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Labor induction
ICD-9-CM73.0-73.1

Labor induction is the artificial stimulation of childbirth. Induction performed without medical indications is termed elective induction of labor. Labor induction is suggested by physicians when waiting for natural labor to proceed is harmful to either the infant or the mother. Methods of inducing labor include pharmacological medications, physical approaches and natural approaches.

Medical uses[edit]

Commonly accepted medical indicators for induction include:

Methods of induction[edit]

Medication[edit]

Mechanical and physical approaches[edit]

  • "Membrane sweep", also known as membrane stripping, or "stretch and sweep" in Australia and the UK – during an internal examination, the practitioner stimulates the cervix to separate the membranes around the baby from the cervix. This causes a release of prostaglandins which can help to kick-start labor.
  • Artificial rupture of the membranes (AROM or ARM) ("breaking the waters").
  • Extra-amniotic saline infusion (EASI),[6] in which a Foley catheter is inserted into the cervix and the distal portion expanded to dilate it and to release prostaglandins. There is no direct effect on the uterus.

When to induce[edit]

There contradicting results found in the outcomes associated with labor induction. The American Congress of Obstetricians and Gynecologists has recommended against elective induction before 41 weeks if there is no medical indication and the cervix is unfavorable.[7] Induction of labor in those who are either at or after term improves outcomes for the baby and decreases the number of C-sections performed.[8] However, recent studies contradict this view. One recent study indicates that labor induction at term or post-term reduces the rate of caesarean section by 12%, and also reduces fetal death.[9] On the other hand, other studies have shown that non-indicated, elective inductions before the 41st week of gestation are associated with an increased risk of caesarean section.[7] Randomized clinical trials have not been used to study this question. It has been found that women who undergo labor induction without medical indicators are not predisposed to cesarean sections.[10] Doctors and patients should have a discussion of risks and benefits when considering an induction of labor in the absence of an accepted medical indiction.[7]

A Bishop Score is used to determine the odds of having a vaginal delivery after labor induction. However, recent research has questioned the relationship between the Bishop score and a successful induction, finding that a poor Bishop score actually may improve the chance for a vaginal delivery after induction.[9] A Bishop Score is done to assess the progression of the cervix prior to an induction. In order to do this, the cervix must be checked to see how much it has effaced, thinned out, and how far dilated it is. The score goes by a points system depending on five factors. Each factor is scored on a scale of either 0-2 or 0–3, any score that adds up to be less than 5 holds a higher risk of delivering by cesarean section.[11]

Risks of Inductions[edit]

Neonatal Risks[edit]

Newborns birthed earlier than 39 weeks have higher rates of morbidity due to respiratory problems.[12] Higher rates of NICU admission in gestational ages 37-38 are observed as compared to those born after 39 weeks. [12] In women carrying their first child, cesarean sections decrease the occurrence of birth asphyxia, trauma, and meconium aspiration. Secondary respiratory distress and pulmonary hypertension is increased with cesarean sections. [13] Inducing labor before 39 weeks in the absence of a medical indication, like hypertension, IUGR, or pre-eclampsia, increases the risk of complications with respiration, infection, feeding, jaundice, neonatal intensive care unit admissions, and perinatal death.[14] During 41st week of gestation, infant mortality and maternal risk of injury is increased. [15] Due to the increasing risks of advanced gestation, induction appears to reduce the risk for cesarean delivery after 41 weeks gestation and possibly earlier.[9][16]

Maternal Risks[edit]

Labor inductions can lead to an increased likelihood of caesarean section delivery for the baby.[17] Studies in this field show contradicting results. One study indicated that while, overall caesarean section rates from 1990–1997 remained at or below 20%, elective induction was associated with a doubling of the rate of caesarean section .[18] Another study showed that elective induction in women who were not post-term increased a woman's chance of a C-section by two to three times.[19] A more recent study indicated that induction may increase the risk of caesarean section if performed before the 40th week of gestation, but it has no effect or actually lowers the risk if performed after the 40th week.[20][21]

Postpartum hemorrhage is a common maternal outcome of induced labor with both oxytocin or prostaglandin. [22] Uterine hyperstimulation increases the potential risk of fetal distress. Umbilical cord prolapse can result in still-birth as well as a severe damage in the oxygen supply to the fetus in distress. The prevalence of obesity in women plays an important role in the use of labor inductions for preventative measures. Labor induction as well as maternal age is the prime risk factor to a developing amniotic fluid embolism. [23]

Global Trends[edit]

There is an overall increase in labor inductions in the world but rates vary in different regions. In the United States and the United Kingdom, a fifth of all births are delivered by elected labor inductions.[24] Elected early term inductions have tripled in the US with emphasis on the extreme increase in Non-Hispanic White women that did not experience medical indicators to induce labor. [25]. In Latin America, approximately 11% of all births were induced. [26] In Africa, the rates are even lower. The lack of standardized technology in developing countries may contribute to the lower rates.

Elective Induction of Labor[edit]

Reasons[edit]

As mentioned in The Business of Being Born, many physicians create an intimate relationship with their pregnant patients in order to prepare them for the delivery. Since birth is spontaneous and unplanned, women might choose to induce labor to feel most comfortable in the presence of the same physician that prepared them for this experience. The financial burden of staying in the hospital for more than the necessary amount can be another reason to elect to induce labor.

Concerns[edit]

Induced labor may be more painful for the woman.[27] This can lead to the increased use of analgesics and other pain-relieving pharmaceuticals.[28] Epidural analgesia is used most commonly for pain management. The most recent reviews on the subject of induction and its effect on Cesaerean section indicate that there is no increase with induction and in fact there can be a reduction.[9][29]

Non-medical interventions[edit]

Some women choose not to induce without medical indicators and resort to more natural remedies to increase the progression of labor. Such approaches are supported by limited research and are not guaranteed.

  • Breast stimulation has been proven to induce labor due to the natural release of oxytocin. [30]
  • Acupuncture is believed to direct energy and blood flow towards the bottom half of the mother's body. Based on a comprehensive literature review, there is a low risk incidence of side effects after several sessions of acupuncture. [31]
  • Castor oil, a bowel stimulant, is theorized to promote uterine contractions. Even though, a clinical trial found no adverse maternal or neonatal outcomes to using castor oil in inducing labor, there is no evidence that castor oil is effective in inducing labor. [32]

See also[edit]

References[edit]

  1. ^ Allahyar,J. & Galan, H. "Premature Rupture of the Membranes."; also American College of Obstetrics and Gynecologists.
  2. ^ Li XM, Wan J, Xu CF, Zhang Y, Fang L, Shi ZJ, Li K (March 2004). "Misoprostol in labor induction of term pregnancy: a meta-analysis". Chin Med J (Engl). 117 (3): 449–52. PMID 15043790.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  3. ^ Budden, A; Chen, LJ; Henry, A (Oct 9, 2014). "High-dose versus low-dose oxytocin infusion regimens for induction of labour at term". The Cochrane database of systematic reviews. 10: CD009701. PMID 25300173.
  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.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  5. ^ Kelly AJ, Kavanagh J, Thomas J (2001). "Relaxin for cervical ripening and induction of labor". Cochrane Database Syst Rev (2): CD003103. doi:10.1002/14651858.CD003103. PMID 11406079.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  6. ^ Guinn, D. A.; Davies, J. K.; Jones, R. O.; Sullivan, L.; Wolf, D. (2004). "Labor induction in women with an unfavorable Bishop score: Randomized controlled trial of intrauterine Foley catheter with concurrent oxytocin infusion versus Foley catheter with extra-amniotic saline infusion with concurrent oxytocin infusion". American Journal of Obstetrics and Gynecology. 191 (1): 225–229. doi:10.1016/j.ajog.2003.12.039. PMID 15295370.
  7. ^ a b c American Congress of Obstetricians and Gynecologists, "Five Things Physicians and Patients Should Question", Choosing Wisely: an initiative of the ABIM Foundation, American Congress of Obstetricians and Gynecologists, retrieved August 1, 2013, which cites
  8. ^ Mishanina, E; Rogozinska, E; Thatthi, T; Uddin-Khan, R; Khan, KS; Meads, C (Jun 10, 2014). "Use of labour induction and risk of cesarean delivery: a systematic review and meta-analysis". CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne. 186 (9): 665–73. PMID 24778358. {{cite journal}}: Missing pipe in: |journal= (help)
  9. ^ a b c d Ekaterina Mishanina et al., "Use of labour induction and risk of cesarean delivery: a systematic review and meta-analysis", April 2014, Canadian Medical Association Journal, [1]
  10. ^ Heinberg EM, Wood RA, Chambers RB. Elective induction of labor in multiparous women. Does it increase the risk of cesarean section? 2002. J Reprod Med. 47(5):399-403.
  11. ^ Doheny, K. (2010, June 22). Labor Induction May Boost C-Section Risk. HealthDay Consumer News Service. Retrieved from EBSCOhost.
  12. ^ a b Jensen, Jr; White, Wm; Coddington, CC (2013). "Maternal and Neonatal Complications of Elective Early-Term Deliveries". Mayo Clinic Proceedings. 88 (11): 1312–1317. doi:10.1016/j.mayocp.2013.07.009.
  13. ^ Ramachandrappe, Ashwain; Jain, Lucky (2008). "Elective Cesarean Section: It's Impact on Neonatal Respiratory Outcome". Clinical Perinatology. 35 (2): 373. doi:10.1016/j.clp.2008.03.006.
  14. ^ "Doctors To Pregnant Women: Wait At Least 39 Weeks". 2011-07-18. Retrieved 2011-08-20.
  15. ^ 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, [2]
  16. ^ Caughey, AB; Sundaram, V; Kaimal, AJ; Gienger, A; Cheng, YW; McDonald, KM; Shaffer, BL; Owens, DK; Bravata, DM (Aug 18, 2009). "Systematic review: elective induction of labor versus expectant management of pregnancy". Annals of internal medicine. 151 (4): 252–63, W53-63. doi:10.7326/0003-4819-151-4-200908180-00007. PMID 19687492.
  17. ^ 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
  18. ^ 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, [3]
  19. ^ Kathleen R. Simpson and Kathleen E. Thorman, "Obstetric 'Conveniences' Elective Induction of Labor, Cesarean Birth on Demand, and Other Potentially Unnecessary Interventions," Journal of Perinatal and Neonatal Nursing 19, no. 2 (2005):134–44
  20. ^ 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.[4]
  21. ^ A Gülmezoglu et al, Induction of labor for improving birth outcomes for women at or beyond term,2009,The Cochrane Library, [5]
  22. ^ Khireddine, Imane; Le Ray, Camille; Dupont, Corinne; Rudigoz, Rene-Charles; Bouvier-Colle, Marie-Helene (2013). "Induction of Labor and Risk of Postpartum Hemorrhage in Low Risk Parturients". Public Library Of Science. 8 (1): e54858. doi:10.1371/journal.pone.0054858.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  23. ^ Stolk, Keon (2012). "Severe maternal morbidity and mortality from amniotic fluid embolism in the Netherlands". ACTA Obstetricia et Gynecologia. 91: 991–995.
  24. ^ "ACOG Practice Bulletin No. 107: Induction of Labor". Obstetrics and Gynecology. 114 (2): 386–397. 2009. doi:10.1097/AOG.0b013e3181b48ef5.
  25. ^ Murthy, Karna; Grobman, William; Lee, Todd; Holl, Jane (2011). "585: Racial/Ethnic Differences in Labor Inductions at Early-Term Gestation". American Journal of Obstetrics and Gynecology. 204 (1): S233.
  26. ^ Bukola, Fawole; M'Mimunya, Machoki; Jean-Jose, Wolomby; Kidza, Mugerwa; Isilda, Neves (2012). "Unmet Need For Induction of labor in Africa: a secondary analysis from the 2004-2005 WHO global Maternal and Perinatal Health Survey". BioMed Central. 12: 722.
  27. ^ National Institute for Health and Clinical Excellence, "CG70 Induction of labour: NICE guideline", [6] July 2008, retrieved 2012-04-10
  28. ^ Vernon, David, Having a Great Birth in Australia, Australian College of Midwives, 2005, ISBN 0-9751674-3-X
  29. ^ Caughey A. (8 May 2013). "Induction of labour: does it increase the risk of cesarean delivery?". BJOG. 121 (6): 658–661. doi:10.1111/1471-0528.12329. {{cite journal}}: |access-date= requires |url= (help)
  30. ^ Jhirad, A; Vago, T (1973). "Induction of Labor by Breast Stimulation". Obstetrics and Gynecology. 41 (3): 347–350.
  31. ^ Lim, Chi Eung; Wilkinson, Jenny; Wong, Wu Shun; Cheng, Lisa (2009). "Effect of Acupuncture on Induction of Labor". The Journal of Alternative and Complementary Medicine. 15 (11): 1209–1214. doi:10.1089=acm.2009.0100. {{cite journal}}: Check |doi= value (help)
  32. ^ Boel, Machteld Elisabeth; Lee, Sue Jean; Rijken, Marcus; Paw, Moo Koo (2010). "Castor Oil for Induction of Labor: Not Harmful, Not Helpful". Obstetrical & Gynecological Survey. 65 (2): 77–78. doi:10.1097/01.ogx.0000368137.31846.18.

External links[edit]


Category:Childbirth Category:Obstetrical procedures

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