Labor induction is a medical procedure that artificially initiates uterine contractions to prepare the body for childbirth. It is sometimes recommended for a vaginal birth when there are concerns about the well-being of the pregnant person or the baby. This article focuses specifically on elective induction, a type of labor induction performed without immediate medical necessity.
Understanding Elective Induction
Elective induction refers to the planned initiation of labor for non-medical reasons, at 39 weeks of gestation or later. This differs from a medically indicated induction, where labor is induced due to a health concern for the pregnant person or the baby, such as preeclampsia, gestational diabetes, or prolonged pregnancy beyond 42 weeks. Elective induction allows for predictability in the timing of birth, which can be appealing for various personal considerations.
Common Reasons for Elective Induction
Individuals may choose elective induction for a variety of non-medical or logistical reasons. A common motivation is a desire to end the pregnancy due to discomfort, including aches, pains, and sleep difficulties. Some individuals opt for elective induction to coordinate with a partner’s availability for support during birth or to align with the schedule of their preferred healthcare provider. There can also be a wish to avoid a perceived large baby, though evidence supporting this as a reason for elective induction is limited. For those living far from a hospital or with a history of very rapid past deliveries, scheduling an induction might offer a sense of security, potentially preventing an unassisted birth outside a medical facility.
How Elective Induction is Performed
Elective labor induction involves several methods, often used in combination, to prepare the cervix and stimulate uterine contractions. Cervical ripening is the first step if the cervix is not yet favorable. This can be achieved pharmacologically with prostaglandin medications, such as misoprostol or dinoprostone, administered orally or vaginally to soften and thin the cervix. Mechanical methods like a balloon catheter can also be used, where a small tube with an inflatable balloon is inserted into the cervix and filled with saline, applying gentle pressure to encourage dilation and prostaglandin release.
Once the cervix is favorable, other methods are employed. A membrane sweep, also known as stripping the membranes, involves a healthcare provider inserting a gloved finger into the cervix and sweeping it around the amniotic sac to separate the membranes from the uterine wall. This action helps release natural prostaglandins, which can promote cervical changes and initiate contractions. Another method is amniotomy, or artificially breaking the water, where a small hook-like instrument is used to create an opening in the amniotic sac, which can release hormones and increase pressure on the cervix to encourage labor.
The final step involves administering oxytocin, a synthetic form of the hormone naturally produced by the body during labor. Oxytocin (often known by the brand name Pitocin) is given intravenously, starting at a low dose and gradually increasing to stimulate regular and effective uterine contractions. Throughout these procedures, the pregnant person’s contractions and the baby’s heart rate are closely monitored to ensure safety and adjust the induction process as needed.
Weighing Decisions for Elective Induction
Deciding on an elective induction involves careful consideration and discussion with a healthcare provider, especially as current research presents varying perspectives on outcomes. While some studies, like the ARRIVE trial, suggest that elective induction at 39 weeks for low-risk, first-time mothers may decrease the likelihood of a cesarean delivery and reduce the risk of hypertensive disorders, other research indicates different results. For example, a Michigan study found that elective induction could lead to a higher rate of cesarean births in a general population, with a rate of 30% compared to 24% for expectant management.
Induced labor can also lead to a more intense experience of contractions compared to spontaneous labor, which might increase the need for pain management, such as an epidural. Inducing labor can result in a longer overall time from admission to delivery, particularly if the cervix is not yet favorable. An unfavorable cervix may mean the induction process takes several days to achieve active labor.
Certain situations may make elective induction unsuitable. Individuals who have had a previous cesarean delivery with a vertical uterine incision or other major uterine surgery are not candidates due to an increased risk of uterine rupture. Other contraindications include placenta previa, where the placenta blocks the cervix, or if the baby is in a breech or transverse position. It is important to confirm gestational age, at least 39 weeks, to mitigate risks of prematurity for the baby.