What is labor?
Labor happens when the uterus begins to contract regularly and strongly, causing the cervix to dilate. Active labor refers to rapid, progressive cervical dilation, usually after the cervix has “ripened” to 4 cm or more. When the cervix is 10 cm dilated (full dilation), pushing can begin. Delivery of the placenta is the last stage of labor, usually occurring very rapidly.
What is an induction of labor?
Babies that come after 37 weeks of pregnancy are said to be born at term. Most babies are born after a woman begins to experience natural labor between 37 and 42 weeks of pregnancy. Sometimes, however, labor is brought on with medications rather than awaiting spontaneous labor. This is called an induction of labor.
Induction of labor may take much longer to deliver a baby than it does for naturally laboring women. This is especially true for women who will be delivering their first baby. The reason is because the cervix is frequently unprepared for the strong uterine contractions of active labor. Such “unfavorable” cervixes need to be ripened slowly by the use of vaginal suppositories like Cytotec or Cervidil, or by dilators like the Foley balloon catheter. All the methods used for cervical ripening share the same general principle: they mimic the body’s natural chemical processes to cause mild uterine cramping and softening/opening of the cervix.
What happens when labor begins?
Once the cervix is more “favorable” or dilated greater than 2-3 centimeters, the health care provider may begin a medication called Pitocin to stimulate contractions. Pitocin is given through an IV and is similar to one of the natural hormones that make the uterus contract. At first you will get a very low dose. The dose will be increased slowly until the contractions reach the desired strength and frequency. Your provider will adjust and continue the Pitocin until the baby is born. If you start contracting well enough on your own, or your baby’s heart rate appears worrisome, the medicine may be turned off. During the process of labor, the doctor may break the bag of water surrounding the baby. This may speed the process of labor by stimulating stronger contractions, but don’t worry; this does not cause any pain to you or the baby.
Why induce?
While most inductions result in the vaginal delivery of a healthy baby, there is, in fact, a higher chance that induction of labor will lead to a cesarean birth. For this reason, induction of labor is usually reserved for times when delivery poses less risk to the mother or baby than does continuing the pregnancy. Certain medical conditions like preeclampsia, poor fetal growth, or low amniotic fluid are some examples. The lack of spontaneous labor by 42 weeks of pregnancy is another reason. Sometimes, social factors, such as living far distances from the hospital, are involved with scheduling an induction of labor after 39 weeks of gestation.
If you feel that you require, or your health care provider recommends an induction of labor, don’t be afraid to discuss these risks and benefits with them. The best decisions are those made together after you have had time to ask questions and make plans.
by: Mark Alanis, M.D. & Amelia Rowland, CNM
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