Karen Kassel, MS, RD, Med
If labor has not started naturally, medical interventions can be used to begin this process. Induction can include medications to soften the
cervix, rupture the amniotic sac, and/or contract the uterus.
Reasons that you may be induced include the following:
If your labor begins naturally, but the contractions slow or stop, steps will be taken to resume labor. This is called augmentation. Your doctor may augment your labor by rupturing the amniotic sac or giving you medications.
Fetal heart rate monitoring
tracks and records your baby’s heart rate and the strength and duration of your contractions. Monitoring can be done externally or internally. A common method of external monitoring involves 2 flat sensors that are placed on your abdomen. One sensor uses ultrasound to monitor your baby’s heart rate. The other measures your contractions.
Internal monitoring provides a more accurate measure of your baby’s heart rate and your contractions than external. The cervix must be dilated at least 2 centimeters and the amniotic sac ruptured in order to do internal monitoring. A sensor is strapped to your thigh. A thin wire called an electrode is inserted into your uterus. An electrode attached to the skin on the baby’s head measures the baby’s heart beat. A separate tube inserted into the uterus measures the strength and timing of contractions.
Fetal heart rate monitoring provides information on how the baby is doing. An abnormal heart rate can be a sign that something is wrong and that action may be needed.
Continuous fetal heart rate monitoring for healthy pregnant women in normal labor is not necessary. It may generate more harm than good. Monitoring the baby's heart rate off and on is a good alternative. For high-risk pregnancies, continuous fetal heart rate monitoring is the standard.
is a small incision into the perineum. The perineum is the area between the vagina and the anus that stretches as the baby’s head is delivered. After the baby and placenta have been delivered, the episiotomy incision is closed with stitches. Episiotomies are more common during a woman’s first delivery.
Episiotomies were more routinely done in the past. Today, few doctors routinely
do an episiotomy. They can result in greater damage than a natural tear. Controlled pushing and massage to the perineum can help reduce or prevent tearing.
Be aware that the current best evidence about episiotomy is that they should not be done without a medical indication. Routine episiotomy is now viewed as doing more harm than good.
If you are at the end of labor and the labor stalls, there are steps that can be taken to speed up delivery of the baby. Two common methods are forceps delivery and vacuum-extractor assisted delivery.
If the baby is not moving down the birth canal and there is a medical need to speed the delivery, forceps may be used. Before inserting the forceps, the area will be numbed with an injection of anesthesia if you do not already have an epidural. The forceps look like a long pair of tongs. They are gently inserted along either side of the baby’s head. The forceps are used to gently grip the baby’s head to help pull it out as the mother pushes. The risks of a forceps delivery are low. The baby may have some bruising or swelling on the head or face. This will fade in a few days. A mother may require an episiotomy or develop a severe tear in the perineum during a forceps delivery. A rare complication is bleeding in the baby’s skull.
Another means to help deliver the baby is with a vacuum extractor. This device has a cup on the end which attaches to the top of the baby’s head and allows the doctor to gently pull while the mother pushes during contractions. The risk to mother and baby is low, although the baby may have temporary bruising or swelling on the scalp.
The blood in your baby’s umbilical cord contains stem cells. These are immature cells that can develop into many different types of cells. Stem cell research is a growing field. It is hoped that stem cells can be used to treat many diseases and conditions, such as leukemia. There are options for handling your baby’s cord blood:
Saving umbilical cord blood is not a routine procedure. If you are interested, you will need to make arrangements during your pregnancy and tell your doctor and the medical staff assisting your delivery. The blood will not be removed from the baby. It will be removed from the umbilical cord and placenta after the cord has been clamped and cut.
Birth plans. Kids Health—Nemours Foundation website. Available at:
http://kidshealth.org/en/parents/birth-plans.html. Updated July 2015. Accessed January 30, 2017.
Gulmezoglu A, Crowther C, Middleton P. Induction of labour for improving birth outcomes for women at or beyond term.
Cochrane Database Syst Rev. 2012;(6):CD004945.
Labor induction. The American College of Obstetricians and Gynecologists website. Available at:
http://www.acog.org/~/media/For%20Patients/faq154.pdf?dmc=1&ts=20121226T0908058985. Updated January 2012. Accessed January 30, 2017.
Labor induction and cervical ripening. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T115335/Labor-induction-and-cervical-ripening. Updated October 11, 2016. Accessed January 30, 2017.
Office on Women's Health
The American Congress of Obstetricians and Gynecologists
The Society of Obstetricians and Gynaecologists of Canada
Women's Health Matters
Last reviewed January 2017 by Andrea Chisholm, MD
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