Induction of Labor and Reasons for it

Apr 10 2009

Induction of labor means bringing on labor before it has begun on its own. Labor may be induced for reasons related to the mother’s health, the baby’s health, or the health of both. Although inductions have been performed for the convenience of either mother or physician, the medical ethics of this practice are questionable, at best.

Maternal Reasons for Induction of Labor

A common maternal reason to induce labor is preeclampsia or pregnancyinduced hypertension. Mild cases of this disease of pregnancy may be treated prior to term with bed rest and observation alone, but severe disease usually requires delivery. An induction is considered safer than a cesarean birth, although if the induction is not successful, a cesarean may become necessary.

When the membranes rupture prematurely, the risk or presence of infection may be a reason for induction. Premature rupture of the membranes(PROM) is defined as rupture that occurs before the onset of labor. If it also occurs before the fetus is at term, it is called preterm premature rupture of the membranes(PPROM). Labor almost always ensues within a few days to a week after rupture, with its onset more rapid the closer to term the rupture. At term, more than 60 percent of women will be in labor within 24 hours and more than 95 percent within-2 hours.

Some practitioners believe that inducing labor within 12 to 24 hours after rupture will prevent or reduce the risk of infection for the mother and the fetus. Many practitioners will induce routinely when the fetus is at term or near term, but only induce when there is evidence of infection if the fetus is preterm. In fact, in a small number of women whose membranes rupture before term, there is only a small leak rather than a large rupture. In these cases, the membranes may reseal themselves and the fluid will stop leaking.

Usually, fever in the mother is the symptom that indicates infection. When the membranes rupture, your temperature must be taken frequently-at least once a day if you are not in labor. If you are admitted to the hospital, as some women are whenever the membranes rupture, your temperature will be taken every 4 or 8 hours. If you are at home you must take your temperature and call your physician or midwife if there is a rise or if you have chills or feel feverish.

Whether to induce or not when membranes rupture without labor is an area of some controversy within obstetrics. Studies are not entirely consistent, but seem to show that while there are more infections when the woman is not induced, the newborn is infected in less than 20 percent of maternal infections. There also may be more cesarean deliveries when induction is used routinely. The most important preventive measure against infection once the membranes rupture is to avoid vaginal examinations.

You may have feelings regarding induction or watchful waiting in the situation of ruptured membranes at term. This is a topic to discuss with your physician or midwife. Find out his or her beliefs and practices. You should feel comfortable with them.