Induced labor: indications and contraindications. 42 weeks pregnant and labor doesn't start - what to do

2024 Author: Priscilla Miln | [email protected]. Last modified: 2024-01-07 12:45

Pregnancy is considered full-term from 38 to 42 weeks. During this period of time, childbirth can begin at any time, therefore, the expectant mother and the gynecologist leading this pregnancy are always ready. But there are special cases when doctors decide not to wait for a natural delivery and artificially speed up the process. After all, sometimes timely interventions can save the mother and child from many serious problems and even save lives. Below we will talk about methods of uterine stimulation in the hospital, and how to induce labor at home.

What is induction?

Induced labor is the stimulation of labor before the process begins. That is, in other words, doctors with the help of various means and manipulations push the uterus and the baby to an early birth. Unfortunately, the procedure is extremely unsafe for both the fetus and the woman in labor, and therefore the induction of labor is carried out strictly according to indications and only under medical supervision. Be that as it may, sometimesthis is the only correct way out of the situation.

No self-respecting doctor would abuse induction in order to complete the process as soon as possible. If the labor activity is somewhat delayed, but at the same time all the indicators of the mother and fetus are normal, most likely, the gynecologist will not apply stimulation, but will wait for the natural completion.

When do doctors order induction?

In order to start inducing labor without waiting for the natural course of events, the doctor must have good reasons. Indications for induced labor can be both on the part of the mother and on the part of the fetus. The following points are considered direct indications from the part of the woman in labor:

• postterm pregnancy, that is, the 42nd week of pregnancy is going on, and childbirth does not begin;
• leakage or outpouring of amniotic fluid;
• abrupt stop or greatly weakened intensity of contractions;
• oligohydramnios or, conversely, polyhydramnios;
• multifunctional disorders in the fetus-placenta system, placental abruption;
• intrauterine hypoxia;
• preeclampsia;
• chronic diseases that worsened during pregnancy;
• diabetes mellitus;
• arterial hypertension;
• oncology.

Even if the expectant mother is absolutely he althy and there is no reason on her part, the doctor can still offer stimulation, focusing on the condition of the fetus. Baby indications for induced labor:

• fetal growth retardation;
• Rhesus conflict;
• malformations of the fetus, in which intervention is required at an emergency moment;
• Intrauterine fetal death.

When is the procedure contraindicated?

If there are no obvious reasons to induce labor, it is better to wait a little more time and wait for the onset of natural labor. In addition, there are a number of factors in which provoked childbirth is not only unnecessary, but can also be dangerous to the he alth of mother and baby. We list contraindications to induction:

• presence of a scar on the uterus from a previous caesarean section or other surgical interventions;
• the fetus is not located head down, that is, it is in a transverse or breech presentation;
• premature abruption of the placenta;
• more than 3 births in history;
• narrow pelvis;
• individual intolerance to the drugs that the doctor is going to use.

But it should be understood that the above contraindications are not absolute and can be reviewed by a gynecologist at any time. In each case, doctors decide the issue on an individual basis and may be inclined to use induction if the expected benefit to mother and baby outweighs the risk. In addition, in some cases, the situation may be fundamentallychange at the very last moment, for example, the fetus is able to abruptly roll over and take a favorable position for stimulation.

How to induce labor in the hospital?

Before inducing labor, advance preparation is necessary. To begin with, the obstetrician-gynecologist advises the patient about drugs and methods of induction, warns about possible risks and complications. Next, the gestational age and the general condition of the pregnant woman and the fetus are carefully checked again. After the consent of the expectant mother, the doctor prescribes an induction.

It is a mistake to think that the medical staff deliberately speeds up the birth so as not to waste time on a pregnant woman. This is not so, if you are scheduled for stimulation, then there are direct indications for this.

Which method of labor induction the doctor chooses depends on the condition of the uterus, more precisely, on the degree of its maturity and, in fact, on the capabilities of the maternity ward.

If the cervix is not ripe

In cases where the cervix is not at all ready for childbirth, the woman is given the drug "Mifepristone", which is used once in the presence of a doctor. Further, the condition of the cervix is observed for 72 hours. If during this period of time the neck has become softer and shorter, continue preparing for induction. If there are no visible results, the doctor may decide on a caesarean section.

When the cervix is ready for delivery

When the cervix is ripe, the doctor may prescribe labor induction with medication or mechanicalimpact. The main task is to cause uterine contractions.

Mechanical action means the use of a Foley catheter and puncture of the bladder. Induced labor in this variant is successful in more than 90% of cases. In the first case, a special catheter is inserted into the cervix and filled with fluid. Under the influence of gravity, the neck gradually opens.

Amniotomy irritates the uterus and causes it to contract, while the doctor constantly monitors the heart activity of the fetus and the intensity of contractions. Separately, the state of the amniotic fluid is assessed, if it is light, the observation of the woman continues for some time.

But in some cases, uterine contractions do not start, and then medications such as Oxytocin come into play. The drug is administered intravenously and the next 5 hours is monitored by CTG in dynamics. If there is no visible effect, a caesarean section is considered.

Possible complications and consequences

Any intervention in the normal course of pregnancy can harm the fetus and mother, especially when it comes to artificial delivery. During stimulation in the maternity hospital, a pregnant woman is under the constant supervision of a doctor who checks CTG in dynamics, therefore, the woman in labor has to lie down all the time, which leads to oxygen starvation of the fetus. In addition, there are other complications with induction:

1. The likelihood of infection increases many times over.
2. Premature separation of the placenta.
3. Rupture of the uterus due to strong contractions. This is usually seen after using oxytocin.
4. Hypoxia, cerebral dysfunction, fetal cerebral ischemia.
5. Increased uterine bleeding.

In addition, it is known that artificial stimulation of labor with oxytocin contributes to excessive pain, and not every woman is able to endure such pain.

How to induce labor at home?

Let's say that all the waiting periods have expired, the baby is not even going to leave his warm shelter, and you are afraid to harm him with medicines. You can try to activate natural contractions.

Before inducing labor at home, make sure you have everything you need for the hospital ready, inform your doctor of your intention, and consider how you will get to the hospital.

So here is a list of things a pregnant woman can do to get into labor soon:

1. General cleaning of the whole house. Just don't risk climbing high, or worse, use strong chemicals. According to women, the contractions began after they washed the floors or windows.
2. Sex. During sexual intercourse, the hormone oxytocin is produced, and prostaglandins are found in semen, which soften and prepare the cervix. In addition, orgasm provokes uterine contractions.
3. Rubbing the nipples. The principle of operation of the method is similar to point 2: during the massage of the nipples in the body of a pregnant woman, oxytocin is produced, which contributes to the contraction of the uterus.
4. Climbing stairs. Hiking or avoiding the elevator contributes to fetal prolapse.
5. Laxatives, microclysters irritate the intestines first and then the uterus. But such drugs should be used very carefully and only after the permission of the doctor.

Agree or not to interfere?

Recently, the number of births ending with artificial stimulation is growing rapidly. This is due to new opportunities for doctors to correctly assess the condition of the mother and fetus. Whether or not to agree to induction is a personal matter for every pregnant woman, but it is better to listen to the doctor's opinion, and if they tell you that it is really necessary, then it is so.

On the other hand, we have already written about how labor is induced in the maternity hospital and what complications are possible after this. Therefore, if there is no direct evidence, you should not rush things and it is better to wait for natural contractions. In cases where there is no strength to endure and you want to give birth as soon as possible, a woman can try this idea of how to induce labor at home. Naturally, with one caveat - only after the permission of your doctor!