Induction or Augmentation of Labour

Induction of labour is the process of stimulating labour contractions before labour commences naturally. Often this is done when a pregnant woman is overdue.

Augmentation of labour is the process of stimulating labour contractions during labour, often when contractions have started but are weak, irregular or have stopped entirely.

There are different ways of inducing labour.

Labour can be induced in a number of ways:

• A tablet or gel can be inserted in the vagina and this can encourage contractions to start and the cervix to soften.
• A medication can also be given by an IV drip into a vein and this can increase the speed of labour.

Labour may be induced for a number of reasons including when:

• A pregnant woman is post-term;
• There is an infection in the womb, known as chorioamnionitis;
• The membranes around baby have ruptured and labour has not started;
• Baby is not growing as expected;
• A pregnant woman has high blood pressure and there are signs that this is affecting her health or the wellbeing of the baby.

In these circumstances, the pregnant woman and baby may be at risk if baby is not delivered promptly. The risks of the induction of labour should be discussed with the pregnant woman so that a joint decision can be made about the delivery.

There are risks associated with the induction or augmentation of labour:

• A labour which is induced or augmented may be more painful than a labour which begins naturally.
• Induction or augmentation of labour may not be effective and other interventions to expedite delivery may be required, including the use of instruments (forceps or vacuum), or a caesarean section.
• Induction or augmentation of labour can increase the risk of bleeding after delivery and rarely can cause a serious injury to the womb. This may require surgery after delivery or rarely removal of the womb (hysterectomy).
• Induction or augmentation of labour can cause the baby to become distressed due to not receiving enough oxygen. This can occur due to a pregnant woman’s sensitivity to the medication used or an abnormal contraction pattern. If this is not detected promptly and continues for too long then there is a potential for harm to the baby, including a brain injury. In these circumstances, there are interventions that the health care provider can provide to relax the uterus and rescue the baby.

There are guidelines available to health care providers who care for pregnant women who undergo induction or augmentation of labour. The guidelines set out which patients may benefit from induction or augmentation of labour and when it is not safe to proceed in this manner.

Induction should be avoided where:

• the placenta is implanted very close to or over the cervix;
• the baby is in a breech position or lying across (transverse);
• the pregnant woman has had certain types of surgery on the womb or a previous caesarean section with a more unusual type of incision;
• the pregnant woman has genital herpes;
• the pregnant woman had suffered a previous uterine rupture.

Once induction has started, a pregnant woman should be monitored carefully. If she has received the tablet or gel then she may, in certain circumstances, be able to go home. She should be provided with clear advice on when to return and the need to monitor baby’s movements and to call if there are any concerns.

Where medication is administered via a line into the vein, the baby and pregnant woman should then be monitored closely in hospital.  The dose should be carefully increased and the heart rate of the baby should be monitored. There should be a prompt assessment and intervention if the baby shows any signs of distress. The medication may need to be stopped urgently and a joint decision should be made between the pregnant woman and the health care team on how to best deliver the baby. This may involve restarting the medication at a lower dose or considering a caesarean section urgently if the baby’s heart rate pattern does not improve with stopping the medication. This can be a sign that a baby is not tolerating the induction process.

Once labour commences, contractions should only be augmented with medication if the contractions are weak, irregular or have stopped. Augmenting contractions which are already effective can increase the risks to both the pregnant woman and her baby.

If you were induced during your labour or if your labour was augmented with medication and you have concerns about the care provided, or whether this may have caused distress to your baby, then please contact us – we would like to help. We have a team of experienced lawyers and medical specialists who can review the medical care you received and help answer your questions. We will provide you with the information and advice you need to make informed decisions about your child’s future and ensure your child’s rights are protected. Rest assured – the consultation is confidential and free of charge.