Medical methods of labor induction. Labor with stimulation

Labor induction- this is an artificial induction of labor at various stages of pregnancy and the activation of labor activity already during childbirth. First of all, we note that urgent childbirth (childbirth on time) occur between 37 and 42 weeks. And with normally flowing childbirthstimulationchildbirth not required.

Nature is designed to childbirth started at 39-40 weeks of gestation. But sometimes it happens that childbirth late ... After 40 weeks, the doctors insistently suggest that mommy go to the hospital for artificial stimulationchildbirth.

Labor induction is used only as a last resort, when something threatens the child or his mother. Also, if you are overstaying your due date and still aren't going into labor, doctors may suggest induction. From some of the reasons leading to "overwear", and hence to stimulation, you can get rid of yourself, without resorting to the help of doctors. For example, the fear of childbirth, as well as the use of drugs, including painkillers, can lead to artificial stimulation.

All methods of stimulation can be divided into two types, which stimulate the ability of the uterus to contract, and which accelerate the process of opening the cervix. Stimulationchildbirth is a fairly common procedure in modern maternity hospitals. Sometimes with a normal start generic activity, there is a weakening or complete attenuation of contractions. And with normally flowing childbirthstimulationchildbirth not required. Medical stimulationchildbirth At home, labor induction (in the absence of an experienced obstetrician-gynecologist nearby) is contraindicated.

Amniotomy- opening the fetal bladder, is one of the most popular means that affect the active contraction of the uterus. The essence of this method of stimulation lies in the fact that the doctor pierces the fetal bladder with a special tool similar to a hook, after which the water leaves. After that, the pressure inside the uterus drops sharply, the child begins to put pressure on the pelvic bones, the cervix opens and provokes childbirth. This method is considered safe, and it does not affect the child's condition in any way. In addition, an amniotomy is an absolutely painless procedure, and only in rare cases it may not be particularly pleasant. It is worth considering that for medical reasons, this stimulation can be resorted to only after the baby's head enters the small pelvis. Otherwise, you may need a drug to stimulate contractions. Now, for these purposes, Oxytocin is used in medicine.

Oxytocin is an analogue of a hormone produced by the pituitary gland. The action of this drug is aimed at stimulating the contractions of the muscular tissues of the uterus, but does not affect the readiness, for disclosure, of the cervix. It is mainly administered intravenously, although there are also solutions for intramuscular injections, and even tablets. When exposed to oxytocin, labor pain increases, so it is used together with antispasmodics. For each woman, doses are selected individually. The action of oxytocin is based on its ability stimulate contraction of the muscle fibers of the uterus.

Prostaglandins- hormones that affect the readiness of the cervix to dilate. These hormones are found in large quantities in seminal fluid and amniotic fluid. For artificial stimulation, prostaglandin suppositories and gels are used, their action is also aimed at stimulating uterine contractions.

The decision on the need for stimulation is made by the doctor, taking into account the conditions of the course of pregnancy.

The 40th week is approaching, but the birth does not begin in any way, or maybe they don’t want to continue, what should I do? Whether it is necessary to resort to excitation or stimulation of childbirth. How does this happen and what are the consequences for the child?

When the due date is approaching, doctors conduct studies (ultrasound, cardiotocography, etc.), according to the results, determine whether the pregnancy is overdue or not?

The doctor looks at such signs: a decrease in the thickness of the placenta, relative oligohydramnios, thickening of the bones of the skull. In such cases, it is recommended to carry out labor induction. Labor induction is done not only with overwearing, but also with preeclampsia, fetoplacental insufficiency. And only after all these studies is it concluded that need whether to call artificial stimulationchildbirth.

So what are the ways stimulationchildbirth do doctors have in their arsenal? To stimulate labor, doctors use:

• amniotomy - artificial rupture of the fetal bladder. They make a puncture in the fetal bladder with a tool that looks like a hook. This procedure is almost painless, since the fetal bladder has no nerve endings, the painlessness of the procedure depends on the professionalism of the doctor who performs the amniotomy. As a result of amniotomy, amniotic fluid begins to drain, after 2-3 hours the birth process starts
• The use of a special gel, which includes prostaglandins in its composition. The obstetrician inserts it into the cervical canal. Prostaglandins contribute to the fact that the cervix "ripens" faster, these hormones stimulate the process of uterine contraction. The procedure is painless, the procedure takes no more than 5 minutes. Childbirth begins after 9-10 hours after the procedure.

Medical stimulationchildbirth carried out strictly according to indications, in the presence of a threat to the life of the fetus or mother.

Stimulation of childbirth - why is it needed?

Stimulation of labor is needed when labor is weak, when labor has already begun, there are contractions, but they are weak, the cervix opens slowly.

12 hours - the time spent by those who give birth for the first time; in the second - 8 hours. If the birth is delayed, the child may suffer, then they resort to stimulation.

There are main drugs that are used to stimulate labor - prostaglandins and oxytocin.
Prostaglandins are used when the weakness of labor activity is observed when the cervix is ​​dilated up to 4 cm. Oxytocin is used at the stage of uterine dilatation from 5 cm to 10-12 cm, during the period of attempts. Prostaglandins and oxytocin are administered intravenously. Oxytocin begins to act, pain intensifies, it should be used in combination with antispasmodics (drugs that relax the muscles of the uterus). There are no standard schemes for the use of oxytocin, different women react to the same dose in different ways, doses must be selected individually.

Note that the condition of the child should be assessed more often than usual (in the 2nd period after each attempt) using cardiotocography or a conventional obstetric tube.

Within 4-6 hours after the administration of stimulant substances, doctors evaluate whether the drugs are useful, if not, then they consider the option of a caesarean section.

In some cases, doctors do not use stimulants, but sedatives, which are required in cases where a woman is physically tired from prolonged contractions. There is still a period of pushing ahead, when a woman pushes to give birth to a child. In such situations, doctors administer sedatives to the woman so that she can rest a little, gain strength before the upcoming attempts.

Is labor induction necessary?

Labor induction is an emergency option for obstetrics, it is necessary that the woman give birth herself and she does not need serious medical intervention. The expectant mother needs to know how to act correctly during childbirth, how to breathe during contractions and attempts. It is desirable that the expectant mother has been trained in a school for pregnant women and knows what childbirth is. Then it is likely that she will not need stimulation.

It is better for the child if the birth takes place without stimulation. When childbirth occurs naturally and the process is not accelerated, the baby experiences less stress when passing through the birth canal. During labor stimulation, a child may experience hypoxia - a lack of oxygen, which is very bad for the baby.

Contractions may not occur, the cervix may not “ripen”, and these means of stimulation are guaranteed to provide hypoxia to the child. The child's brain suffers from hypoxia, but how severe the damage is visible only after birth. The consequences may be disorders of the central nervous system: regurgitation, delayed speech development, autism syndrome, ADHD, cerebral palsy, visual impairment, hearing impairment, epileptic syndrome

Children who are born as a result of stimulation of labor activity have a yellowish skin color. This is neonatal jaundice, which resolves within 2-3 weeks. The cause of jaundice is an increase in the blood substance bilirubin, which enters into a chemical reaction with oxytocin.

Labor induction points

Stimulation, or stimulationchildbirth at home is a procedure that induces contractions (uterine contractions) during pregnancy, but before the natural onset of labor.

Stimulate a point between the thumb and forefinger, a point at a height of 4 fingers from the ankle and a point in the corner of the little finger on the leg. Each point for 20 seconds, 2 minutes break and so on 3 times.

Methods for approaching childbirth with folk remedies at home:

If the due date set by the doctors is behind you, and labor has not begun, you can try to take the following actions.

• Take 3 times a day for 1 tablespoon of vegetable oil: it contains semi-saturated fatty acids, which contribute to the production of its own prostaglandins in the body. These substances help prepare the cervix for the upcoming process and start the birth mechanism.
• Drink any vegetable oils (olive, linseed, wheat germ, and so on) that are rich in vitamin E and omega 3 and 6 acids. Start with 1 tablespoon and work up to 3 tablespoons per day. It is better to drink on an empty stomach, but you can drink it in salads and with bread. The oil helps tissues and muscles to be elastic, prevents ruptures.
• It is necessary to drink tea from raspberry leaves. Brew 1 tbsp per 0.5 l. Start drinking no earlier than 36 weeks, because. can provoke childbirth. Start drinking 1 glass a day, from 38 weeks to 2 glasses, from 39 weeks to 3 glasses. Drink instead of tea and always drink warm or hot.
• Have sex: during sexual intercourse, the nerve cells of the cervix are irritated, a signal is sent to the pituitary gland, which “gives the command” for the body to produce oxytocin, the hormone that starts childbirth. manual or oral stimulation clitoris, even without orgasm, can also be effective to start childbirth. Semen contains prostaglandins that cause uterine contractions.
• Increase physical activity: you can walk up the stairs, wash the floors - all this helps to bring the birth closer. Excessive stress should be avoided, otherwise it can lead to placental abruption.

Remember that it is undesirable to give birth and stimulate labor at home if you want to give birth to a healthy child.

In this article:

When the pregnancy has come to an end in time, and childbirth has not yet occurred or labor is too weak, there is a need for stimulation of labor. Induction of labor is a natural or artificial acceleration of the activation of labor activity through the administration of medications or certain procedures.

Indications for labor induction

Labor induction is used in the case when a woman cannot give birth on her own due to the presence of such factors: overweight of the fetus or mother, the presence of some serious diseases in history (diabetes mellitus), placental abruption, early discharge of amniotic fluid, etc.

Mandatory stimulation of labor is carried out with placental abruption, when there is a possibility of bleeding and the life of the fetus is at risk. They stimulate labor activity when the pregnancy is overdue, and childbirth does not occur. Rare irregular contractions or their complete cessation, cases when a woman is completely exhausted after contractions are also a reason to induce labor. Large-scale and polyhydramnios is an indication for artificial stimulation, since in this case the birth may be delayed, and there is a possibility of hypoxia in the fetus.

Artificial methods of labor induction

During childbirth, the doctor monitors how the labor activity is progressing: he palpates the woman's abdomen, determines the frequency and number of contractions, their duration. The most accurate indicator is the disclosure of the cervix. If the cervix opens too slowly or the opening has stopped, then, if necessary, labor is stimulated.

Induction of labor can be carried out with the help of:

1. oxytocin;
2. prostaglandins (gel, suppositories);
3. amniotomy;
4. mifepristone, pencrofton, miropriston.

Oxytocin

To open the cervix, hormonal analogs are used to promote the opening and maturation of the cervix. The most effective and common drug is oxytocin. It refers to the method of artificial stimulation of labor by intravenous administration. It is used for weak labor, as a stimulation of lactation, as a remedy for postpartum hemorrhage.

There are some contraindications against the use of oxytocin. So, it cannot be prescribed if the woman has a very narrow pelvis or there is an anomaly in the position of the fetus. There is also the possibility of overdose or side effects due to inaccuracies in dosage. As a side effect, excessive contractions of the cervix may appear, which leads to impaired blood circulation and fetal hypoxia. Bleeding may develop.

Prostaglandins

Prostaglandins are used in medical practice as a means to stimulate labor. They are prescribed in cases where the cervix is ​​not ready to dilate. Normally, prostaglandins are found in the amniotic fluid, and in small amounts in the tissues of the body.

The safest is the use of a labor-stimulating agent in the form of a gel or suppositories - this method is the most gentle and effective. Labor induction gel, which contains prostaglandins, helps to improve hormonal levels and prepare the cervix for dilation and childbirth. Labor activity occurs within 4 hours after the introduction of the gel. Under the action of oxytocin, contraction of the cervix is ​​​​stimulated, pain is softened.
The gel is injected vaginally with a sterile syringe into the back wall of the vagina. After that, the woman needs to lie down to avoid the gel leaking out. If you enter the gel directly into the cervix, there is a possibility of hyperstimulation of labor. In the absence of the desired effect after 6 hours, the gel is reapplied. The maximum dose of the injected gel is no more than 3 ml in total.

Although the gel, as a labor accelerating agent, has good reviews, there are still a number of contraindications to the use of this gel. These include the presentation of the fetus, a clinically narrow pelvis in a woman, the presence of indications for a caesarean section.

Amniotomy

Folk methods of stimulation

Folk methods of stimulating labor include such remedies as castor oil (castor oil), champagne, the use of kelp, etc.

Castor oil

Induction of labor at home can be carried out with the help of an oil such as castor oil. Castor oil, due to its relaxing effect, can lead to the opening of the cervix and hasten childbirth, if taken in large quantities. To stimulate labor, you need to drink 1 tablespoon of castor oil. But still, modern medicine is against such a drug as castor oil, because castor oil can cause diarrhea and lead to dehydration (castor oil is also used as a laxative).

Castor oil is not considered a good and suitable remedy for inducing labor. You can use more gentle and more effective methods to stimulate labor than castor oil or castor oil.

Laminaria

You can bring the process of childbirth closer in a natural way at home with the help of a special diet, which includes foods rich in fiber. In this sense, seaweed (or, in other words, kelp) is very good. Laminaria contains a large amount of iodine. And the vitamins and elements contained in kelp are in no way inferior to expensive vitamin preparations. To have a relaxing effect, it is enough to eat a little kelp, and it will have a stimulating effect on the body.

Laminaria in obstetrics is used not only at home in official medicine. In order to make it convenient to use kelp, they are formed into sticks 6-9 cm long. Laminaria absorb moisture well, therefore, when placed in the vagina, they expand the cervical canal. In addition, it is believed that kelp contributes to the production of prostaglandin, which expands and softens the cervical canal.

Laminaria is used in two stages: first, 6 sticks are introduced for 16 hours, and if childbirth has not begun, then these sticks are removed and another 6-12 sticks are introduced for the next 16 hours.

Alcohol

It is believed that taking a small dose of alcohol has a relaxing effect on the body and leads to a natural acceleration of labor. Partly it is. For example, if you drink a little red wine, it will not harm the baby and will help bring contractions closer. Champagne is not recommended. Champagne does not have the necessary effect on the body and can only harm. Therefore, doctors are against this method.

Useful video

), translated by Ekaterina Zhitomirskaya. Published in AIMS (AIMS - Alliance for the Improvement of Maternity Services) AIMS JOURNAL Vol:26 No:2 2014 6-8

In today's Western culture, most women are aware of labor induction even before they become pregnant.

They know that stimulation is offered if it is considered safer for the baby to be born than to remain in the womb. I also suspect that many women are aware that one of the main reasons for prescribing stimulation is the gestational age after which the baby is considered "term." Also, many women know some other women who have been stimulated, so they know other stated reasons for stimulation. These reasons may include the age of the woman, if it is higher than “usual”, and premature outflow of water, and / or health problems, as well as complications of pregnancy, in which induction of labor may be necessary.
But that's not all. The decision whether or not to induce labor has many more aspects that it also makes sense to take into account. I have spent the last few months researching this topic. The result is the recent edition (revised and expanded) of my book Wickham S (2014) Inducing Labor: making informed decisions. AIMS, London. In May, for the presentation of this book in Bristol, I prepared a talk entitled "10 facts about labor induction that every woman should know." I didn't mean to dwell on common knowledge (see above), instead I wanted to draw your attention to some facts, circumstances and assumptions that are less known and that it may make sense to take into account when we decide on stimulation. In fact, of course, there is much more to know, so my list of ten facts is just a launching pad for discussion, and not exhaustive information on the issue.

1. It's not like a normal birth.

This is clear to some, but I know from experience that not everyone. Induced labor is very different from labor that begins spontaneously. Of course, each woman has her own personal experience of childbirth, but there are differences that are almost universal. First, to induce labor, a woman is given a synthetic hormone that causes more pain than spontaneous labor. And this pain comes faster. Synthetic hormones, unlike our own hormones, do not cause the release of painkillers into the blood, which are produced by the female body during normal childbirth. In addition, stimulation may have its own side effects, which means that such a woman will be observed more closely. This closer observation can lead to a restriction of the woman's mobility, which increases tension and, consequently, pain, and this, in turn, can make the woman feel that the situation is out of control.

2. It hurts

I already started talking about this in point 1, but there are other sources of pain that I think women should be aware of before making a decision. For example, contractions caused by a prostaglandin gel or balloon, which are often used in the first stage of labor induction, can quickly become painful without any visible effect. This creates a negative birth experience, and it is easy to get tired and/or lose heart much sooner than in the early stages of spontaneous labor. Oxytocin-induced contractions can also be very strong, and often the woman has less time to adjust to them than in spontaneous labor. More frequent vaginal examinations and other manipulations (such as using a balloon) may cause additional pain.

3. "The service comes in a package"

I wrote a lot about this on my website (), so I won't repeat too much. But the fact that I keep being asked if physiological management of the third stage (delivery of the placenta) is possible, as well as the refusal of CTG and / or vaginal examination if labor has been stimulated, makes me think that this is not a well-known fact. Not that someone wants to prevent a woman from making the right decision. But the drugs that are used to stimulate labor are quite powerful. They block the release of their own hormones, and this can cause problems for a woman and a child. And the effect of these drugs that stimulate labor must be evaluated, monitored and, if necessary, compensated. If a woman feels that such side effects of stimulation are not what she needs, then it may be better to ask herself if this stimulation is even needed.

4. Detachment of the membranes is not so harmless

It is now common practice in many places to suggest to women at some point in their pregnancy that they "peel off" or "manually separate" their membranes in the hope that this will reduce the number of women who need drug stimulation. Even if we ignore the assumption that all women who are offered stimulation will agree to it, we must understand that the separation of the membrane can cause discomfort, bleeding and irregular contractions, while some studies have shown this procedure to accelerate the onset of labor by as little as 24 hours. . The authors of the Cochrane review concluded: “There is no significant clinical benefit from routine use of manual sheathing starting at 38 weeks. Performing this manipulation to induce labor must be considered in conjunction with the woman's discomfort and other side effects of the procedure. .: CD00451. DOI: 10.1002/14651858.CD000451.pub2).

5. "Natural stimulation" is an oxymoron.

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I have already written about this elsewhere, and this article can be read on my website (Wickam S (2012) When is induction not induction? Essentially MIDRIS 3(9): 50-51), but the main idea is easy to state: either we we are waiting for the natural onset of childbirth, as happens according to natural laws, or we are trying to intervene and cause childbirth before they would begin on their own. Sometimes there are good reasons to induce labor, but if a woman takes castor oil or asks her midwife to separate the membranes by hand daily or chooses some other “folk” method of stimulation, then she is going to induce her birth with non-drug means. Please note, I am not trying to say that there is something wrong here, but I believe that since we live in a culture that devalues ​​female bodily functions, it is important to be clear about what our intentions are.

6. It's NOT the law

While I was writing the book, I was surprised to learn that the AIMS hotline received a call from a woman whose midwife said, “We have to stimulate you 24 hours after your water breaks. This is the law." This woman agreed to induction of labor, which turned out to be very traumatic for her. I want all women to know that there are no laws that dictate what a pregnant woman should or shouldn't do. Both me and AIMS are very worried about this. Any physician who claims such a thing should be reported to higher authorities. Any woman who is threatened in any way or simply made statements like this, we ask that you contact AIMS for information and other support.

7. It's not "just a drop"

It always worries me when I hear midwives or doctors underestimate the recommended intervention. I especially do not like the expression "drop" or "a little help" used in relation to intravenous drip of oxytocin. It's a powerful drug, and that's how it should be treated. It can cause fetal distress, and in some clinics it is generally accepted to increase the dose of oxytocin until the child reacts with distress (!), and only then stop increasing the dose - it is believed that the proper level of oxytocin is determined in this way. But even when the dose of oxytocin is stopped increasing as soon as effective contractions are established, this drug should be treated with attention, and professionals should not underestimate, whether intentionally or not, its effect.

8. The female body will not let you down. Stimulation and system - easily

The name speaks for itself. Stimulation does not always work, and the woman is not to blame. I would like to reassure all women whose labors were unsuccessfully stimulated that everything is in order with them and with their bodies. This is another case where some of the expressions used in the roadblock are clearly worth revisiting.

9. Risks of overexposure come later, are lower, and are harder to prevent.

Below I provide data that I use both here and in the book. This is a generalization of the results of a study that studied the risk of stillbirth at different stages of pregnancy. If you look at the values ​​- and I especially ask you to compare the risks
at 37 and 42 weeks pregnant, you will see that the increase in risk is not at all as early as many people think, and that the increase in risk is not as strong as is often assumed. In fact, the outcomes of labor in women who waited for spontaneous labor and those who delivered with stimulation were so similar that no single study comparing stimulated labor and spontaneous labor was able to demonstrate the benefit of stimulation. It was only when these studies were brought together that it was possible to notice small differences. However, the quality of one of the studies (just the one that tipped the scales) leaves much to be desired. Based on this, I want to ask if there is any real benefit from the current protocols that offer labor stimulation after 40 but up to 42 weeks. Much more is said in the book on this subject, including a complete review of the literature on the subject.

Risk of stillbirth of unknown etiology
at 35 weeks 1:500
at 36 weeks 1:556
at 37 weeks 1:645
at 38 weeks 1:730
at 39 weeks 1:840
at 40 weeks 1:926
at 41 weeks 1:826
at 42 weeks 1:769
at 43 weeks 1:633

Adapted from Cotzias CS, Paterson-Brown S, Fisk NM (1999) Prospective risk of unexplained stillbirth in singleton pregnancies at term population based analysis. BMJ 1999; 319:287. doi: dx.doi.org/10.1136/bmj.319.7205.287

10. Risks for old-timers are not as certain as commonly believed.

The final point refers to the assertion that as women age, the risks increase and therefore their labor should be stimulated. Indeed, some studies suggest a correlation between increasing maternal age and an increase in some complications, but there are several reasons to treat these data with caution. Older women are more often examined and more likely to undergo various interventions, and this in itself can cause complications. "Older" women are more likely to have health problems, and it is difficult to say what is the cause of complications - the woman's health or her age. The studies that have addressed this problem do not always separate one from the other, and the studies that have done so have involved women who have given birth a long time ago and cannot be compared with today's women. Thus, there is a severe lack of material in this area, and modern research on this topic, unfortunately, has only led to the fact that even younger women are increasingly being stimulated and at earlier dates, so women also do not get much from the results of such studies. benefit.

A day or two after my presentation, I asked some colleagues what facts they would add to the list, and they offered many interesting points. These were not ten facts, but dozens and almost hundreds of things that we would like women to know about. But at least it's a start. You can find more information about this (and much more) in the book Inducing Labor: Making an Informed Decision, published by AIMS. Our current goal is to get this message across to as many women as possible before they decide to induce.

Sarah Wickam is a midwife, educator, author and researcher who has had an extensive and varied practice in midwifery education, research, articles and books.
Sarah currently organizes Recipes for Normal Birth workshops for midwives and other professionals working in obstetrics, writes books for AIMS, speaks at various seminars and conferences, does extensive consulting and writes a bi-weekly column on her website www.sarawickham.com. where you can read many of her articles. Her latest book is Labor Induction: Making an Informed Decision.

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The birth of a baby is a long-awaited moment for any mother. This process does not always go smoothly, so you need to be prepared for minor complications. Fortunately, medicine does not stand still. Even if the baby is not in a hurry to be born at the appointed time from 38 to 42 weeks, there is a way out of the situation. In this case, doctors often decide to induce labor.

Specialists decide on the stimulation of labor activity in the presence of certain indications that threaten the life of the baby. Among them are the following:

• post-term pregnancy (between 41 and 42 weeks);
• severe stretching of the size of the uterus due to multiple pregnancy or polyhydramnios;
• diabetes, heart disease of a different nature, renal failure in chronic or acute forms that threaten the life of a woman and a child;
• the absence of contractions for more than 12 hours after the discharge of the fetal waters.

Why is stimulation dangerous?

Inducing labor often saves the life of both the mother and the baby. But this procedure often carries difficulties and inconveniences. Why is labor stimulation dangerous and is it harmful to the child?

• Contractions caused by artificial means are much more painful than natural ones. In this regard, women in labor often require pain medication, which is not recommended during childbirth.
• The next inconvenience is the position in which a woman has to be during contractions. Drugs that stimulate labor activity are administered through a dropper. This forces the woman in labor to lie only on her back, which is extremely uncomfortable during childbirth.
• Increased risk of caesarean section.
• And the most dangerous thing is oxygen starvation of the baby, caused by active uterine contractions. Fortunately, such cases are rare, but there is still a risk of developing such a situation.

A post-term pregnancy is a significant reason for the immediate induction of labor. Normal childbirth begins from 38 to 41 weeks, and a period of more than 42 weeks in medical practice is considered to be post-term. The danger of this process lies in the aging of the placenta, due to which its functioning is reduced. For a child, this threatens with oxygen starvation.

How long does it take to induce labor? If natural labor does not begin between 41 and 42 weeks, doctors decide to urgently induce labor.

Artificial stimulation of labor

Obstetricians can provoke contractions under certain indications even before the onset of labor, as well as during childbirth to activate them. In practice, medicine uses four methods of artificial induction of labor:

• the use of prostaglandins;
• opening the amniotic sac (amniotomy);
• separation of the fetal egg;
• taking oxytocin.

How is labor induction done?

During amniotomy, the obstetrician-gynecologist inserts a hook through the cervix, piercing the fetal bladder. This causes the water to flow. The baby's head rests against the pelvic bones, opening the cervix. This provokes labor activity. Doctors recommend using this method only for multiparous women.

Prostaglandins are hormonal preparations in the form of a gel, suppositories or tablets. Labor activity usually begins 3-4 hours after the application of funds. If this does not happen, the drug is injected into the vagina after 6-12 hours. Prostaglandins open the cervix, causing the uterus to contract.

Oxytocin is an artificial analogue of the hormone in the form of injections for intravenous administration. The drug is potent, so it has a number of side effects. Oxytocin is administered by doctors through a drip in certain doses until regular contractions are achieved.

After the start of stimulation, the baby's heartbeat is constantly monitored. After the activation of labor activity, the introduction of the drug is stopped.

Separation of the fetal egg. This method is as follows: the doctor, penetrating the neck with a finger, massages the fetal membranes from the walls of the uterus with massage movements. The procedure is allowed to be performed only for a period of more than 40 weeks.

Artificial stimulation of labor takes place carefully under the constant supervision of specialists, observing the condition of the woman in labor and the child. Doctors achieve results in 1 contraction in 5 minutes.

If after 4 hours after the procedure, labor activity has not begun, a caesarean section is performed.

Reasons for artificial induction of labor

The decision on artificial stimulation of labor activity is made by the gynecologist even before the expected date of birth if the woman in labor has chronic pathologies of the heart and kidneys, diabetes. If polyhydramnios was detected during a doctor's examination or during an ultrasound scan, artificial labor induction is used in every second case. With multiple pregnancy occurring with complications, the procedure is also inevitable.

The absence of contractions for more than 12 hours after the water breaks, a post-term pregnancy are good reasons for the immediate stimulation of labor.

Alternative ways to induce labor

Many women in labor, learning about the need for artificial stimulation of labor, are looking for alternative methods that do not require medical intervention. The effectiveness of such methods is somewhat lower, but there is a chance to achieve natural childbirth on your own. These methods include:

• sexual intercourse;
• bath with the addition of aromatic oils;
• breast massage;
• therapeutic measures;
• castor oil;
• contraction-inducing herbs.

The onset of labor with artificial stimulation

Labor activity, depending on the method of stimulation chosen by the doctor, begins in different ways.

The separation of the amniotic membranes is carried out only with the cervix open. The obstetrician, inserting a finger into the vagina, separates the fetal membrane from the uterine wall. In most women, after this, water breaks and, under the influence of prostaglandin, contractions begin.

Almost all methods of artificial induction of labor are carried out with the cervix open. If the uterus does not open naturally, drugs containing prostaglandins are used. For some women, a single use of the remedy is enough to start natural labor. If, after 24 hours, childbirth has not begun, specialists resort to other methods of stimulation.

The puncture of the amniotic sac by an obstetrician mimics the natural process of childbirth, when the waters break on their own. If contractions do not begin a day after the water breaks, the doctor artificially induces labor with oxytocin to minimize the risk of infection.

If an insufficient amount of oxytocin is released in the body of a woman in labor, the doctor introduces drugs that stimulate this process. In medical practice, pitocin is often used for such purposes. Usually this drug works within half an hour after application. At this time, the obstetrician carefully monitors the reaction to the introduction of the drug, if necessary, increases the dose of Pitocin.

Methods of stimulation of labor activity

Ways to stimulate childbirth are conditionally divided into:

1. Artificial (use of prostaglandins, amniotomy, separation of the amniotic sac, use of oxytocin);
2. Natural (drinking castor oil, sexual intercourse, increased physical activity, stimulating bath, use of special herbs, additional therapeutic measures, breast massage).

Every woman has the right to choose when she needs labor stimulation and by what method. However, you should definitely ask the advice of a specialist!

Labor can't start, needs stimulation

Expectant mothers, being at 38-40 weeks of pregnancy, are often interested in: is it possible to stimulate labor on their own at home without the use of medications and the intervention of doctors? Can! For this, natural methods of stimulating labor activity are suitable. If the method does not work, doctors use artificial induction of labor.

Artificial opening of the fetal bladder- a painless, but unpleasant way to stimulate labor. The method is one of the most popular types of inducing labor without the use of medications and consists in puncturing the amniotic bladder, which entails the discharge of water.

Oxytocin- a way to stimulate childbirth. The drug is an artificial analogue of the hormone that causes contractions. It is administered to a woman in labor intravenously until regular contractions are achieved.

Sexual intercourse. Male sperm contains prostaglandins. The amount of the hormone in it is not as large as in medications, however, with a normal pregnancy, such a hormone content will be quite enough for the timely onset of labor. During sexual intercourse, a woman's body produces oxytocin, which causes contractions to begin.

Separation of the fetal egg- at the moment a little outdated method. They were actively used to stimulate labor activity several decades ago. Now the method is rarely used, since the procedure itself is painful, and it can also cause bleeding in a woman in labor.

Nipple stimulation. This method, against the background of a woman's excitement, causes a surge of oxytocin in the blood. The main disadvantage of this method is the duration. Nipple massage should be done 3 times a day for 15-20 minutes on average. Not every woman can stand it, it will be especially difficult for owners of sensitive breasts.

additional therapeutic measures. Massage of certain areas is another way to stimulate labor. Many women choose this method, because it is both useful and pleasant. However, as practice shows, this method is less effective in stimulating labor than the others.

The use of herbs that cause contractions. For this method, a decoction is prepared, consisting of spicy herbs - cinnamon, ginger, cloves. Swabs are soaked with the finished infusion and inserted into the vagina. You can use this method only with a mature pharynx. Otherwise, intense uterine contractions caused by herbs will lead to oxygen starvation of the baby.

Stimulating bath. To provoke the onset of contractions can help a warm bath with the addition of aromatic oils. To carry out the procedure, a mixture of 250 ml of cream and 5 drops of essential oils (cloves, ginger, cinnamon) is added to water with a temperature of no more than 40 degrees. Take a bath for 30 minutes.

Castor oil. Castor oil causes spasms of the intestines, which leads to uterine contractions. To stimulate labor, castor oil in pure or diluted form is taken orally. At one time you need to drink 50 ml of the product. Half an hour later, severe diarrhea begins. This is what causes the fight to start.

Labor induction at home

Timely stimulation of labor at home will save the woman in labor from subsequent medical intervention in the hospital. Not all natural methods will immediately help induce contractions. The body of each woman is individual. Try on yourself several methods of stimulation in order to understand which method is right for you.

Stimulation of labor in the maternity hospital

Artificial stimulation of labor activity works in 100% of cases. But such methods are unsafe for both the mother and the baby. However, do not be afraid of artificial stimulation of labor. Sometimes only she can save the life of you and your child. Before carrying out such a procedure, it is worth considering all kinds of methods, weighing the pros and cons, and, of course, consult a doctor.

Childbirth after stimulation

After artificial stimulation, labor contractions are more painful than during natural childbirth, and last longer than 1 minute.

Breathing exercises can help reduce pain. Otherwise, the birth of a baby after stimulation is no different from natural childbirth.

Natural induction of labor

Natural stimulation of labor activity can be practiced only after agreement with a specialist. The most effective methods include sexual intercourse and taking castor oil. Don't be discouraged if these methods don't help. After all, there is medical stimulation, after which the baby will definitely be born on time.

After the 37th week of pregnancy, the moment of the natural birth of the child comes. However, this does not always go smoothly. Sometimes it is necessary to induce contractions with the help of surgical or medical intervention. Labor induction is carried out only by a doctor when labor begins spontaneously and then stops: the woman can no longer give birth. This article describes methods and techniques for safely inducing labor in a hospital or at home.

What is labor induction

The procedure of labor stimulation is the birth of a child as a result of contractions caused by an artificial method. It is carried out to stimulate the labor activity of a pregnant woman according to the doctor's indications. It is aimed at ensuring the opening of the cervix of the woman in labor. If the birth canal is closed or not completely ready before the start of delivery, then such labor activity is called weak. For this procedure, both medicines and natural methods can be used, which are described below.

Artificial Methods

There are several artificial methods of labor induction. The first is transcervical. The essence of the method is that a catheter with a solid rod is inserted into the cervical canal. Then it is replaced with a needle. It is used to pierce the amniotic membrane to remove some of the amniotic fluid. After that, a highly concentrated sodium chloride solution or a 20% glucose solution is injected inside. This method is not used on women who suffer from high blood pressure or kidney disease.

The next way is transabdominal. It is not used if the placenta is attached to the anterior wall of the uterus. The method consists in the fact that doctors inject saline solutions with ultrasound determination of the location of the placenta. It is used in case of injury or bleeding. A saline solution is injected into the amnion (inner part of the placenta) after a certain amount of amniotic fluid has been taken. Unfortunately, in this case, the child does not survive, as the saline solution kills him. After a couple of days, artificial labor is performed.

Artificial childbirth is also carried out by expanding the cervical canal, after which the fetal bladder is opened. Stimulation of labor can occur if the woman in labor has contraindications to hypertonic solutions. There are also medical methods that contribute to the opening of the cervix and contraction of its muscles. However, induction of labor with drugs is used in extreme cases, when other manipulations are contraindicated for the mother. After such a procedure, there is a risk of consequences.

natural stimulation

If artificial induction of labor is not suitable for a woman, the doctor or obstetrician suggests breaking through the membranes. This is the manual separation of the amnion from the uterine wall. The doctor inserts a finger into the cervix and with the help of gentle movements separates the membrane from the wall. There is also a rupture of the water bladder with the help of an amniotic hook. There are options for natural stimulation of labor at home, but more on that later.

Why is labor induction dangerous?

By itself, the stimulation of childbirth can not only harm the child, but also the woman. Any type of stimulation is carried out only with the permission of a doctor who is familiar with the medical indications of the patient. Complications occur frequently. In the following sections, you will learn about the dangers of induction during childbirth in the clinic, how it can harm the mother or newborn baby, and why such a procedure can be dangerous.

Pain during contractions

In order to stimulate delivery, a woman can be injected with synthetic hormones, which cause severe pain than during natural labor. Such pain passes quickly, does not cause the release of painkillers into the blood. During normal labor activity, they are produced by the female body. At the first stage of stimulation, gels or balloons can be injected that cause painful contractions. Painful discomfort is also caused by vaginal examinations. Read on to find out how to stimulate contractions on your own.

Uncomfortable body position

In the case of using droppers, doctors put the woman in the most uncomfortable and ineffective positions that prevent the birth of a child - lying on her back, on her side or standing on all fours. In such positions, unpleasant discomfort occurs, which can intensify. This interferes with the process of labor, and the pain of contractions increases markedly.

Oxygen starvation of the fetus

Stimulation of labor can lead to the development of oxygen starvation of the fetus (fetal hypoxia). This is a violation of the intensity of blood supply. Such a problem does not sum up in the development of the child. The diagnosis is “removed” after 3 months, when the child develops as it should, no deviations are observed. In some cases, labor with stimulation can lead to disruption of the functioning of the baby's heart system. However, we can fix that.

Indications for labor induction

Labor is stimulated in several medical indications. The most common reason for the use of stimulants is the gestational age (more than 41 weeks). In such cases, natural stimulants can be used, which can also be used at home. This procedure is done to reduce the risk of a caesarean section. It is used if the child is large.

With multiple pregnancies, when babies simply cannot appear in the usual way, stimulation is also prescribed. If the mother has kidney disease, thyroid disease, gestational diabetes, high blood pressure, then doctors prescribe stimulation. This method is also used for prolapse of the umbilical cord. Doctors want to avoid complications during and after the birth process.

How to stimulate labor in the hospital

In the maternity ward, obstetricians and doctors stimulate labor in various ways. Doctors determine the methods of stimulation for certain indications and situations. They may use pills, injections, opening the membranes, injecting oxytocin or prostaglandin. Such methods have advantages and disadvantages, which you will learn about in the following sections.

Preparations for stimulating labor

Drugs in our time have become increasingly used to speed up labor in certain cases. They are used in order to cause a minimum of physical damage to the fetus during the process. If you want to use drugs during childbirth, rather than other more dangerous methods, then this can be discussed with your attending gynecologist.

Oxytocin

The substance oxytocin is a synthesized analogue of the hormone that the pituitary gland produces. It stimulates the contraction of the muscle fibers of the uterus, which helps with weak labor, postpartum bleeding and to stimulate lactation. Available as a solution for subcutaneous and intramuscular injections. The disadvantage of this drug is that a woman cannot move normally while under the connected drip system.

Doses are selected for each woman individually - each body reacts differently. The drug does not affect the readiness of the cervix to dilate, so when oxytocin acts, labor pain appears. Can be taken with antispasmodics. This drug is not used if it is undesirable to have a child through normal childbirth, if the baby is in the wrong position, if the components are intolerant, if there are scars on the uterus, and others. Side effect - can lead to hypoxia.

Miropriston

The drug Miropristone is a medical preparation that is used to terminate a uterine pregnancy in the early stages (up to 42 days) and to artificially induce labor. An analogue of this tool is Pencrofton. Both drugs are used in confirmed ectopic pregnancy, a pregnancy that occurred while using intrauterine or hormonal contraceptives. It is contraindicated in:

• individual intolerance to the components of the drug;
• porphyria;
• anemia;
• violation of hemostasis;
• adrenal insufficiency;
• uterine fibroids;
• smoking;
• acute inflammatory pathology of the female reproductive system.

birth control pills

A popular method by which the uterus "ripens" is the use of prostaglandin hormones. They stimulate delivery by acting on the cervix, causing structural changes. They are used in the slow course of labor, the reason for which lies in the immaturity of the uterus, its resistance. Next, consider the pros and cons of such hormones.

Prostaglandins

Hormones have a beneficial effect on the female reproductive system. They stimulate smooth muscles, fallopian tubes, uterus and cervix. The drug causes painful contractions that help a woman give birth faster. Available in the form of tablets that have side effects. The tool works in much the same way as Oxytocin. Side effects include nausea, fever, vomiting, diarrhea, and more. They cost a little more. Tablets are used for artificial termination of pregnancy in the early stages.

Detachment of amniotic membranes

Prenatal stimulation detachment of the membranes is performed only by a gynecologist or midwife during a gynecological examination. From the lower sections of the uterus near the internal pharynx of the cervix, the amniotic membranes are carefully peeled off. This procedure is used several times until the woman's labor activity begins. It is rarely used, only in extreme cases and as prescribed by a doctor.

Puncture of the amniotic sac

Amniotomy is performed exclusively in the process of delivery. It is not used today, because there is a risk of infection of the child with various infections. Rarely, when other methods cannot be used, a puncture of the amniotic sac is used. At the same time, it is used when the cervix is ​​softened, using a special tool to puncture the fetal bladder.

Foley catheter

To use this method, you need to consult a specialist. Upon inspection, the size that suits you is determined. Please note that the caterer is introduced in the hospital by doctors, it is forbidden to do this at home. It will harm the baby and the mother. It is rarely used and only when there is a medical indication for use. Foley catheter is contraindicated in:

• inflammatory process in the cervix (cervitis);
• inflammation of the vaginal mucosa (vaginitis);
• rupture of the fetal bladder;
• low placenta previa.

Stimulation of labor activity at home

Not infrequently, girls do not want to use various medications, lie down on the operating table, so they discuss possible methods of stimulation during childbirth at home with their gynecologist. Such an independent solution comes to mind the fastest. If you also do not want to use folk methods, you can choose one of such methods as late sex, gymnastics for pregnant women, nipple massage and castor oil. If you don't know how to induce labor yourself at home, the following sections will help you.

Sex in late pregnancy

During sex, oxytocin is produced, which helps speed up labor. Male sperm contains prostaglandins, which promote maturation and expansion of the uterus. Unfortunately, this method is used only when the water has not broken, because this can infect the placenta. Sexual contact is prohibited if you have a low placenta previa.

Labor induction exercises

A little exercise is also a natural labor stimulant. Walking slowly down the street every day will help you bring on contractions as soon as possible. We recommend that you climb the stairs over the step, dance and slowly rotate your hips. It is forbidden to lift weights, use strength exercises on simulators. Another option would be mopping without a mop.

The advantage of using such methods is that the cervix softens and smoothes faster, which causes a quick delivery in a woman. However, this method will be harmful to women with preeclampsia, indications for caesarean section, for up to 40 weeks, chronic diseases that are not related to pregnancy in any way. Before using this method, consult your gynecologist.

Nipple massage

A special nipple massage helps the female body produce the hormone oxytocin. It stimulates the contraction of the uterus, which helps to start labor faster. It also helps a woman get used to the discomfort, because after birth, the baby will “bite” your breasts. When massaging the nipples, the same feeling is felt. Massage is done several times a day for 15 minutes. Nipples need to be lightly pinched and stroked.

Castor oil to speed up labor

Castor oil has been used in the past to induce bowel movements, since castor oil has a laxative effect. Today it is sold in the form of candles. Castor oil stimulates the contraction of the intestines and uterus. However, if you use a dose a little higher, diarrhea sets in, which can lead to dehydration. Such an action can lead to real danger. It is better to put a couple of drops of castor oil on bread and eat it with tea.

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