Induction of childbirth: how, in which cases?

For some pregnancies, the doctor may decide to induce labor. We then speak of artificial induction of labor, which is done through different medical techniques within a health facility. The onset of childbirth has one goal: induce the contractions that will help open the cervix, and thus to promote vaginal delivery. When can you induce labor? Is it painful? How long do you give birth after an induction? We also review the different techniques to induce childbirth (by balloon, tampon, with the detachment of the membranes, or even oxytocin.

In what cases do we induce childbirth?

Labor can be induced for medical reasons:

• If there is one baby’s health risk. This is the case, for example, if abnormalities in the heartbeat of the fetus appear or if the baby has growth retardation.
• If the mom-to-be has gestational diabetesor an infection in the amniotic fluid or a risk of pre-eclampsia.
• If the term of pregnancy is exceeded. From the 39th week of pregnancy, induction is recommended, i.e. approximately 8 and a half months of pregnancy and if the cervix is ​​favorable to induction.

Who decides to induce labour?

The onset of labor is decided by the doctor following you, for medical reasons, but it can be requested by the patient herself, for reasons of convenience. In all cases, medical details are provided to you by the medical team who will decide to induce labor.

Does inducing labor hurt?

Labor induction can be more painful, especially at the level of the contractions felt. Depending on the medical method used, for example the administration of oxytocin or the stripping of membranes, the contractions are usually more intense than those of a natural childbirth. Some inconveniences such as vaginal burns, in the case of the tampon technique, can also be restrictive and hurt. In all cases, painkillers can be offered to you by the medical team. Don’t hesitate to ask!

After induction, how long to give birth?

The length of time it takes to give birth after an induction varies from woman to woman. In general, delivery takes place between 24 hours and 48 hours after the onset of induction. In other cases, it may take longer.

To induce labor, there are several methods depending on the condition of the cervix, whether it is favorable (i.e. softened cervix and already a little open) or not. The two main techniques are intravenous infusion of oxytocin and administration of a prostaglandin gel directly into the uterus.

Oxytocin to induce labor

Inject oxytocin to the future mother. Secreted naturally by the body, oxytocin is a hormone that stimulates labor. When this is not produced sufficiently, synthetic oxytocin is administered intravenously to pregnant women to artificially trigger contractions. The goal is for contractions of normal intensity to appear. It is common to combine this injection of oxytocin with an epidural anesthetic, which will facilitate the progress of labour.

Prostaglandins to induce labor

Applying a prostaglandin hormone gel in the uterus. In order to promote the maturation and thinning of the cervix and thus trigger contractions, a prostaglandin gel can indeed be introduced into the cervix. Health professionals will tend to favor this method when the cervix is ​​immature. If it is mature, they will either choose prostaglandins or oxytocin to promote the onset of labor. There are also prostaglandin tablets (misoprostol 25 mcg) to be taken by mouth.

The balloon technique to induce labor

As indicated by his name, the balloon method is practiced with the use of a small balloon. It is not a balloon, but aa soft rubber probe that is inserted into the cervix. When it is in place, it is gradually inflated with water, which will allow the cervix to open and the membranes to come off, and thus trigger the delivery. When the balloon technique is used, the mother may feel contractions or pain in the lower abdomen and slight bleeding. If the method works, it will induce labor, sometimes with rupture of the water bag and expulsion of the balloon once the cervix is ​​open. Once the catheter is in place, the patient can still walk, eat, go to the toilet or even take a shower.

Inducing a tampon delivery

Another technique is to place a tampon in the vagina (vaginal dinosprostone), which will diffuse prostaglandin hormones to cause contractions and thus the onset of labor. Vaginal burning may also be felt after application. Once labor has started, the tampon is removed. If labor has not started, it can remain for a maximum of 24 hours, after which it is removed.

Stripping of membranes to induce labor

Less and less used method, the detachment of membranes can also be considered to induce labour. Indeed, if an induction without urgent medical reason is envisaged, the pregnant woman can be offered this technique. The detachment of the membranes does not, however, systematically induce labor. It can sometimes be painful and “lead to a greater frequency of bleeding during vaginal exams”according to a document from the High Authority for Health (HAS). Know that this practice is obligatorily proposed to you before being carried out. Your consent is indeed required.

Are there any natural methods to induce labour?

There are other so-called natural methods that help mature the cervix in order to induce labor. This is the case ofacupuncture, a technique that consists of placing needles on targeted points of the body of the future mother to initiate labor. Moreover, we also speak of grandmother’s methods to induce labor. Walking, cleaning, taking a hot bath, eating spicy food… But their effectiveness remains to be proven.

What is Italian triggering?

Having sex might help bring the baby to life a little faster. Chantal Birman, liberal midwife interviewed by the Journal des Femmes, says thatA “sexual intercourse can help induce labor. But the condition is not to shower and to make sure to keep the seminal fluid (which contains prostaglandins) in you for at least two hours.“. Indeed, sperm, which contains these prostaglandins, could in some cases cause contractions. In fact, this technique therefore seems a bit complicated. On the other hand, according to an Italian study published in November 2019 in The Journal of Sexual Medicine, sexual intercourse just before the term of pregnancy would not significantly increase the chances of spontaneous onset of labour. However, the researchers did not take into account the occurrence of an orgasm, the positions practiced during the sexual act and especially the stimulation of the nipples which, according to other scientists, promotes the release of oxytocin. However, this hormone plays an essential role in the onset of childbirth.

What are the risks of an induction of labour?

Inducing labor is not without risks. It can cause a greater medicalization of childbirth. Labor can be longer, more tiring and the contractions more painful for the mother-to-be. THE risk of caesarean section is also present, and higher, when labor is induced on an unfavorable cervix. Induction may also produce a stoppage of dilation of the cervix, which necessitates a caesarean section. On the other hand, the fact of triggering a delivery would not entail more risks for the baby than during a “normal” delivery.

What monitoring during the onset of childbirth?

Any triggering requires monitoring of the pregnant woman, but also of the foetus. For this, the medical team generally proceeds to a fetal monitoring before the onset but also during, continuously, especially if oxytocin or the administration of prostaglandins is used. Induction of childbirth is thus always carried out near a cesarean section, if necessary.

Sources: Fact Sheet: Induction of Labor. HAS

Fact sheet on the induction of labour. Birth security network Born together in Pays de la Loire (April 2022)

Summary of professional recommendations: artificial induction of labor from 37 weeks of amenorrhea. HAS (April 2008)