Induced delivery: what it is
There is talk of induced delivery when some pharmacological techniques are used to initiate the labor in childbirth, that is, to stimulate the modifications of the uterine neck and the contractions necessary to start labor, often starting from the 41st week of pregnancy.
Let's see when the induction of the delivery and how it happens.
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In this article
- When it is necessary to induce childbirth
- How induction of childbirth works
- The techniques of pharmacological induction of childbirth
- The techniques of mechanical induction of childbirth
- The timing of induction
- The epidural with induced delivery
- The risks of induction methods
When it is necessary to induce childbirth
"A significant percentage of pregnancies, about 10% (which rises if factors such as age and obesity are present), do not reach labor within 41 weeks of gestation" underlines Enrico Ferrazzi, Director of the Obstetric and Gynecological Clinic of the Hospital of the Children V. Buzzi of the University of our city.
«Numerous studies have shown that, a 41 weeks plus 3-5 days, the risk that the fetus bears labor poorly is very high because the placenta, now "old", may no longer be able to oxygenate and nourish it properly. This is why it is preferable to induce childbirth rather than wait for it to occur naturally beyond the term ».
The woman can also choose not to opt for this procedure, but "of course she must sign a specific consent document".
So, you choose theinduction "If the birth labor does not start spontaneously within safe terms, that is, within 7-14 days (the limit set varies from hospital to hospital, ed) after the expiration of the presumed date of birth, because beyond this term the fetal risks increase »Adds Stefano Bianchi, head of obstetrics and gynecology at the San Giuseppe Hospital in our city.
«Induction is also chosen when, for various reasons, the child has to be delivered in advance of natural times and there are no conditions that indicate an urgency such as to have to resort to a caesarean section. It is necessary to induce delivery even if the membranes rupture spontaneously before labor (usually within 12-18 hours, but even here the protocols of the hospitals are slightly different), because the rupture of the sac no longer guarantees the sterility of the "nest" uterine".
"Hypertension, uncompensated diabetes, too small a fetus, or reduced amounts of amniotic fluid are also causes that can predict the induction of childbirth," comments Ferrazzi.
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How induction of childbirth works
«At the Buzzi Hospital in our city, later 40 weeks and 3 days (but the period may change depending on the hospital, ed.) the mother is invited to do a series of checks, which vary according to the health facility. We generally evaluate the amniotic fluid through different tracings and then at 41 weeks and 3 days we propose induction ».
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The techniques of pharmacological induction of childbirth
1. The prostaglandins
"The prostaglandins - or rather a synthetic substance that mimics the natural chemical mediator - are manually applied vaginally in the form of gel or small strips of tissue which, little by little, are able to make the uterine neck mature, softening and smoothing it, to allow it to dilate easily »explains Professor Bianchi.
It is also possible to administer prostaglandins orally or sublingually, «currently it is the most used method in the world, and as such recommended by the World Health Organization. However, it requires a greater number of monitoring (one every three to four hours, that is, at each administration of the drug): the effect on the uterus and on labor is absolutely similar "adds Ferrazzi.
2. Oxytocin
«Usually a complete cycle can include up to two successive applications. After that, it is necessary to reassess the problem and very rarely it continues - continues Bianchi -. Labor with prostaglandins it is no longer painful, but it is undoubtedly more lungo, because we frequently start from zero with the neck still closed and the time it takes to get to the active phase of childbirth is longer ».
L'oxytocin, on the other hand, it is mainly used in the case in which the cervix is already dilated and smoothed out to reinforce contractions already present. «Intravenously, an analogue of oxytocin produced naturally at the time of labor is profused, which intensifies contractile activity. With synthetic oxytocin the labor is average more painful».
The techniques of mechanical induction of childbirth
The double balloon
«At Buzzi - Ferrazzi specifies - when the uterine neck is still closed, but it is now necessary to resort to induction, a special double balloon is applied which remains in place for 12-18 hours and mechanically leads to neck dilation. Due to the characteristics of the cervix during pregnancy, this balloon is not painful ».
Read also: Things that REALLY happen in the delivery roomThe timing of induction
"After nine months of gestation, if the birth is induced and it is not natural, it is good that the labor is not too fast: the faster you do it, the more risks there are. This is why low-dose drugs or mechanical methods are typically used without jeopardizing the course of labor so that it is not too fast or painful. Generally, however, in 75% of cases delivery takes place within 12 hours, a time only slightly longer than a natural birth »adds Professor Ferrazzi.
The epidural with induced delivery
The induction of childbirth does not preclude the use ofepidural. "In some cases, if there are already very painful contractions, at the Buzzi in our city we begin to do it even before the active phase, that is, in the latent phase in which uterine contractions are still irregular" continues Enrico Ferrazzi.
The risks of induction methods
With both methods there is a risk of uterine hypertone: that is, the uterus, artificially solicited to modify itself, tends to remain contracted and this can compromise the oxygenation of the fetus.
Finally, in 20-25% of cases the induction may not be successful and require recourse to the caesarean. “If a 28-year-old woman is in her first pregnancy and the birth is spontaneous, at full term, she has a risk of a caesarean section of 6-8%. If the same woman undergoes an induction of childbirth, after 41 weeks, the risk of a caesarean increases to 15-20% because the placenta is "older" and risks not supporting the oxygenation of the fetus during labor »concludes Ferrazzi.
Read also: The 4 stages of childbirthInduced childbirth: a mother's experience
Story of a mother who, after a traumatizing first birth, experienced a second birth induced with the gel. This time, however, everything went well: a fast, almost painless delivery. In the end, little Fiammetta was born.
Read the whole story of a mom who had an almost painless gel-induced birth
Questions and answers
What is meant by induced birth?
By induction we mean a set of maneuvers or administration of substances that have the aim of starting the labor of childbirth.
What is one of the main reasons for inducing childbirth?
One of the main reasons for inducing labor is pregnancy that goes on too long after term.
What is the most common method of inducing childbirth?
The most widely used system in the world for induction of childbirth is oxytocin which is administered intravenously.
TAG:
- give birth
- induction of childbirth
- prostaglandins
