce labor, although it often ends this way. The oxytocin test is mainly diagnostic, because the use of oxytocin can sometimes lead to disturbances in the pulse and heart function, an allergic reaction or hypoxia (e.g. in insufficient placenta). The oxytocin test allows you to reduce the risk of complications and make a decision in advance, e.g. about caesarean section. Contraindications to the use of oxytocin:
- prematurity and other fetal problems that pose a threat to the fetus during vaginal delivery
- overly tense uterus
- surgeries performed by the mother on the uterine muscle
- overstretched uterus (e.g. in numerous multiparous women, during multiple pregnancy)
- insufficiently mature cervix.
Induction of labor: AMNIOTOMY
It is one of the oldest methods of labor induction. It is based on a puncture of the fetal bladder, which usually leads to the active phase of labor. In the membranesduring pregnancy, because prostaglandins accumulate, which accelerate the labor. The amniotomy is performed using a special amniotome, a ball, long injection needle or Kocher forceps under visual control (gynecological specula, amnioscope) or by inserting the tool down the finger of the examiner. The procedure is completely painless. After bladder perforation, labor should be completed within 12 hours due to the risk of ascending infection. A complication of this method of labor induction may be umbilical cord prolapse or bleeding from a torn vessel in the membranes of the membranes. The main contraindications for an amniotomy are:
- no conditions for vaginal delivery (e.g. unprepared cervix, narrowed pelvis, incorrect position of the fetus)
- fronting the child's limbs
- vaginal infection
- polyhydramnios
- premature birth
- situation where the frontal part of the child does not have close contact with the mother's pelvis.
Induction of labor: LEFT
So-called high enema is still considered one of the most effective and safe means of inducing or enhancing contractions in he althy women. However, it is used less and less because it is poorly tolerated, especially emotionally, by future mothers. Sometimes, however, it is worth considering its advantages, or at least considering the use of a glycerin suppository before childbirth, in order to effectively defecate. Residual feces may be an obstacle to the child's free passage through the birth canal, and in the event of uncontrolled defecation during labor, it may pose a risk of possible infectious complications in the newborn. Often, nature solves this problem by itself, as diarrhea can be one of the symptoms of the natural birth process. CHILD STIMULATION You (or with the help of your partner) can induce or speed up the birthing action. Nipple stimulation triggers contractile activity as a result of the release of natural oxytocin. If your uterus has so far reacted strongly to the caresses of the breasts (in some women their stimulation may even trigger an orgasm), this method has a greater chance of success.
When labor induction fails
Regardless of the method, induction may fail, i.e. labor may not commence or complications may arise which are a contraindication to vaginal delivery. Therefore, induction, especially in the event of a threat to the he alth of the mother or the child, requires intensive medical supervision and constant preparation for a possible cesarean section.
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