Labour is characterized by uterine contractions that in return create physical changes to the cervix such as dilation and effacement in preparation for delivery of a baby. Labour induction, though sometimes confused with labour augmentation, refers to the process of artificially initiating labour in cases where labour has not began naturally or when life threatening health risk(s) have been diagnosed.
Labour augmentation, on the other hand, refers to the process of artificially accelerating labour in cases where the labour process is slow and or unsatisfactory creating the risk of the baby going into distress or the mother getting fatigued before delivery. Ideally every pregnancy should proceed to term and labour should begin naturally, however, in some instances labour does not begin naturally or it progresses too slowly and induction may be necessary to reduce foetal and/or maternal health risks.
Induction of labour is the initiation of labour using pharmacological and other non-pharmacological methods. Process of natural labour In an ideal situation, natural or normal labour occurs between 37 and 42 weeks of pregnancy. Pregnancies that proceed without complications can last for the entire 42 weeks, however in some cases one may deliver early. Normally labour prepares the body for delivery, however, during pregnancy there can be “false” labour and the real labour.
False labour contractions occur when the stomach muscles contract and relax and as the United Kingdom National Health Services (UK NHS, 2009) reveals, “These are called Braxton Hicks contractions, and they are not the start of labour. ” Real labour pains come in intervals of 3-5 minutes and generally last upto 30 seconds. At every interval when the contractions stop, the baby is pushed down to make the cervix open and be ready for delivery. Reasons for induction of labour
Health reasons that may necessitate labour induction are; pregnancy-induced hypertension also known as preeclampsia that may lead to complications such as eclampsia (life threatening seizures), insulin-dependent diabetes that’s not well controlled during pregnancy creating health risk for the mother and foetus, prolonged or preterm rapture of the uterine membranes, prolonged/post term pregnancy where the pregnancy proceeds past the expected date of delivery (EDD), and infection of the foetal membranes also known as chorioamnionitis.
Another kind of labour induction is elective induction “… in which the physician and woman decide to end the pregnancy in the absence of a medical reason to do so” (Klossner & Hatfield, 2005, p. 255) and is offered when the pregnancy has reached its term and when the health of the mother and foetus cannot be put at risk. In some cases pregnant women request to be induced for social and/or emotional reasons e. g. domestic demands, the partner has to travel and the couple or woman wants the partner to be present at delivery. How is readiness for induction of labour determined?
One of the most common methods used to determine cervical readiness for induction of labour is the Bishop Scoring System that measures five main factors i. e. foetal station or level of descent towards the cervix, cervical dilation, effacement, consistency and position. Each of these factors is given a score between 0 and 3, as shown on Table 1 below, and the higher the overall score, the higher the probable success of the labour induction process and the lower the score the higher the probability that the induction process may not be successful and other procedures such caesarian section may be considered.