Labor induction methods at 41 weeks. The long-awaited baby: stimulation of labor

The content of the article:

Many women tend to give birth only naturally, without medical intervention, so the decision of doctors to induce labor often upsets expectant mothers and even scares them. Meanwhile, in some cases, it is preferable and even safer to “hurry up” mother nature and induce labor artificially, without waiting for the activation of the birth process, i.e. until they start. And if in some cases doctors prefer caesarean section, in other situations they tend to avoid surgical intervention and opt for induction of labor. Let's look at what circumstances can push this.

Indications for labor induction

The child, being in the uterus, ceased to receive the required amount of nutrients;

There is too little amniotic fluid or it is infected;

The placenta has ceased to cope with its direct "duties", has become worse to function and can no longer provide the baby with everything necessary. As a result, there is practically no benefit from the stay of the child in the uterus.

There was a rupture of the membranes, but progress in childbirth did not come, even after 24 hours. In this case, doctors often begin to stimulate labor much earlier.

The date of conception was determined exactly, and, focusing on these dates, it was found that the woman was walking around, i.e. her pregnancy is post - term and has been going on for more than 42 weeks .

Mommy is diagnosed with diabetes mellitus, as a result of which the placenta began to “age” ahead of time, or the baby, while in the womb, can reach such a size that it will be difficult for him to pass through the birth canal. Induction in this case is carried out at -39 weeks of gestation.

Mommy has late preeclampsia or preeclampsia (a pathological condition in which edema appears, blood pressure rises and there is protein in the urine); such an ailment could not be cured, although the necessary measures were taken (drug treatment was prescribed, bed rest was observed, but this did not help).

Mommy suffers from chronic or acute diseases, including hypertension, kidney failure, as a result of which the prolongation of pregnancy can damage the health of both the woman in labor and her child.

A woman and her baby have an acute rhesus conflict, in this case, the pregnant woman needs to give birth to a baby as early as possible.

Anomalies of labor activity, which are manifested by sluggish, irregular contractions.

They also undertake to stimulate labor in a situation where there is a risk that a woman will not be able to get to the maternity hospital (for example, there is a significant distance from her home to the clinic, or she has a tendency to rapid labor, since last time she gave birth quite quickly).

The main condition under which the stimulation will be successful is the maturity of the cervix, it must be soft, ready for disclosure. If the cervix is still not ready and induction needs to be done, it is treated with a special gel that contains the hormone prostaglandin E2 in order to accelerate its maturation. Instead of a gel, candles with a similar hormone are often used, which are inserted into the vagina; or they prefer mechanical means: they insert a catheter with an inflatable balloon, a special “expander” or dried kelp algae (when it begins to swell and at the same time absorb all the vaga from the vagina, the cervix will also expand). The hormone gel is injected into the vagina with a syringe, near the cervix. Do not be afraid of this procedure, as it is almost painless. Pain can occur when the cervix dilates.

After a certain time (after about 2-3 hours), the doctor will examine the cervix in order to fix or not confirm the progress (it is important for him to know if the opening process has started). If nothing happens after the procedure, the doctor may decide to administer an additional dose of medication. However, such cases are not so frequent, as a rule, the woman's body begins to react to prostaglandin, and its administration is quite enough to start the birth mechanism. Currently, "outpatient methods" are being developed to accelerate the maturation of the cervix, so in the future, pregnant women will be able to use them, as they say, at home.

If the cervix is already ripe, it has come to full readiness, but there are still no contractions, the doctor continues to stimulate labor, for example, artificially breaks the fetal membranes or simply separates the fetal membranes from the cervix. Some women may experience discomfort during such manipulations, this is not due to the rupture itself, but to the introduction of an instrument into the vagina. When the amniotic fluid is poured out, the contractions should intensify and become more frequent, as a result, the baby will move more intensively through the birth canal. Most often, doctors tear the membranes only when the cervix has dilated by 5 cm or more. However, if the birth progresses extremely slowly, the procedure can be performed when the dilatation has reached only 3-4 cm. It happens that the fetal membranes do not rupture to the very end and the baby is born right with them, while the doctor or midwife also breaks them, so that the child can breathe on his own for the first time in his life; it is customary to say about such babies that they were "born in a shirt." Such a variant of delivery cannot be considered pathological.

Bishop's degree of dilatation of the cervix

Evaluation of results:

From 0 to 2 points - the neck is immature;

From 3 to 5 points - the neck is not mature enough;

More than 5 points - the neck is mature.

Induction of labor with oxytocin

They can also try to induce labor by administering oxytocin, a hormone that is well known to pregnant women, because it is produced by the pituitary gland during 9 months of waiting for a child. When is oxytocin given to a woman?

1) labor has already begun, but the contractions are not strong enough;

2) progress in labor activity is practically absent.

Contractions usually kick in about 30 minutes after oxytocin has been administered; they are slightly different in frequency and regularity from contractions that occur naturally. If, after oxytocin enters the body of a woman, childbirth has not begun, the procedure is canceled and resorted to surgical intervention, a caesarean section is performed. The hormone is also stopped to be administered if contractions are established at the proper level and labor activity no longer needs additional stimulation, i.e. contractions continue on their own.

The baby grows and develops in the womb, and meanwhile the uterus becomes more and more sensitive to such a hormone. If it was found that the cervix is ripe, then artificially introduced oxytocin can significantly increase labor activity. Such manipulation is designed to imitate the natural process that would occur in the body without medical intervention. Oxytocin enters the body through a dropper, this is a simple and safe way to track the amount of the drug entering the blood with high accuracy. First, a small dose is administered and at the same time they monitor how the uterus reacts to the hormone; for this, doctors must constantly be with the woman during the manipulation. Until the contractions become strong enough, the rate of drug administration can be increased (gradually!). If it suddenly turns out that the uterus is overly sensitive to the hormone and the drug provoked too strong and prolonged contractions, then the dose is reduced or the stimulation is completely stopped.

According to the results of numerous studies, it is the use of prostaglandin in combination with oxytocin (i.e., starting the process of maturation of the cervix and artificial stimulation of labor) that significantly accelerates natural childbirth. However, many doctors are still waiting for the uterus to mature on its own in order to create favorable conditions for the introduction of oxytocin.

In obstetric practice, the drug Misoprostol is also often used, the effectiveness of which is higher than that of prostaglandin, since its use requires a small dose of oxytocin to stimulate labor, and the intensity of labor is higher. This medication is also injected into the vagina.

Labor induction is contraindicated if:

The child is quite large, and the pregnant woman's pelvis is narrow, because in this case the baby will not be able to pass through the mother's birth canal;

An urgent delivery is required;

The woman's previous pregnancy ended in a caesarean section, in which she was made a classic vertical incision, or mommy gave birth six or more times. In these cases, strong contractions can provoke uterine rupture;

Placenta previa was detected (i.e., it reached the internal canal of the cervix or completely closed it);

There was a prolapse of the umbilical cord;

The fetus is located incorrectly (is in a transverse position or in a breech presentation);

A woman has an active phase of herpes;

The pregnancy is multiple.

Maria Sokolova

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The 41st week is already underway, and the little one is still in no hurry to enter the light of God ... This situation is familiar to every 10th woman. And passively waiting for future fights is not always the ideal solution.

When labor stimulation is really needed, whether it is dangerous, and how it is carried out - we understand the nuances.

Indications for labor induction - who decides to induce labor and when?

The term "induction of labor" is used when labor has to be induced artificially at some point in the pregnancy.

It is worth noting that in the period from the 37th to the week, labor induction is not required if there is no indication for it.

Also, it is not needed in the case of a normal birth.

Experts consider indications for the stimulation of labor activity ...

True.
Identification of pathological changes in the placenta.
Symptoms of any disorders that are dangerous to the health and life of the fetus.
Late toxicosis (not always).
Early broken water (given the high risk of infection through the cervix).
Placental abruption.
Certain chronic diseases of the mother. In particular, diabetes, hypertension, etc.

Naturally, the decision to induce labor is made by only a doctor and only after a full examination , which will establish that further pregnancy can harm the baby or mother.

It is worth noting that a post-term pregnancy is not just an extra week or two of discomfort for the mother, it is, first of all, the risk of bleeding in the mother, hypoxia in the baby, as well as weak labor, etc. Therefore, if the doctor decides to stimulate labor need strictly follow the instructions!

If you have any doubts whether it is worth doing stimulation, you can contact another specialist to make sure that the decision was made correctly.
It is impossible to rely solely on the date of the birth expected by the doctor (or on your own date) when making a decision. That's why this date is "estimated". That is, the decision is made only after 40 obstetric weeks - and only according to indications.

Possible complications and consequences of labor stimulation - why is it dangerous for the mother and baby?

Stimulation of childbirth is far from an “ordinary” phenomenon. This is an extremely emergency option for childbirth, which, in fact, should be natural and without medical intervention.

Of course, any interference with the natural process cannot be beneficial - but, in most cases, stimulation does not cause significant harm.

However, it is worth mentioning the possible risks for the baby from using this procedure:

Hypoxia.
CNS disorders in the baby after birth.

Risks for mom:

Painful childbirth: stimulated contractions are always stronger than usual - and with shorter breaks.
It is impossible to move under a dropper, which complicates the general condition of the woman in labor.
Stimulation does not work in all cases, and then a caesarean section is indispensable.

3 methods of stimulating labor in the maternity hospital

The conclusion - whether there is a gestation - is made by specialists at a certain time (closer to the expected date of birth) and solely on the basis of research:

Cardiotocography.
Assessment of all parameters (fetal size, fluid composition, placenta condition, etc.).

If, according to the results of the examination, a thickening of the bones of the fetal skull, oligohydramnios, aging of the placenta or other signs indicating overmaturity are revealed, then an appropriate decision is made on artificial stimulation of labor.

All methods are classified into 2 groups:

Methods and means that accelerate the opening of the cervix.
Methods and means for stimulating uterine contractions.

The most popular medical methods of labor induction include the following:

Amniotomy. In this case, a specialist inserts a special tool-hook through the cervix and, having hooked the amniotic membrane, punctures the bladder, as a result of which water is poured out and contractions begin. The opening of the bladder also stimulates the production of prostaglandins, which enhance labor activity. The method is often used, but it is considered risky due to the possible infection, especially if the method could not start the birth process. Also, possible risks include prolapse of the umbilical cord (here, emergency honey / intervention will not be enough) and damage to blood vessels with subsequent bleeding. The procedure is absolutely painless.
Oxytocin. An agent that is a synthesized analogue of a hormone produced by the pituitary gland. This drug in the form of tablets or a solution is used to activate the contractile abilities of the muscles of the uterus in various cases - to stimulate labor or lactation, with postpartum hemorrhage, with weak labor activity. In order to avoid complications, the use of the drug is excluded in case of an abnormal position of the fetus, scars on the uterus, placenta previa, as well as in the narrow pelvis of the mother. The dosage is usually selected specifically for each situation, taking into account the individual characteristics of the mother. Side effects and risks: increased labor pains, powerful contraction of the uterus (note - there is a risk of circulatory disorders in it and, as a result, hypoxia of the baby).
Prostaglandins. This tool is used in the case when the cervix is simply not ready for disclosure, although the process of childbirth is already underway. These hormones contribute to the rapid “ripening” of the uterus, which is immature for childbirth, stimulating smooth muscles, as well as acting stimulant on the cervix, on itself, and so on. When administering the drug, specialists seek to minimize the risk of a side effect of prostaglandins, using them in the form of a gel or suppositories. It is worth noting that tablets and solutions of the drug are often used during abortion, and the risks of using the drug during childbirth orally and intravenously are quite high: excessive stimulation of uterine contractions (note - with all the consequences), nausea and vomiting, and so on.

There are other drugs to stimulate labor, but they are used extremely rarely.

It is worth noting that drug stimulation is prescribed only in exceptional cases, when there is a threat to the life of the mother or baby.

Inducing labor at home is strongly discouraged unless you have an OB/GYN nearby or your doctor has advised you to do so.

Any actions that can lead to the approach of childbirth - only on the recommendation of your gynecologist!

The main "techniques" that are used at home to stimulate childbirth include ...

Nipple stimulation. Such massage provokes the production of oxytocin, which in turn stimulates childbirth. That is why early attachment of the baby to the breast after childbirth helps to accelerate the birth of a child's place and reduce the risk of bleeding. If you do not plan to give birth ahead of time, then you should be more careful with intimate relationships if they are present at a later date (do not overdo it).
Enema. Intestinal contraction also promotes the release of prostaglandins.
Proximity. The most well-known method of approaching childbirth, but very risky in the later stages. It is worth saying that uterine contraction and the production of oxytocin are guaranteed, and in the male seed there are prostaglandins that soften the cervix.
"Up down" : Walking up and down the stairs can help a mother who is a little late in labor.
Squats, long walks. Remember that excessive loads lead to placental abruption.
Spicy dishes. Spicy spices in food are stimulants for intestinal contractions, and after it - for the walls of the uterus.

In addition to these, there are other ways to bring the moment of childbirth closer, including funny, dangerous and downright stupid.

Video: Natural methods of inducing labor

But it is important to remember the main thing:

Do not use any means and methods for approaching childbirth if your due date has not yet come, and there are no such doctor's recommendations. You risk harming yourself and your baby, and the consequences can be unpredictable.
Pregnancy fatigue is not a reason to induce labor!
Any remedy for stimulating labor can turn into a tragedy if there are no qualified doctors nearby, if it takes a long time to get to the hospital, if the mother has a narrow pelvis and cannot give birth on her own (in an emergency), if the baby lies upside down, and in other cases.
It is strictly forbidden to stimulate labor on your own at home with medical methods, including candles and acupuncture.

If the results of the examination show that everything is in order with the little one, and the doctor recommends waiting a little longer, do not rush the baby - let him live in the belly. Give him time - he will decide when it is time to be born.

The site site reminds: this article in no way replaces the relationship between a doctor and a patient. It is informative in nature, it cannot be considered as a guide for self-treatment and diagnosis.

Pathological symptoms and some physiological conditions of a pregnant woman require the direct intervention of the attending physician!

Childbirth is a complex physiological process of expulsion of the fetus from the uterine cavity. After the opening of the cervix in the first stage of labor, the baby begins to move through the birth canal due to uterine contractions - contractions. In the second period, contractions (contractions of the abdominal and diaphragm muscles) join the contractions, as a result of which the baby is born into the world. After that, the placenta quickly separates and the placenta exits. Here it is, the happy ending!

To start normal labor, two basic conditions are needed: a mature cervix and sufficient strength and duration of contractions. Typically, the cervix "ripens" (i.e., becomes soft, shortens to 1 cm or less, and dilates by more than 1 finger) by the 38th to 39th week of pregnancy. With the onset of labor, the cervix continues to open and smooth out. This is due to contractions, as well as pressure on her fetus. An important role is played by the fetal bladder, which "weds" into the opening of the cervix, contributing to its opening. For the successful completion of the first stage of labor, uterine contractions must be sufficiently strong, long-lasting and occur at regular intervals.

In cases where the contractions are not intense enough, short or rare, they speak of the weakness of labor activity. This condition is also indicated by a low rate of cervical dilatation (normally 1 cm per hour). Also, this condition is diagnosed through observation, CTG (cardiotocography) and vaginal examination.

There are primary and secondary weakness of labor activity. The primary is manifested by contractions of weak strength, a violation of their rhythm and duration from the very beginning of childbirth. The second option is characterized by the appearance of the same changes, but not immediately, but after a certain period of time after the development of normal labor activity.

What is the danger of weakness of labor activity?

Many expectant mothers are perplexed - is labor stimulation really necessary? After all, you can often hear arguments about how they gave birth in the old days for several days, and nothing - everyone treated this normally. But it is important to understand that such a situation is not at all the norm and threatens the development of serious complications. For a baby, the danger of weak labor activity is to increase the risk of developing severe oxygen starvation, which is fraught with neurological disorders and cerebral circulation disorders in the newborn. In addition, during prolonged labor, amniotic fluid may enter the lungs of the fetus, leading to inflammation of the lungs and impaired breathing of the child after birth. These consequences often require long-term observation and treatment of the baby in the future.

On the part of the mother, there is a threat of birth injuries, and as a result of insufficient contraction of the uterus in the postpartum period, bleeding may begin.

Therefore, in all cases of development of weakness of labor activity, it is necessary to stimulate it - to increase the strength, duration and frequency of contractions.

Stimulation in childbirth: let's try without drugs

Most often, the concept of "rodostimulation" in expectant mothers is associated with the use of special medications, but, in addition to this, there are a number of non-drug ways to normalize labor activity:

The active behavior of the woman in labor contributes to the strengthening of labor activity.
Stimulation of the areolas (nipple circles) and nipples of the mammary glands leads to the release of the hormone oxytocin, which enhances uterine contractions.
Labor activity is enhanced when the position of the woman on her side, the same name as the position of the fetus.
Amniotomy (opening the membranes) is an effective measure to activate contractions. This is explained by the fact that after the discharge of amniotic fluid, the volume of the uterus decreases, which allows it to contract more efficiently. In addition, amniotomy activates the formation of prostaglandins - substances that are powerful stimulants of uterine contractions. This manipulation is painless, since there are no pain receptors on the surface of the membranes.

Medical stimulation during childbirth

Before starting medical stimulation in childbirth, it is very important to assess the condition of the woman in labor. When she is tired, a drug sleep is prescribed, which lasts about 2 hours. The positive effect is due to the fact that during this period, childbirth does not stop, and the cervix continues to open. Often, after a rested woman in labor wakes up, labor activity returns to normal, and the need for labor stimulation may disappear. If this measure did not help, then, as a rule, the doctor decides on drug stimulation during childbirth.

To date, drugs of the prostaglandin group and oxytocin are used for this purpose.

Prostaglandins are biologically active substances that trigger regular labor activity. They contribute to the opening of the cervix and increase its contractions. Prostaglandins are used with the development of primary weakness of labor or with the development of secondary weakness of labor, if the cervical dilatation is not more than 6 cm. These drugs also have side effects - nausea, vomiting, increased blood pressure, increased heart rate, bronchospasm (difficulty respiration due to a decrease in the lumen of the bronchi). Given this, contraindications for the appointment of such drugs are bronchial asthma, increased blood and intraocular pressure (glaucoma), severe liver and kidney diseases. These drugs are administered intravenously.

Oxytocin (from the Greek oxys - fast, tokos - childbirth) is a synthetic analogue of the hormone oxytocin, which is responsible for the contractility of the uterus. Since the most common cause of the development of weakness in labor is the insufficient production of one's own oxytocin, the introduction of this substance helps to correct the situation and normalize the process of childbirth. Sensitivity to oxytocin increases towards the end of the first stage of labor, so it is most effective for secondary weakness of labor and weakness of attempts. It is also administered intravenously.

The introduction of these drugs requires constant supervision of an obstetrician-gynecologist and midwife. Careful monitoring of the contractile activity of the uterus and the condition of the fetus is necessary. It is important to prevent an overdose of prostaglandins and oxytocin, which causes uterine hypertonicity, which, in turn, leads to impaired uteroplacental circulation and intrauterine suffering of the baby, premature detachment of the placenta.

Along with the stimulation of labor, antispasmodic drugs are usually administered to relieve spasm of the cervix during contractions and soften it. Strengthening contractions with a dense cervix leads to its rupture. To prevent fetal oxygen starvation, drugs are prescribed that improve uteroplacental blood flow and increase the resistance of fetal brain cells to oxygen deficiency.

With persistent weakness of labor, combined with other diseases, and with the impossibility of natural childbirth, a caesarean section is indicated.

Conditions for labor stimulation are:

Correspondence of the size of the fetal head to the mother's pelvis, which shows the possibility of the fetus moving through the pelvic cavity during childbirth;
Satisfactory condition of the baby (according to cardiotocography, ultrasound, Doppler uteroplacental blood flow). With oxygen starvation of the fetus, it is impossible to perform rhodostimulation, as this can lead to vasospasm, disruption of the uteroplacental circulation and deterioration of the child's condition.
Absence of a fetal bladder. Rhodostimulation is not carried out with a whole fetal bladder. This threatens with a serious complication - placental abruption due to an excessive increase in intrauterine pressure. Usually, with the development of weakness in labor, an amniotomy is first performed (puncture of the fetal bladder), and then the woman in labor is observed for 2 hours. If during this time labor activity has not returned to normal, drug stimulation is prescribed.

Is it possible to avoid stimulation in childbirth?

Prevention of the development of weakness of labor activity is largely a normal pregnancy. For the expectant mother, a full-fledged sleep is necessary - at least 8 hours a day, a rational balanced diet, favorable conditions for psychological comfort. An important role is played by the absence of chronic foci of infection, good physical shape, training at school for pregnant women and support from relatives. Gymnastics for pregnant women, breathing exercises, swimming in the pool, yoga, outdoor walks are recommended. Also, the expectant mother needs to take vitamins (B6, ascorbic and folic acid), which have the ability to increase the energy potential of the uterus.

Such different concepts

It is important to understand that labor stimulation and labor induction are two completely different procedures. Rhodostimulation is always an intensification of already existing contractions, when labor activity began on its own, but then there was a failure in its normal development, and it began to weaken. Labor induction is carried out if it is necessary to induce labor, when there are no contractions yet.

Causes of weakness of labor activity:

previous abortions, miscarriages, curettage of the uterus, inflammatory diseases of the female genital organs, uterine fibroids, hormonal disorders and chronic diseases;
the age of the primipara is less than 18 and more than 35 years;
a large number of births (4 or more);
causes leading to overstretching of the uterus (large fetus, polyhydramnios, multiple pregnancy), preventing the full contraction of the myometrium - the muscles of the uterus;
hereditary predisposition, which can be traced through the female line;
complications of the course of pregnancy - postmaturity, fetoplacental insufficiency (i.e., the inability of the placenta to meet the needs of the developing fetus);
woman's fear of pain, lack of psychological attitude to childbirth.

When is it not possible to induce labor?

Contraindications for labor stimulation are the presence of a scar on the uterus, incorrect position of the fetus, its oxygen starvation, a clinically narrow pelvis (a situation where the size of the fetal head does not correspond to the size of the mother's pelvis), placenta previa (when the placenta blocks the exit from the uterus), severe preeclampsia, fatigue women in labor.

Nature made sure that children could be born without outside help. Of course, without medical attention, any complications can lead to fatal consequences. Fortunately, in the modern world, women are not left alone with their problems. Labor usually begins between 38 and 42 weeks of gestation.

At the same time, they develop naturally and end with the birth of a child. But if the baby is in no hurry to be born at the appointed time, doctors may prescribe labor induction.

In what cases may stimulation of labor activity be required? There are several indications for stimulating the onset of labor:

First of all, labor induction when overwearing. As you know, full-term births are considered starting from the 38th week, and at 42 weeks they talk about a post-term pregnancy. This entails certain risks: the placenta begins to age and no longer cope with its functions. The amniotic fluid changes color due to the accumulated toxins in them, the child may experience chronic oxygen starvation. Usually, when overwearing, stimulation is prescribed between 41 and 42 weeks, and in the presence of signs of prolongation, and at 40 weeks;
If the uterus is distended too much due to multiple pregnancy or polyhydramnios, most likely, it will also come from artificial stimulation of labor in the maternity hospital;
chronic diseases, such as diabetes, some disorders in the cardiovascular system, kidney disease and other ailments that threaten the health of the mother and child, can also be a reason for stimulation as early as 38 weeks;
Labor induction may also be needed for those who already have amniotic fluid broke but contractions don't start for 12 hours or more. The fact is that after the rupture of the amniotic sac, the child becomes vulnerable to various infections.

In some cases, stimulation may also be needed when labor activity began spontaneously, but for one reason or another does not lead to natural delivery: contractions begin to fade or the cervix does not open.

What is the danger of labor stimulation: consequences

Like any intervention in the natural course of labor, induction of labor has consequences, including negative ones.

Why is labor induction dangerous? First of all, it is worth mentioning that artificially induced contractions are often much more painful, and therefore there is a need for additional anesthesia.

Some types of stimulation require the introduction of drugs using a dropper, which creates additional inconvenience: the woman is forced to lie on her back, limited in her movements. But this is far from the most comfortable position for a woman in labor, it is much more convenient to walk or lie on her side.

In addition, stimulation in some cases causes the child to oxygen starvation, which is unlikely to have a positive effect on his health.

Sometimes stimulation does not give any results, in this case, depending on which method of stimulation is chosen, it is either postponed to another time, or a caesarean section has to be performed. Given all this, it is necessary to weigh the pros and cons before agreeing to induce labor.

The doctor must be 100% sure that artificial stimulation is really necessary, that it will be more useful for the baby to be born right now and in this way.

There is evidence that with artificial stimulation of labor in the maternity hospital, forceps and other similar instruments are much more likely to be used. Many experts advocate that the stimulation itself becomes the reason for this. However, it is quite possible that the same complications that led to the need to stimulate labor activity lead to such consequences.

Is labor induction harmful? Certainly yes. Like any artificial intervention in a natural process. But according to the indications described above, such an approach to childbirth is really necessary.

Contraindications for labor induction

Like any medical procedure, labor induction has a list of contraindications. In particular, stimulation is not carried out if a woman, after a cesarean section in a previous birth, plans to give birth a second time on her own. Hyperstimulation of the uterus can lead to rupture along the old suture.

In addition, the incorrect position of the fetus or its size, in particular, the discrepancy between the size of the fetal head and the size of the small pelvis can also become a contraindication to labor induction. As well as the state of health of the fetus, based on CTG.

Types of stimulation

Depending on the indications and the stage at which labor activity is located, if any, various methods of stimulation are used.

Detachment of amniotic membranes

When overstaying a pregnancy, doctors sometimes resort to a procedure such as detachment of the amniotic membranes. This is done during a routine gynecological examination. The doctor carefully peels off the amniotic membrane at the very pharynx of the uterus, which causes the onset of contractions. This procedure does not always lead to the desired results the first time.

Sometimes it is necessary to repeat it several times. If the desired effect cannot be achieved, then the stimulation is transferred or resorted to other methods.

This method of stimulation does not carry any special risks. A woman should not experience pain during the detachment of the membranes, since they do not have nerve endings. However, some discomfort is still possible.

Prostaglandins

Much more often they resort to another method - the introduction of prostaglandins. Prostaglandins are physiologically active substances that the human body produces on its own, and they are found in almost all organs and tissues of the body, as well as in all natural secretions. Especially theirs in semen and amniotic fluid. Prostaglandins act on the cervix, causing it to ripen and dilate.

Prostaglandin preparations are administered vaginally: in the form of suppositories or gel. Neither the gel nor the candles hinder the woman's movements, do not cause any discomfort. Usually, contractions begin within half an hour after stimulation of labor with the gel, however, in some cases, labor does not begin after the introduction of the gel. If there are no contractions within a day after the introduction of drugs to stimulate labor, they can be re-introduced.

Why is this method preferred by gynecologists? The fact is that the gel for stimulating labor has practically no contraindications and side effects. Of course, the risk of hyperstimulation remains in this case, but it is much lower than with other methods. In addition, it does not penetrate the amniotic membrane, which means it does not have any effect on the baby.

Unfortunately, in some cases, prostaglandin can slow down the transition to the active stage of labor.

Puncture of the amniotic sac

The puncture of the amniotic sac as a stimulation of the onset of labor is used extremely rarely, as this is associated with some risks. In particular, the rupture of the amniotic sac leaves the fetus without natural protection, which can cause infection. In addition, if the breakthrough of the bladder does not cause the development of labor, you will have to resort to other methods of stimulation, or even to a caesarean section.

More often this method is used to speed up labor in the event that the contractions are delayed. The puncture of the amniotic bladder is done during a routine gynecological examination using an amino hook - a long plastic hook-shaped instrument that is inserted into the vagina, and through the cervix they pick up the amniotic membrane and pierce it, which causes the outflow of amniotic fluid.

Usually, the amniotic sac is punctured when the baby's head has already sunk into the pelvic area. In such a situation, the amniotic membrane is pinched, and the vessels of the amniotic sac are also pinched. Otherwise, when punctured, there is a risk of damaging the blood vessel and causing bleeding.

In addition, there is a risk of umbilical cord prolapse, which also leads to risks for the child: when passing through the birth canal, the fetus will squeeze the umbilical cord, and thereby deprive itself of oxygen. This is another reason why bladder puncture, as a way to provoke the onset of labor, is extremely rarely resorted to.

Oxytocin

Oxytocin is an artificially synthesized analogue of a natural hormone that stimulates uterine contractions. It is produced by the pituitary gland under the influence of other hormones. Oxytocin is usually used if there is an attenuation of labor activity, a decrease in the intensity of contractions. It is administered intravenously with a dropper.

An overdose of oxytocin very quickly leads to oxygen starvation of the fetus and even to hyperstimulation of the uterus, so this is done under the supervision of a doctor. In parallel with the introduction of oxytocin, the condition of the child, as well as the intensity of contractions, is necessarily monitored.

If symptoms of fetal hypoxia begin to be observed, the administration of oxytocin is immediately stopped, and in some cases special drugs are administered that reduce the contractile activity of the uterus.

Considering that some women have hypersensitivity to oxytocin, the doses of the drug are selected strictly individually, according to preliminary analyzes.

It is with oxytocin that, as a rule, the main complaints of women about excessive pain in contractions are associated. Therefore, very often, in parallel with the introduction of the hormone, analgesic procedures or epidural anesthesia are practiced.

Recently, doctors have begun using birth control pills containing artificially synthesized antigestogens. These drugs block a number of uterine receptors that are responsible for blocking progesterone.

As a result, the balance of the hormones progesterone and estrogen changes in favor of progesterone, which leads to the development of labor. In addition, hormones have a positive effect on the cervix, accelerating its maturation and opening.

Previously, such drugs were used for emergency contraception and early termination of pregnancy, up to 5-7 weeks. In these cases, the effectiveness is achieved due to the same hanging of the progesterone level.

Because these drugs are known to be abortifacient, many women are wary of taking them, believing that it will adversely affect the fetus. However, this drug has practically no effect on the condition of the mother and child.

According to the degree of ease of use, effectiveness and number of side effects, at this stage, this method of stimulating labor and preparing the cervix for opening can be considered the most preferable.

The number of caesarean sections with the use of antihistogens, such as mifepristone and miropristone to stimulate labor, is significantly lower than with other methods of stimulation.

Contraindications for the use of this drug may be liver and adrenal insufficiency, asthma, diabetes, bleeding disorders, as well as individual intolerance to the drug.

It is quite natural to be afraid of new and untested, unfamiliar methods of influence. If you are offered this method of stimulation, and you are still afraid to use it, consult with several good doctors, find out from them about the pros and cons of pills, and only then make a decision.

Natural methods of stimulation

We examined the methods of stimulation in the maternity hospital, but in fairness it is worth mentioning that you can be stimulated at home. If, after talking with your doctor, you yourself already understand the need to speed up the onset of labor, and you have already been assigned a stimulation day, you can try resorting to one of the ways to naturally stimulate labor. However, it is still recommended to consult with your doctor first.

The easiest, most obvious and natural way to induce labor at home is to sex. It is also jokingly called male therapy. During sex, and especially orgasm, uterine contractions occur, which can become the natural onset of childbirth. In addition, during sex, natural oxytocin is released into the blood of a woman, and semen, as already mentioned, contains a large amount of prostaglandins. As a result, the stimulation is really natural and complex.

Of course, having sex for a long time is not very convenient, you will have to choose positions in which both partners will be able to relax and have fun. In addition, it is psychologically difficult for some men to have sex with a woman before childbirth. However, all these problems are fairly easy to overcome.

Some apply Castor oil to simulate childbirth. There is no data on how this method actually works, and whether it really works. In general, castor oil is a fairly strong laxative. It is assumed that the increased work of the intestine has an effect on the uterus, which causes labor. Castor oil to stimulate labor is a rather controversial remedy, as it can cause nausea and diarrhea, which is not pleasant, and is also fraught with large water loss.

Walking and light exercise can also induce labor, so they can also be used to stimulate labor at home. It often happens that in recent weeks a woman has been eager to wash the floors, rearrange some things in the house, and her relatives dissuade her from this. Now is the time to satisfy your need to improve your own home. This will help to simultaneously exercise your instincts and calm down, and also speed up the birth of the baby.

Acupuncture can also be a way to naturally stimulate labor. As you know, such a doctrine as acupuncture claims that there are points on the body that are responsible for the functioning of various organs and body systems. An injection with a fine game at the right point, which is responsible for the uterus and its condition, can contribute to the onset of childbirth.

In conclusion, I would like to say that you should not be afraid of stimulation, although it is important to understand how much it is really necessary in your case. Remember that without your consent, doctors have no right to carry out any intervention in the natural process of childbirth. And no one has the right to force you.

Answers

Induction of labor is a measure to accelerate the onset of labor. It happens medical, that is, it is carried out in a maternity hospital, and independent. The latter represents the actions that the expectant mother herself performs in order to speed up the process. Natural stimulation of labor is possible if the doctor gives the go-ahead, and the pregnancy is full-term. In the maternity hospital, doctors will carry out any actions only if the pregnancy is post-term and there are no contraindications for natural delivery.

Why Women Decide on Natural Labor Induction Methods

We will give just a few of the reasons.

1. Protein in the urine and periodic increase in blood pressure. These are well-known symptoms of incipient preeclampsia - a severe pathology of pregnancy, dangerous for both the mother and the baby, the treatment of which is only childbirth. Meanwhile, true preeclampsia is a contraindication to certain types of stimulation. For example, at high pressure, the administration of oxytocin is contraindicated. Yes, and self-stimulation of childbirth is also not safe. It is possible to provoke an untimely, too early separation of the placenta.

2. They are afraid of the birth of a child that is too large, more precisely, birth injuries, ruptures of the perineum and cervix. In this case, there are indications for inducing labor only if the mother has a narrow pelvis. It happens that doctors say that you will give birth to a child with such a weight, but with this it is no longer. Although in this case, not even the weight plays a role, but the circumference of the head. If she is 36 cm or more, problems may arise. However, if at 32-34 weeks a tendency to a large fetus was set, this does not mean at all that this trend will continue to the birth. It often happens that a woman has a large belly, and a large fetus was previously placed, and an ordinary, average baby weighing 3300-3500 grams is born. That is, natural stimulation of labor carried out at home at 40 weeks is not required at all.

3. Feel bad: there are problems with sleep, lower back hurts, leg cramps tormented, frequent going to the toilet, tachycardia, etc. But this is not a reason to hasten the onset of labor. Just a little more patience. Then you will miss your pregnancy.

4. The expected date of delivery has arrived. Not all women give birth on this day. Childbirth at 41 and even at 42 weeks is considered the norm, if there are no signs of a prematurity of the fetus. They are detected by ultrasound and CTG.

5. False contractions often appear, but they do not turn into true ones. Braxton Higgs contractions in some women occur from 20 weeks ... This is not an indicator that labor is about to begin. But not a reason to induce labor itself.

6. There are no symptoms of impending labor. In fact, some women do not have any precursors until the very contractions. For many, the mucous plug only comes off during contractions, then the stomach drops. Well, the “cleansing” of the body is generally a very subjective sign of an early birth.

7. I want to give birth on a certain day or, conversely, not to give birth, for example, on a holiday. Childbirth is triggered not so much by the mother's body as by the child himself, when he is ready for them. Many mothers worry that giving birth on the holidays is not safe. Allegedly, doctors and midwives will celebrate, drink, and they will not care about women in labor. This is not true. Ordinary horror stories. A child born on a holiday will probably even be proud of his date of birth.

Natural Ways to Induce Labor: An Overview of Techniques

1. Primrose oil and other remedies from naturopaths and herbalists. It is taken orally, in the form of capsules, a dietary supplement sold in a pharmacy, at a dosage of 500-2000 mg per day. Primrose oil is also used as a lubricant for perineal massage. Massage is recommended for all nulliparous women, as it is a kind of prevention of perineal ruptures during childbirth, improving elasticity. It is necessary to pull it down with 2-3 fingers. There should be no pain, you need to do it very carefully.
Primrose oil is said to contain prostaglandins, which is why it is so effective.

2. Various "laxative" techniques. The most popular is castor oil. Recommended dosages from experienced mothers and doctors vary. Someone says that you need to drink the whole vial, and someone - that two tablespoons is enough. Read the instructions or ask your doctor.

Why give yourself diarrhea at all? Of course, this is not the point, but the activation of intestinal motility. The intestines, in turn, will tone the uterus.

You can use an enema with water or glycerin suppositories for the same purpose. It is very good to eat foods with a laxative effect, such as cabbage, beets, cucumbers, prunes, vegetable oil, etc.

3. Physical activity. Walking up and down stairs is usually advised, but walking on level ground will do. The main thing is to be more upright so that the fetus quickly sinks deeper into the pelvis and thereby stimulates the opening of the cervix.

4. Sex. Without a condom and with the obligatory strong excitement and orgasm. This will bring the uterus into hypertonicity, and the sperm will contribute to the rapid maturation of the cervix, as it contains prostaglandins - substances that are used even in maternity hospitals to stimulate labor. The effect of one sexual intercourse is unlikely to be. It will take more than one day of active sex life.

5. Conversation with an unborn child. Tell him how you and all your relatives are waiting for him, love him, how much you bought for him, how you prepared. Even doctors agree that such conversations are effective.

6. Meditation and taking sedatives (valerian tablets). Stop waiting for childbirth, pay attention to any little thing, and they will begin faster. Relieve stress.

7. The so-called exercises that stimulate the onset of childbirth. The simplest is squatting or mopping on all fours.

8. Obstetric cocktail. There are different folk recipes, but they all boil down to the fact that a generic cocktail (not necessarily liquid, it can be a salad, for example) should contain substances that promote the maturation of the cervix and have a stimulating effect on intestinal motility. One American café even has a "labor-inducing salad" on the menu.
The labor-inducing foods include ginger, pineapple, licorice, eggplant, pepper, vinegar, and cinnamon.

9. Stimulation of the nipples with hands and a breast pump. You can simply massage the chest in a circle. But it is more effective to take a breast pump and try to "pump". This will lead to a very active production of oxytocin and will tone the uterus. If you notice colostrum - it's not scary. The mammary glands have long been prepared for breastfeeding.

Artificial stimulation of labor

Doctors often observe two trends among women with full-term pregnancies:

simple, in terms of assistance and effectiveness of manipulations - when there are all obstetric harbingers of the imminent birth of a child, but the uterus is calm, there is no hypertonicity;
more complex - when the birth canal is not yet ready, that is, the cervical canal is tightly closed and has a length of more than 3-4 cm according to the results of a manual examination by a gynecologist and (or) ultrasound using a vaginal probe.

In the first case, to provoke labor, doctors perform an amniotomy or puncture of the amniotic sac. The anterior waters recede, the fetus descends lower into the pelvis. Contractions appear within 1-2 hours. If there are no contractions, they put a dropper with oxytocin for the entire period of contractions and attempts. Oxytocin provokes active contractions.

If the cervix is not ready, the bladder will not be punctured, first by introducing a special gel or medication, by mifepristone tablets, the cervix is prepared for opening. It should become shorter and softer. With a small opening, an amniotomy is performed and, if necessary, oxytocin is administered.

Many women are very afraid of the puncture procedure and the so-called manual separation of the membranes. But this is not scary at all, does not cause pain and, of course, does not require anesthesia. Much more unpleasant are frequent examinations of the cervix in the process of its gradual opening and other obstetric manipulations.

Stimulation can be artificial or natural, it is not so important what prompted the onset of labor. The most important thing is that they pass quickly and without injury.