Induced labour Explained

In some countries, a lot of women focus on natural birth and that also means no induction birth, no pain relieve, no assisted birth and definitely no to epitomsy.

However, in Singapore, natural birth is defined otherwise. As long it is a vaginal birth, it is consider natural birth. Mostly all mothers give birth in a hospital than birthing centres; and most babies are delivered by professional doctors, gynaes rather than midwives.

In today's context, having a birth that is induced is very common. Why do we have induced birth? There are varied reasons for doing so and most of them are due to medical reasons.

For most induced birth, you are more likely to need instruments such as forceps or ventose to help deliver your baby. This may be due to the complications of the pregnancy that led to induction and/or it may be due to problems caused by the induction itself. Consider what pain relief you would like if the induction works and makes your contractions very strong and difficult to cope with.

Reasons for inducing:
- Your pregnancy has gone beyond 41 weeks and is considered overdue. You will usually be offered an induction sometime between week 41 and 42.
- Your water bag has broken but labour hasn't started. Most women go into labour within 24 hours of their waters breaking. If it does not happen, there is a risk that you or your baby could develop an infection, so you will probably be offered an induction.
- You have diabetes - provided your baby is growing normally, it is recommended that you induced after 38 weeks of pregnancy.
- You have a chronic or acute condition, such as pre-eslampia or kidney disease, that threatens your wellbeing or the health of the baby.
- Your water level is low.

There are a number of methods your doctor can use to try get your labour to start. Some may need to be repeated depending on individuals.

How to speed up labour
1. Membrane sweep
A membrane sweep often helps to stimulate labour and is now offered routinely to women who are overdue.

The membranes that surround your baby are gently separated from your cervix. The doctor can carry out this procedure during an internal examination.

2. Prostaglandin
Prostaglandin is a hormone-like substance, which help stimulate uterine contractions. Your doctor or nurse will insert a tablet, pessary or gel containing prostaglandin into your vagina to ripen your cervix.

Vaginal prostaglandin is most commonly recommended method to induce labour because it often works better and has fewer disadvantages than other methods.

3. Artificially rupturing the membranes (ARM)
ARM is sometimes called "breaking the waters". Breaking your waters is no longer recommended as a method of induction (unless vaginal prostaglandin cannot be used for some reason). However, doctors may use it to speed up labour.

This procedure can be done during an internal examination. The doctor will makes a small break in the membranes around the baby using an amniohook. This procedure often works when the cervix feels soft and ready for labour to start.

Artificial rupture of the membranes (ARM) does not always work and once your waters have been broken, your baby could be at risk of an infection if labour is too long. If there's an infection, you will be given antibiotics.

4. Syntocinon
Syntocinon is a synthetic form of the hormone oxytocin. You would be offered it if your labour hasn't start following a membrane sweep or prostaglandin or if your contractions are not very effective.

You will be given the Syntocin through an intravenous "drip", allowing the hormone to go straight into your bloodstream, through a tiny tube into a vein in your arm. Once contractions have begun, the rate of the drip can be adjusted so that contractions happen often enough to make your cervix dilate without becoming too powerful. As syntocin can cause strong contractors and put your baby under stress, so you will need to be monitored continuously.

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