Definition of "Labor induction"

Last modified: 6 months



Labor induction (induction of labor, IOL) is artificially stimulating childbirth.

Patient information

What is labor induction?
It's when you want to bring about childbirth, without waiting for nature to run it's course. You do something to help stimulate it.

Methods
  • Mechanical approaches, including:
    • Membrane sweeping (aka membrane stripping, stretch and sweep), where during an internal exam, the Dr moves their finger to separate the membranes around the baby (amniotic sac), from the cervix (mouth of the uterus). This causes a release of hormones, which may soften the cervix, and prepare the uterus to contract. Contractions may help the cervix open
    • ARM (artificial rupture of membranes)
    • Extra-amniotic saline infusion, where a Foley catheter is inserted into the cervix, and the distal portion with a baloon is expanded to dilate the cervix, to induce it to, itself release prostaglandins
    • Intrauterine catheters, which compress the cervix mechanically to generate release of prostaglandins in local tissues
  • Medications, including:
    • Prostaglandin, administered intravaginal, endocervical, or extra-amniotic, including either:
      • Dinoprostone (prostaglandin E2, product name Cervidil, Prostin)


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      • Misoprostol (prostaglandin E1 analog), with Dinoprostone having most evidence behind it
    • Oxytocin (synthetic), administered IV, with a high dose not seeming to have greater benefits than a standard dose
    • Mifepristone, which is described, but rarely used in practice, as it is uced to induce abortion

Patient information

How can you artificially stimulate childbirth to start?
There are things you can do mechanically. As well as drugs you can give.

What can you do mechanically?
You can try to separate the amniotic sac suspending the baby, from the cervix, to help hormones release. You can insert a balloon and inflate it to dilate the cervix, again, to induce hormone release. You can also break the amniotic sac, by literally piercing it, which we call ARM or breaking waters.

With drugs, what can you give?
Prostaglandin. Or oxytocin.

Indications
  • Postterm pregnancy (i.e. pregnancy gone past the 41st week), improving outcomes for the baby by inducing at or after term, and decreasing the number of C-sections required
  • IUGR (intrauterine fetal growth restriction)
  • Health risks to the woman in continuing the pregnancy (e.g. pre-eclampsia)
  • PROM (premature rupture of membranes, where the membranes have ruptured, but labor doesn't start within a specified period of time)
  • Abortion (premature termination of pregnancy)
  • Fetal death in utero, or previous Hx of stillbirth
  • Twin pregnancy continuing beyond 38 weeks
  • PMH that puts risk on the woman and/or her child, e.g. diabetes, HTN

Patient information

Why artificially induce labor? Why not let nature run it's course?
If the baby's still not wanting to come out, after the due date, which we call post dates. If the baby is small for dates because there's some medical problem, which we call IUGR. There's a health risk to mom, such as impending seizure, called pre-eclampsia. The amniotic sac may already have ruptured, so it's dangerous for bub to remain in the womb. A dead fetus, due to abortion or stillbirth. If there are twins.

Prognosis
  • Induction in those either at or after term improves outcomes for the baby, and decreases the number of C-sections performed

Patient information

What do you say to people who say mother nature prefers it when you use the natural approach?
Research shows that if you induce at or after term, it improves the outcome for bub. And it decreases the need to do a C section.

Paperwork
  • In the form "Labor induction assessment", affix the Pt Label
  • Under Initial Assessment to Plan Method of Induction:
    • Indications
    • ACM Code(s)
    • EDB: __/__/____
    • Gestation
    • Gravida
    • Parity
    • BMI
    • Method of Induction, including ticking for PGE2, 1mg, 2mg, Dinoprostone (Cervidil), ARM, Syntocinon
    • Booking Date: __/__/___ (enlisting to Page a particular number)
    • Date of Induction: __/__/____
    • Midwife/Doctor booking induction
    • Authorized by Reg/Consultant
    • Tick whether Prostaglandin ordered on medication chart by Registrar/Consultant
    • Modified Bishop Score, as shown in an assessment table, which is a Score of 0, 1, 2, or 3, based on whether Dilation is 1, 1.2, 3.4, 5; Length Cx (cm) is 3, 2, 1 or 0; Station is -3, -2, -1.0, or +1/+2; Consistency is Firm, Medium or Soft; Position is Posterior, Mid, Anterior. Table allows the Total summation of the score. Criteria for ARM is a Bishop Score of 7 or Greater
  • Maternity Unit Assessment to Determine Method of Induction:
    • CTG, including ticks for whether Pre Prostin, or Post Prostin
    • Ticks for PGE 2, including ticks for 1mg or 2mg, including Date and Time
    • Tick for Dinoprostone (Cervidil), including tick for 10mg, and Date and Time
    • Tick for Bishop Score 7 or Greater: Registrar Notified
    • There is also a repeat Modified Bishop Score table here which can be filled
    • Authentication, including Inserted by Name, Signature, Designation, Date; and Supervised by Name, Signature, Designation, Date
  • Repeat Assessment (As Required):
    • CTG, including ticks of Pre Prostin or Post Prostin
    • Tick for PGE2, including tick for 1mg, and Date and Time
    • Repeat of the Modified Bishop Score
    • Authentication, including Inserted by Name, Signature, Designation, Date; and Supervised by Name, Signature, Designation, Date
See also
  • Childbirth
  • Bishop score (used to assess for need to IOL)

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