How can you induce a woman to go into labor, and why would a doctor induce someone instead of just letting them give birth whenever it happens naturally?

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How can you induce a woman to go into labor, and why would a doctor induce someone instead of just letting them give birth whenever it happens naturally?

In: Biology
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The body signals the uterus and cervix, etc., to start the process through hormones. One way of inducing labor is to inject those hormones or precursors into the pregnant woman. Another is to manipulate the amniotic sac to cause hormones to start releasing a bit more naturally.

There are two basic reasons for induction: risk to the mother and risk to the fetus. One common example is postterm pregnancy; the pregnancy has gone on too long. The bigger the baby, the more chance for the birth process to harm baby or mother or both, but that’s not the core reason. The mechanisms of pregnancy, like the placenta, aren’t designed to function forever, and will stop working, resulting in stillbirth. There are other reasons, but they’re ultimately about risk to mother baby.

Labor is induced by giving the pregnant woman drugs which cause the uterus to contact, which starts labor. They may also be given drugs that cause the cervix to dilate.

The reason for inducement is that there is some serious risk to either the mother or the baby. Some risks include gestational diabetes, preclampsia (high blood pressure), baby way too big or small, problems with the placenta that mean the baby can’t get proper nutrients or oxygen, or the water breaking without going into labor.

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The biggest and most common reason is because placentas have veins and arteries that age at a way faster rate than all the other blood vessels in your body. Like “old people” vessels, they become stiff and narrow, and less and less efficient at doing what they need to do to support a baby. If the placenta “dies” before the baby is born from spontaneous labour, the baby will die because it won’t be able to get the oxygen and nutrients it needs. This is the cause of a lot of stillbirths. We know that the longer a pregnancy goes on, the more likely the placenta is to “get old” and cause the baby to die. So by looking at all the data you can pinpoint the exact time in which the risk of stillbirth starts to become higher than the risk of complications from induction. At that point most drs will suggest induction. The date we use when I work is 41 3/7 days gestation or 10 days past due

The way we do inductions where I work is like this

First we assess the woman’s cervix to see if it is “ready” for labour. When someone has had a few babies before or if their body is pretty close to going into labour on it’s own the cervix becomes “soft” or “ripe”. I explain it to patients as kind of like making sure the door is unlocked before you try to open it. If the woman’s cervix isn’t ready, we place a medication inside her vagina up beside the cervix which causes cramping that softens/ripens the cervix. This often takes 12-24 hours so we usually watch people for a few hours after giving it and then send them home. If her cervix is “ready” then we admit her and start an iv and administer oxytocin which is the chemical the brain releases to cause contractions. We start at a low dose and then turn it up every 30-60 minutes to mimic how the brain releases increasing amounts of oxytocin. We monitor the baby to make sure it is not in distress as well as of course the mother. We check every 4 hours or so (or sooner if the woman is saying or showing signs that things are moving quickly) to make sure the oxytocin is working to open up her cervix. We do all the normal things to help the woman cope with labour. Eventually she will feel the urge to push and yeah etc baby happens the end

There was a large study called ARRIVAL and if showed that the risk to mom and baby after week 39 begins to increase. The risks include chance of preeclampsia and gestational diabetes developing and increase chance of c-section which has its own risk.

There are different ways to induce and it will depend on the bishop score. A bishop score looks at effacement (how thin the cervix is) dilation, if the cervix is back, middle or front, if cervix is hard, med or soft, and the baby’s station.

If the bishop score is 7 or below then the cervix needs to be ripened first otherwise the induction medicine will not work.

There are a few ways to ripening the cervix. There is prostaglandins hormone which can be oral or a vaginal insert. Prostaglandins is used to soften the cervix by the body. Prostaglandins also used for blood pressure and it is also produced during menstruation and causes contractions/cramps.

There is also the Foley ball which you need to be dilated a bit to do. The Foley is a catheter that is inserted in the cervix and blown up like a balloon. Then it puts pressure on the cervix similar to what the baby’s head will do.

There are membrane sweeps which can be done in doctors office. You need be dilated enough for doctor to fit a finger in. Then they separate the sac with the uterus. If you have a bishop score 6 or over this can increase chance of spontaneous labor but 5 or below it will not have effect more than someone who didn’t get it. A sweep may make water break so it’s not free from risk but it’s pretty low. Plus this way you will spontaneously go into labor which means baby won’t need to be on the monitor while you are in labor so you can move around more and even walk halls or take a shower etc.

If you are ripened you may go into labor on your own after cervix is soft but you may not so then pitocin will be introduced. Pitocin is a man made version of oxytocin which body produces to cause contractions it is used during active labor. It is also used in breastfeeding to cause the milk to be let down and at the same time that will cause contractions in the uterus which helps the uterus shrink to normal size. There is an open wound in uterus after birthing the placenta so the contractions also help with the healing of that.

Generally they will start pitocin on a small dose then raise the dose after a set time like every 30-60 minutes. For me they only go from 1-20 but they used to give even higher doses.

If body isn’t responding to the pitocin then they may break the waters.

In the end a c-section may be needed if labor doesn’t progress and baby or mom get stressed.

Now I will say that I went in 3 times for out patient ripenings over a week so I had 2 of the inserts which takes 12 hours each time and 8 of the pills which you get every 8 hours. During all of that my cervix went from no 50% effaced and not dilated to half a cm and 70% effaced. I would go home after each session hoping to go into spontaneous labor. Even with the best knowledge we have we don’t really know what triggers labor and birth so if a person’s body isn’t ready even the best medicine will not result in labor

At 41 weeks I went in to be fully induced. I had to start with the inserts again. About 8 hours in my water broke. When they went to take out the insert 4 hours later it was missing. It may have been dislodged when water broke but it could have been gone even later. Even with water being broken and the insert I had to wait several more hours before they started pitocin as I wasn’t ripe enough yet.

When I was on pitocin I stayed at 5 cm dilated for 8 hours so they inserted a catheter to measure the power of the contractions and determined they weren’t strong enough so they moved the pitocin to 20 (luckily was already on an epidural at that point). Then after another 6 hours or so I was 9.5 cm dilated so they actually moved the little part that wouldn’t finish dilating around the baby’s head so that I could be ready to push. In the end the baby got wedged in and I needed a c-section.

What’s more because the baby was 41 weeks she had pooped in utero so she ended up being in the NICU for 2 weeks. Which is anecdotal but supports the idea that late term increases the risk to baby. Babies are more likely to poop after 40 weeks because their bodies are ready. So she could have been “breathing” in the poop for a few days. It feels very strange to have a healthy pregnancy and a late term baby and spend time in the NICU.

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I don’t know how it exactly works in another countries.
I am a doctor from Mexico.
You question has two parts.

1) How? As some one else said before, it works via hormones, more specifically Oxitocin. Ocitocin Is a neologism made by two Greek words.

Oxi= fast and
Tokos=labor/vaginal delivery/pregnant woman just one step away from giving birth.

Sol literally means: To Fast Forward the labor.
We put it via IV in the saline solution and there is a mathematical formula to put that on a patient.

There is another wey tough, but I just don’t like it.
If you read a little bit of molecular mechanism of the labor, you will notice that is basically an inflammation chain reaction, so if you swollen the cervix that works. So some doctors just pinch the cervix with a needle or something else….. works like magic.

2) There are several situations in which you need to FF the labor, for example, some babys are ready to get out, but for some reason the mom’s body doesn’t work as expected, and after monitoring the baby you realize that is suffering inside, so your first action is to activate the normal mom’s system to pump the baby out.

Here in Mexico anyways, the overcrowded Hospitals doesn’t give you the chance to give every mom the time they deserve, so, even when mom’s fine, baby’s fine, and nothing wrong is going on, we just FF the delivery.
As you can imagine, there are other not so medical reasons to FF, for example, you’ve been in the hospital for 36 hours straight, you haven’t eat properly, you haven’t sleep properly and there is this lady who’s just came and you can not go home until she’s done delivering, so you can wait the 16 hours labor or you can just FF and in 30 minutes it will be it.

Hope this helps

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Either

1 there is a risk to the baby (compression of the umbilical cord, inadequate fetal oxygenation, or other emergency)

2 OR the mother is ‘failing to progress.’ Bodies are not perfect, and sometimes the body doesn’t continue or start labor. The risk for the baby and mother increase the longer the baby stays in there after roughly 39 weeks.

Doctors give drugs (often pictocin but im sure there’s other options) it speeds up the uterine contractions and dilation of the cervix for the baby to pass through.

Inductions are done for many reasons. The baby is more than 2 weeks late. (The bulk of the birth weight is put on in the final weeks. Waiting too long increases the potential the baby will be too big or mom too small. Increasing the risks/rates of vaginal tears or emergency c sections)

Water broke more than 24 hours ago (increasing risk of infection)

Birthing stalled out and hasn’t continued to progress.

Then there’s more superficial reasons like but I want my baby to have THIS birthrate! Or I’ve worked a 15 hour shift and this baby is coming because I’m going home.

There’s a lot of reasons and a lot of ways.

Some are medical and some are at home.

Some people are just all done being pregnant. It’s too detrimental to the mental of physical health and it’s time for baby to arrive. Baby could be in distress. The water broke and labor hasn’t started naturally and the risk if infection is too high. You’ve been pregnant over 40 weeks, or over 42 weeks which is generally considered overdue.

Castor oil, spicy foods, walking, sex, and other methods can work but aren’t reliable.

More medical methods involve Foley bulbs physically opening the cervix, or pitocin and other drugs used to trick your body into having contractions. Sweeping of the membranes or artificial rupture of the amniotic sack can start off labor.

In very rural areas planning the delivery is often required. Waiting for a natural labor to start, and then driving 40 miles to a hospital is problematic (at best) . So planning and inducing can sometimes be the only option

You’re getting a bunch of good medical answers but I think it’s also important to point out that your question seems to be predicated on the idea something happening naturally is “better.” This is a logical fallacy known as the naturalistic fallacy. Things that are natural are not necessarily better, and assuming they are is both bad logic and potentially dangerous.

Diseases and parasites are natural. The medicines that let us live health lives free of them are not. Air conditioning and central heating are not natural, but they save lives every year when weather becomes extreme. Nature is not all good. It has lots of awful and painful things associated with it. Assuming natural things are better will lead you to bad conclusions, as evidenced by all the great answers in this thread.