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What does labour induction mean?
This is the process of starting off labour by initiating uterine contractions. The process may include the initial preparation of the neck of the womb (cervix) to facilitate its dilatation (opening) in labour.
How does this differ from labour augmentation?
Labour augmentation is carried out when the woman is already in labour but where the progress of labour has been unsatisfactory. It is therefore an act of accelerating the process and never involves cervical preparation.
When is labour induction considered necessary?
Indications for inducing labour are many and varied.
It may be deemed necessary to intervene and bring about labour and delivery for fetal reasons and, less commonly, for maternal reasons.
If there is sufficient concern about the baby’s well-being, labour may be induced. This may be because of growth restriction, recurrent vaginal bleeding (antepartum haemorrhage), maternal diabetes or infection.
Are there any other fetal indications for inducing labour?
Yes. Prolonged rupture of membranes is regarded as a risky state, as infection may ascend into the uterine cavity and affect the baby. It may be decided therefore that the baby will fare better outside the womb. In the case of a Rhesus negative mother who is carrying antibodies, if the fetus is seen to be affected by the antibodies, delivery may be deemed to be the best way forward and labour could be induced.
In multiple pregnancy, labour may be induced because one or the other twin is not doing too well.
"Unstable lie" is another indication. If the baby is changing position all the time, labour may be induced as a "stabilizing" procedure to try to prevent an otherwise unnecessary caesarean section.
What about a prolonged pregnancy?
This is one of the most common indications for labour induction. When the pregnancy continues beyond the expected date of delivery mark (40 weeks), most obstetricians will adopt a conservative wait-and-see policy while monitoring the well-being of both the mother and the fetus.
If all remains well, most will advocate no intervention until at some point ten to fourteen days after the "due date".
Induction of labour is advised at or soon after this point.
Why is maternal diabetes an indication for inducing labour?
If for any reason, insulin-dependent diabetes is not well controlled in pregnancy, the fetus is clearly at risk and fetal demise is a real possibility. Labour may be induced when doctors are reasonably confident of fetal survival outside the womb.
Diabetes that starts during pregnancy (gestational diabetes) is normally not an indication for inducing labour.
Well-controlled insulin-dependent diabetes is also a less clear-cut indication. Many experts argue that, in such cases, intervention in the form of labour induction is not necessary, at least not before the due date. This remains a subject of debate even among experts.
Is a large fetal size an indication for induction of labour?
This is another controversial indication. Some obstetricians argue that after thirty-seven weeks, when the fetus is mature, labour may be induced before a large baby gets bigger. The argument is that you will prevent a potentially difficult delivery and probably a caesarean section. Evidence that this is true is lacking.