Labor induction

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Labor induction
Intervention

ICD-9-CM

73.0-73.1

Labor induction is a method of artificially or prematurely stimulating childbirth in a woman.[1]

Contents
[hide]

1 Indications 2 Methods of induction o 2.1 Medication o 2.2 Processes 3 When to induce 4 Criticisms of induction 5 Elective induction 6 See also 7 References 8 External links

[edit] Indications
Common suggested reasons for induction include:

The baby is believed to be getting too big.

Postterm pregnancy, i.e. if the pregnancy has gone past the 42 week mark. Intrauterine fetal growth retardation (IUGR). There are health risks to the woman in continuing the pregnancy (e.g. she has preeclampsia). Premature rupture of the membranes (PROM); this is when the membranes have ruptured, but labor does not start within a specific amount of time.[2] Premature termination of the pregnancy (abortion). Scheduling concerns. Fetal death in utero. Twin pregnancy continuing beyond 38 weeks.

[edit] Methods of induction

Methods of inducing labor include medication and processes. If an induction causes complications during labor, a Caesarean section is almost always conducted. An induction is most likely to result in successful vaginal delivery when a woman is close to or in the early stages of labor. Signs of impending labor may include softening of the cervix, dilation and increasing frequency or intensity of contractions. The Bishop score may be used to assess the advisability of induction, and is based on such factors.

[edit] Medication

Intravaginal, endocervical or extra-amniotic administration of prostaglandin, such as dinoprostone or misoprostol.[3] In the few controlled trials that have been done, extraamniotic administration appears to be more efficient than intravaginal or endocervical administration of prostaglandins in labor induction, with no differential effects on other outcome measures.[4] Intravenous administration of synthetic oxytocin preparations, such as Pitocin. Natural Induction - Many midwives or other holistic providers practice "natural" induction, which may include use of herbs, castor oil or other medically unconventional agents to stimulate or advance a stalled labor. Use of mifepristone has been described.[5] Relaxin has been investigated,[6] but is not currently commonly used.

[edit] Processes

"Membrane sweep", also known as membrane stripping, or "stretch and sweep" in Australia and the UK - during an internal examination, the midwife moves her finger around the cervix to stimulate and/or 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")

[edit] When to induce

Until recently, the most common practice has been to induce labor by the end of the 42nd week of gestation. This practice is still very common. Recent studies have shown an increasing risk of infant mortality for births in 41st and particularly 42nd week of gestation, as well as a higher risk of injury to the mother and child .[7] The recommended date for induction of labor has therefore been moved to the end of the 41st week of gestation in many countries including Sweden and Canada. In order for induction to progress to a vaginal delivery, your body, and baby, must be ready to endure both the induction and the labor. Inducing labor before 39 weeks may result in the newborn having to be taken into the neonatal intensive care unit, NICU, due to under-developed lungs. But that is just one risk of inducing labor too early. According to an article from Fit Pregnancy, the odds of having a vaginal delivery after labor induction must be assessed by a "Bishop Score". [8] 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 open it is. The score goes by a points system depending on five factors. Each factor is scored on a scale between 0-3, any score that adds up to be less than 5 holds a higher risk of delivering by cesarean section. [9]

[edit] Criticisms of induction

Induced labor tends to be more intense and painful for the woman. This can lead to the increased use of analgesics and other pain-relieving pharmaceuticals.[10] These interventions have been said to lead to an increased likelihood of caesarean section delivery for the baby.[11] However, studies into this matter show differing results. One study indicated that while overall cesarean section rates from 1990-1997 remained at or below 20%, elective induction was associated with a doubling of the rate of caesarean section .[12] Two more recent studies have shown 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.[13][14] Research published in the Journal of Perinatal and Neonatal Nursing 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.[15]. With early induction comes the increased risk of a caesarian section. Even though C-sections are medically acceptable, a vaginal delivery is much more advantageous for numerous reasons[citation needed] . Catecholamine, a hormone produced by the kidneys and secreted in the vaginal canal, is found in higher amounts in infants born vaginally[citation needed], ensuring optimal survival outside the womb (Catecholamines)[citation needed]. Another benefit to vaginal births are the contractions, contractions actually help squeeze out fluid from the babies lungs, insuring less chance of respiratory problems[citation needed]. Research also states babies born through the vaginal canal have fewer setbacks such as asthma and allergies later in life ("Vaginal Birth vs. Cesarean Section the Pros and Cons")[citation needed]. However, if a vaginal birth is not possible, C-sections are successful and can have less risk of postpartum hemorrhage, decreased risk of pelvic floor injuries as well as no trauma such as swelling and bruising to the vaginal area (Vaginal Birth).

[edit] Elective induction

In 1999, Intermountain Healthcare, in Salt Lake City, Utah, noticed a striking trend that was part of a larger U.S. phenomenon. Women and their doctors were more frequently choosing to induce labor and increasingly, those inductions were happening at 37 or 38 weeks gestational age. Clinicians were concerned that early inductions might have negative health consequences for babies and moms. Intermountain data showed that women who deliver before babies reach 39 weeks gestational age tend to have longer and more complicated deliveries, an increased proportion of which lead to more C-sections. Also found were an increase in the number of newborns with medical complications in the group delivered before 39 weeks. This led to efforts to implement guidelines to reduce elective inductions before 39 weeksthe ideal gestational period. In 1999, approximately 28 percent of all inductions at Intermountains hospitals occurred before 39 weeks. In 2011, that percentage is under 2 percent.[16] And with the significant drop in early elective inductions, Intermountain has also seen a drop in the average length of labor, fewer C-sections, and a reduction in certain newborn complications in electively induced patients. Following Intermountain's guidelines continues to benefit new babies and their moms. It has also saved patients tens of millions each year. Some[who?] feel that doctors show increasing propensity toward induction simply for personal convenience or to relieve load on hospital facilities. "[Induction] enables doctors to practice daylight obstetrics," says Dr. Marsden Wagner, a neonatologist who served for 15 years as a director of women's and children's health in industrialized countries for the World Health Organization. "It means that as a doctor, I can come in at 9 a.m., give you the pill, and by 6 p.m. I've delivered a baby and I'm home having dinner." [17] A growing number of pregnant women are opting to have induced labor, according to a 12-year study of women in Illinois that was published in the September 2008 issue of the journal Medical Care. The researchers say that the consequences are not clear, but some believe that elective inductions will be done for convenience reasons.[18]

[edit] See also

Tocolytics, labor repressants

[edit] References
1. 2. 3. 4. ^ Houghton Mifflin Company, (2006): The American Heritage Dictionary. ^ Allahyar,J. & Galan, H. "Premature Rupture of the Membranes."; also American College of Obstetrics and Gynecologists. ^ 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): 44952. PMID 15043790. ^ A Guide to Effective Care in Pregnancy and Childbirth. Murray Enkin, Marc J.N.C. Keirse, James Neilson, Caroline Crowther, Lelia Duley, Ellen Hodnett and Justus Hofmeyr. (Oxford University Press, 2000) [1] [2]

5.

6. 7. 8. 9. 10. 11.

12. 13. 14. 15.

16. 17. 18.

^ 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): 13918. doi:10.1016/j.ajog.2005.11.026. PMID 16647925. ^ 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. ^ 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, [3] ^ Faulkner, J. (2008). The truth about induction. Fit Pregnancy, 15(2), 44-46. Retrieved from EBSCOhost. ^ Doheny, K. (2010, June 22). Labor Induction May Boost C-Section Risk. HealthDay Consumer News Service. Retrieved from EBSCOhost. ^ Vernon, David, Having a Great Birth in Australia, Australian College of Midwives, 2005, ISBN 09751674-3-X ^ 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 ^ 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, [4] ^ 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.[5] ^ A Glmezoglu et al, Induction of labor for improving birth outcomes for women at or beyond term,2009,The Cochrane Library, [6] ^ 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 ^ Intermountain Healthcare, January 2011 ^[unreliable source?]Uterine Ruptures Associated with Prostaglandin Used with RU486 Accessed 20 Feb 2008 ^ Pregnant Illinois Women Increasingly Choosing Induced Labor Newswise, Retrieved on September 18, 2008.

[edit] External links

Family.doctor.org Harman & Kim. "Current Trends in Cervical Ripening and Labor Induction" American Family Physician 1999; 60:477-84. Inducing Labor - WebMD.com Induction of labour. Clinical guideline, UK National Institute for Health and Clinical Excellence, June 2001. Josie L. Tenore: Methods for cervical ripening and induction of labor. American Family Physician, 15 May 2003. "Catecholamines - blood ." National Library of Medicine . N.p., n.d. Web. 28 Mar. 2011. <http://www.nlm.nih.gov/medlineplus>. "Vaginal Birth vs. Cesarean Section the Pros and Cons." Women's Healthcare Topics . N.p., n.d. Web. 28 Mar. 2011. <http://www.womenshealthcaretopics.com/VaginalBirthvsCesareanSection.html>.

[show]v d eObstetrical surgery and other procedures (ICD-9-CM V3 72-75,

ICD-10-PCS 1)

Vaginal delivery

Induction (Artificial rupture of membranes/Amniotomy) Episiotomy Symphysiotomy Forceps in childbirth Ventouse in childbirth shoulder dystocia (McRoberts maneuver, Woods' screw maneuver, Zavanelli maneuver) Manual placenta removal

Caesarean section Elective On maternal request EXIT procedure Postpartum hemorrhage Hysterectomy B-Lynch suture Sengstaken-Blakemore tube M: OBS phys/devp/memb mthr/fetu/infc, epon proc, drug(2A/G2C) [show]v d eUterotonics/labor inducers/oxytocics (G02A) Ergot alkaloids Ergometrine# (Syntometrine) Methylergometrine E: Misoprostol/E1# Gemeprost/E1 Dinoprostone/E2 Prostaglandins and Sulprostone/E2 analogues F: Dinoprost/F2 Carboprost/F2

M: OBS phys/devp/memb mthr/fetu/infc, epon proc, drug(2A/G2C) Retrieved from "http://en.wikipedia.org/wiki/Labor_induction" Categories: Obstetrics | Childbirth Hidden categories: All articles lacking reliable references | Articles lacking reliable references from April 2011 | All articles with unsourced statements | Articles with unsourced statements from April 2011 | All articles with specifically marked weasel-worded phrases | Articles with specifically marked weasel-worded phrases from April 2011
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