You can't wait for your little miracle to finally come into the world, but the birth hasn't materialised? If your baby doesn't want to set off on its own, the labour will be induced. In this article, we'll tell you how this works, which aids are used and which medications are used.
Most women want a gentle birth in hospital or in a birthing centre. A few weeks before the due date (ET), the hospital bag is packed, the birth plan is drawn up and you register at the hospital for the birth. And as the due date draws ever closer, you expect contractions to announce that your little miracle is finally about to be born. And what happens if nothing happens?
What is labour induction?
Not every baby wants to be born on the due date. Some are in a hurry and come earlier (premature birth), others would like to take their time.
"My son was in no hurry at all. On the day of the due date, the CTG was unable to record a single contraction. No wonder. I didn't have any contractions either. I didn't go into labour until two days after the due date. If he had come any later, I would have had an induction of labour too."
Julia, mum of Paul
During induction of labour, the expectant mother is given medication to induce contractions. The more advanced your pregnancy is, the more strenuous it will be for you. However, it doesn't get any easier for your baby either, as it is constantly growing and at some point the placenta will no longer be able to nourish it properly. Nobody knows exactly when the placenta is too old to nourish your baby. That is why an induction is recommended between the 7th and 14th day after the due date.
Why is a birth induced?
There can be various reasons for inducing labour. Most gynaecologists look at your baby's growth, assess the CTG and then weigh up with you when an induction is advisable for you and the baby. Of course, how you are feeling is also important. But even if the mum-to-be is older than 40, this can be a reason to induce labour. There are also new studies that show that children born after the 38th week of pregnancy often reach a birth weight of more than 4,000 grams.
"It was the same for me: our son was born by caesarean section at 40+2 and weighed an impressive 4,030 grams."
Julia, mum of Paul
The larger and heavier the baby is at birth, the greater the risk of a perineal tear, more severe post-partum haemorrhage or a delayed birth. A high BMI of the mother can also be a reason to induce labour, as can smoking during pregnancy.
However, there are now also many women who wish to induce labour of their own free will; a so-called "induction of labour". Favourite line. This is what midwife Katharina says:
"Inducing labour with medication is not a good idea. This is because labour begins when you and the baby are ready for the birth. If there is a medical reason why your baby is no longer being well cared for in the womb, it will help with the induction. Then the birth begins. If the reason for the induction is that the date of birth would be a good fit, or you just want your baby to be born, then the medication will either not work or it will cause unnecessary pain."
Katharina, midwife and mother
Your desire for the baby promotes the start of labour. You can find out what else you can do further down in the article.
However, a high-risk pregnancy can also be a good reason to induce labour. There are various reasons that lead to a high-risk pregnancy:
- premature rupture of membranes
- Too much or too little amniotic fluid
- a relatively large child
- Gestational diabetes
- Pregnancy toxaemia (pre-eclampsia or HELLP syndrome)
- etc.
When is the labour induced?
There is no precise indication of when a birth is induced. The induction of labour always depends on the personal circumstances and the state of health of mother and child. However, it is safe to say that every gynaecologist will send an expectant mother to the hospital from the 42nd week of pregnancy to induce labour. This is because nobody wants to risk complications in labour because the due date has been missed.
What happens during labour induction?
If the gynaecologist or the expectant mother has decided to induce labour, the pregnant woman will be admitted as an inpatient. For you, this means: pack your hospital bag, pack your birth plan and off you go to the hospital. Together with the hospital team, you will decide on a Method of inducing labour decide: mechanical or medicinal. Both procedures have been significantly improved over the last few years, which has reduced the risks.
Which method you choose is up to you, but you should take the doctor's advice into account. They will be able to assess whether a previous caesarean section, your state of health or the condition of your child could affect the induction of labour. And they know which medication has the highest success rate in your case. In any case, you must be prepared for the fact that the labour will not start immediately. Induction with medication can take hours. Often even a few days.
Drug induction of labour
One way to induce labour is the so-called Labour drip. You will be given an infusion containing the active ingredient oxytocin. This hormone causes contractions in the uterus and therefore also labour pains. A special side effect: your body also releases the hormone oxytocin when you hold your baby in your arms and promotes milk production. If you are given a contraceptive drip to induce labour, this also strengthens the mother-child bond and can speed up the milk coming in after the birth. However, the labour drip can only work if your uterus is already ready for the birth. When the cervix is already soft. Ideally, the cervix is shortened and the cervix is already a few centimetres open. Then a contraceptive drip can give you and your baby the little push you still need. As soon as the contractions are regular, the drip is switched off again.
An alternative to the contraceptive drip is the active ingredient Prostaglandinswhich is administered via a gel or tablet. The tablet is also better known under the name "Cyclotec". However, Cytotec should only be administered very carefully. This is because - unlike the contraceptive drip - the effect is difficult to assess. The effect cannot simply be switched off again.
"Cytotec is a medication that is not approved for induction of labour. It may only be used if the benefits and possible side effects for you and your baby have been carefully weighed up. And then it must be used carefully, i.e. in low doses."
More on the topic You can read about "Cyclotec as a tocolytic" here.
Prostaglandins ensure that the cervix softens and opens. This stimulates labour. Unfortunately, the problem lies in the dosage: neither the gel nor the tablet (which is crumbled and dissolved in water) can be dosed correctly. Before you decide to induce labour with prostaglandins, you should weigh up all the pros and cons carefully.
Mechanical induction of labour
If you decide against inducing labour with medication, doctors and midwives will try to induce labour mechanically. This involves mechanically stimulating the cervix so that the body itself releases prostaglandins, causing the cervix to open. Of course, a combination of both methods is also possible.
One way to mechanically induce labour is the Egg pollen solution. The outer covering of the amniotic sac is carefully released with a finger. This procedure is not usually particularly unpleasant, provided the doctor or midwife is very careful. It is possible that slight vaginal bleeding may occur afterwards, but this is usually harmless. There are studies that show that an egg pill solution ensures that fewer or no contraceptives are needed during the further course of the birth.
Another option is the Balloon catheter. A small catheter is inserted through the vagina into the cervix with one or two small balloons at the tip. The balloons are filled with saline solution and are designed to stretch the cervix. This stretching can be uncomfortable and even painful for some women. By stretching the cervix, the body itself is supposed to release the necessary hormones so that the cervix matures. The balloon catheter causes the contractions to become less intense later on. It is also possible to induce labour with a balloon catheter if you have previously had a caesarean section.
In some cases, the birth is already underway, but the contractions are not strong enough to bring the baby into the world. In these cases, a Amniotomy is performed. This involves opening the amniotic sac. The midwife inserts a small instrument through the already opened cervix and punctures the amniotic sac. This procedure is painless, but is not recommended as a means of inducing labour. By opening the amniotic sac, the water cushion in front of the head is gone. The hard baby's head presses directly on the cervix. This triggers contractions and accelerates the birth.
How long does it take for the labour to start?
The induction of labour can take different lengths of time. Just like natural labour, neither doctors nor midwives can predict how long it will take for labour to begin. Some midwives report that the duration of labour induction in the Labour drip at around three hours lies. However, there can also be individual differences here. With ovarian detachment, it can take up to 48 hours for labour to begin. With the use of Cyclotec the duration of labour induction varies greatly, so it is not possible to give exact details. If you decide in favour of induction of labour with a Balloon catheteryou have to reckon with at least 24 hours.
What are the risks of induction of labour?
Of course, induction of labour is also associated with risks. These risks must always be lower than the risk to you and your baby if you remain pregnant for longer. The use of prostaglandins is particularly risky. This is because they are difficult to dose. They can therefore lead to contractions and even a rupture of the uterus. They often lead to very strong and painful contractions so that an increased Use of painkillers is necessary. In addition, the risk of a Emergency caesarean section or the Use of a suction cup or forceps increase.
What can I do myself to induce labour?
If you realise that the due date is getting closer and closer or you have already passed it, you can also do a few things at home to ensure that the birth begins:
You need the hormone prostaglandin and oxytocin to start labour. Your body and your baby's body produce both hormones. You can influence their production through your diet. Your diet can influence your blood insulin level. If it is high, it inhibits the production of prostaglandin. Therefore, try to organise your diet before the birth so that it prepares you well for the birth. You need lots of protein, good fats and few carbohydrates. This will not only promote the onset of labour, it will also reduce the pain.
The contractions are supported by the pressure of your baby's head on the cervix. You can influence this through your movement. Extensive walks in the fresh air promote the onset of labour. They also have an influence on your sugar balance. Walking not only has a mechanical effect, but also influences the correct hormone production.
If you want to increase this pressure, it helps if you take time to circle your pelvis. This will gently rock your child towards the birth. You can also support this by squatting deeply. You can find out how to do this in my antenatal course.
A very well-known and long-used remedy in obstetrics is the Castor oil cocktailbetter known as a labour cocktail. This involves mixing castor oil with apricot juice and almond butter. However, you should speak to your midwife in advance to clarify whether it is possible for you to induce labour. This is because castor oil can lead to severe diarrhoea. But it can also cause the same contractions as induction with prostaglandins. The castor oil cocktail is not a harmless remedy. Especially not if you take a prescription with alcohol. Alcohol enhances the effect of the castor oil. However, alcohol is also harmful to your baby's brain during labour induction.
Some gynaecologists advise Sexual intercourse to promote labour. Also the Stimulation of the nipples is supposed to set the birth in motion. The sperm contains hormones (prostaglandins) that are supposed to trigger the contraction of the uterus. In addition, oxytocin is released when the woman orgasms. You won't be able to persuade the child to be born if the baby isn't ready yet. But you can be sure of the fun factor. And that definitely promotes a good birth.
Are you still looking for a birth preparation course? Our midwife Katharina will show you in her Online birth preparation course in over 30 video lessons on how to best prepare yourself and your partner for the birth.
One Response
Thanks for the great post about the induction of labour. My best friend is having a baby soon, which is why I wanted to help prepare. I didn't realise that induction could be so important for the baby.