home Audience 6 Stimulation of labor. How labor is induced in the maternity hospital

Stimulation of labor. How labor is induced in the maternity hospital

Methods of natural stimulation labor activity are used in cases of post-term pregnancy and to prepare the cervix for childbirth. By the approximate date of onset of labor, the cervix shortens significantly, which causes pain in the pregnant woman in the lumbar region and frequent urination, Natural stimulation helps relieve pain and speed up the process if labor does not occur on the date prescribed by the doctor. All natural ways labor stimulation absolutely safe for both the child and his mother.

Nipple stimulation

One of the main ways to naturally stimulate labor is nipple massage. It is believed that when massaging and pinching the nipples, the body of a pregnant woman begins to more actively produce the hormone oxytocin, which causes labor pains. Nipples should be stimulated several times a day for 10-15 minutes. When using this method, contractions should begin within three days after the start of stimulation.

Castor oil

Castor oil is primarily known as a natural laxative; this is its main property in stimulating labor. By affecting the intestines, the oil simultaneously stimulates the uterus, accelerating the birth process. To soften the specific taste of oil, you can add fruit juice or syrup. In half the cases of using this method, 100-150 grams of drink castor oil cause natural contractions immediately after consuming it.

Modern traditional medicine does not recommend the use of castor oil, which can cause diarrhea and lead to dehydration.

Walks

Walking at a brisk pace is advisable fresh air also promotes natural stimulation of labor. When the expectant mother takes active walks, the baby's head, under the influence of gravity, begins to put more pressure on the cervix, which stimulates more active production of oxytocin. As a rule, almost all pregnant women take regular walks before giving birth, so the effectiveness of this method is quite difficult to determine. But no expectant mother should give up active walks, because they contribute to the adoption of the “correct” position of the fetus before childbirth.

Oxytocin is a hypothalamic hormone of oligopeptide structure that has a stimulating effect on the smooth muscles of the uterus.

Homeopathy

This method can also be classified as a natural method of stimulating labor, but when using this method you should still consult a homeopathic specialist. The main homeopathic remedies that enhance the activity of labor are caulophyllum and pulsatilla, which are considered absolutely safe for health. The results of surveys of many women who have already given birth indicate that homeopathic medicines helped them solve various problems that arise during pregnancy.

In addition, natural methods of stimulation include: having sex with the obligatory violent orgasm in a pregnant woman, taking a small dose of alcohol, drinking tinctures of certain medicinal herbs, balloon inflation, acupuncture.

Childbirth is a natural process of bringing a child into the world, carefully thought out and planned by nature. However, there are cases when, without medical care it cannot be avoided and labor stimulation is required.

In what cases is labor induction performed?

This procedure is carried out to artificially induce labor and activate labor directly during childbirth. First of all, the indication for stimulation is post-term pregnancy, which entails certain risks, weakness and incoordination of labor. In addition, stimulation is prescribed for polyhydramnios, multiple pregnancy and serious chronic diseases that threaten the health of mother and child. Depending on the indications and state of labor, they are used different kinds stimulation.

Detachment of amniotic membranes

This method of stimulation is usually used during postterm pregnancy. This procedure is performed during a routine gynecological examination. It consists of detachment of the amniotic membrane at the os of the uterus, which contributes to the development of contractions. In this case, the woman does not experience pain due to the absence of nerve endings.

Use of prostaglandins

These physiologically active substances affect the cervix, promoting its ripening and opening. Prostaglandin preparations are used vaginally in the form of gels and suppositories. As a rule, contractions begin within half an hour after their introduction. But there are situations when labor does not activate. In this case, the drug is re-administered a day later.

Puncture of amniotic sac

This method of stimulating labor is used for protracted labor, when the baby’s head is in the pelvic area. The procedure involves inserting a special instrument in the form of a hook through the cervix, which causes a puncture of the membranes and effusion. amniotic fluid. The use of this manipulation is associated with the risk of infection and prolapse of the umbilical cord, which impairs the delivery of oxygen to the fetus.

Use of oxytocin

This drug is a natural hormone that stimulates uterine contractions. It is usually used in cases where there is a fading of labor - a decrease in the intensity of contractions. The drug is used with parallel monitoring of the condition of the fetus and the intensity of contractions.

Tablets to induce labor

In terms of effectiveness, ease of use and number of side effects, this method of stimulating labor is the most preferable. It involves the use of artificially synthesized antigestogens (Mifepristone, Miropriston), which promote cervical ripening and the development of contractions.

If labor does not begin, and the baby is already due to be born, doctors are forced to resort to artificial stimulation with the help of various methods. However, each of these methods has its own indications and contraindications, so asking a doctor to speed up labor for some reason is strictly not recommended.

Types of stimulation

Postterm pregnancy is characterized by oligohydramnios, a decrease in the thickness of the placenta, thickening of the baby’s cranial bones, and so on. Lack of labor activity in due date is fraught with deterioration in the functioning of the placenta, which leads to a significant deterioration in the condition of the fetus. In such cases, labor stimulation is prescribed, for which artificial rupture is often used. amniotic sac or an amniotomy, in which the bladder is pierced with a hook-like instrument. This procedure is practically painless (there are no nerve endings in the amniotic sac) and allows you to start the process of delivery due to the discharge of amniotic fluid.

After the amniotomy is completed, labor begins approximately a few hours later.

Labor is also accelerated with the help of a special “prostaglandin” gel, which the obstetrician injects into the cervix of the woman lying on the gynecological chair. This procedure allows labor to begin nine to ten hours after the drug is administered. If labor has begun, but labor is too weak and the cervix is not dilating well, doctors resort to stimulation with droppers of oxytocin or prostaglandins. Oxytocin is a hormone produced by the brain that stimulates smooth muscle and increases uterine contractility. Prostaglandins (hormone-like substances) have similar properties. Four to six hours after inducing labor using one of the above methods, doctors evaluate the benefits of them - if there is no effect, the woman is given C-section.

Features of stimulation

Contraindications to accelerating labor are its hyperactivity, hypertension, the presence of chronic fetal hypoxia or uterine scar, as well as cardiovascular or other dangerous diseases women in labor. Ideally, a woman should give birth on her own, since childbirth is a natural process that should be accompanied by proper breathing during pushing and contractions. Doctors say that stimulation is most often needed by women who are trying to control the birth of a child with their heads, while complete and instinctive dedication to the process allows the body to do everything as it should.

Expectant mothers are recommended to undergo special training at a school for pregnant women - then speeding up childbirth is unlikely to be necessary.

Also, natural childbirth is desirable for the reason that a child born without stimulation experiences less stress during the passage of the birth canal. In addition, non-interference in labor prevents oxygen deficiency in the baby. Application medicines stimulation is also not useful - for example, oxytocin most often gives the skin

If something does go wrong, rest assured that the doctors will do everything possible for you and your child. When complications arise and all plans are disrupted, it is easy to lose control of yourself, but try not to panic. The doctor will be able to explain the situation, talk about possible consequences and ways out of it. Together you will decide what is best for you and your child.

Once mother and baby finally reach their estimated due date after 40 long weeks, regular check-ups become more frequent.

If the actual due date is a few days later than expected, this will not cause problems, provided that both are in good health.

Using ultrasound, the doctor will periodically monitor the child’s condition and his life support. Only when the examination shows that the baby is too small is delaying the onset of labor considered undesirable. In this case, early artificial induction of labor is recommended. The same applies to the situation when the child is very large and weighs more than 4500 g. And here artificial birth is preferable, since otherwise the child will continue to gain weight, and spontaneous childbirth can become extremely difficult.

More than 20% of births in France involve the use of stimulant drugs (according to medical indications, and at personal request). In both cases, the woman receives medications that speed up the process of labor, since labor can be protracted and more painful.

Indications for induction of labor

Here are some of them.

When labor does not come at the appointed time (41st week of amenorrhea).
When the water has already broken and there are no contractions for 24-48 hours.
When problems arise with the normal development of the fetus (intrauterine growth retardation).

A woman in labor can agree on a due date in advance if she lives far from the maternity hospital or has already had a rapid labor.

Conditions. Doctors do not often give consent to induced labor if a woman does not have the indications listed above.

The doctor may ask you some questions before making any decisions.

It is advisable that this is not the first birth and that the cervix has already dilated.

Stimulation is not carried out before 39 weeks, as there is a danger of harming the baby’s health.

If there are no indications, do not insist on induction of labor - trust your doctor.

The lower your stress level, the more likely it is that you will not need labor induction.

Post-term pregnancy

The end of the 9th month (41st week of amenorrhea) is the end of pregnancy.
If by this time you have no signs of labor, you will be sent to the maternity hospital. The child's condition will be checked there. By this time, the placenta may cease to fully perform all its functions (nutrition and oxygen saturation of the blood).
The doctor will prescribe an ultrasound and CTG to check the heart rhythm, the amount of amniotic fluid and assess the biophysical condition of the fetus according to the Manning scale. If any abnormalities are detected, the doctor may decide to induce labor.
In any case, 3-5 days after the deadline that you determined with your doctor, labor will be induced artificially. Deadline for natural childbirth - 42 weeks of amenorrhea.

How is labor induced?

When the decision has already been made, it is necessary to determine the degree of maturity of the cervix. For this purpose, the doctor will perform a vaginal examination and determine the degree according to the Bishop system (scale from 0 to 10). A result of 6-10 points indicates that the cervix is mature: it opens (to the width of 1-2 fingers), shortens (about 1 cm in length), softens and its center falls in the middle of the vagina. The mature cervix will quickly open: labor will soon begin.

If the cervix is immature, 3 cm long, in good shape and located in the back of the vagina, then it is not yet ready to open - you will have to be patient.

If the cervix is mature enough. You will be placed in the delivery room, under a system and a heart monitor, like any other woman in labor. The only difference is that you will be given drugs that provoke contractions (oxytocin). Then the doctor punctured the amniotic sac. You are due to give birth during this day.

If the cervix is not mature enough. If according to the Bishop system you did not dial a large number of points you will need additional stimulation. This may take several days, so bring a book or player with you... The obstetrician will insert a tampon soaked with hormones into the vagina. It should cause contractions followed by opening of the cervix, shortening, softening, smoothing and moving forward. After a few hours of monitoring on a heart monitor, you will be able to return to your room. If after 24 hours there are still no contractions, your doctor will examine you again to determine the degree of maturity of the cervix. If the degree of maturity is sufficient, intravenous administration of birth-stimulating drugs and puncture of the amniotic sac may be prescribed. If the cervix is not yet ripe, after six hours you will have an application with hormonal gel.

Be patient. If you are sent to the ward to wait for labor to begin, take advantage of this to rest, shower, and move around calmly. Perhaps labor will begin at night and you will need strength. It is better to wait until contractions begin on their own than to induce them artificially, and then, if unsuccessful, have a caesarean section.

When labor is induced, the fetus is under constant monitoring.

Regular control

After the expected due date, the doctor will first determine the volume of amniotic fluid. Its decrease can negatively affect the blood supply to the umbilical cord and oxygen supply to the child. Therefore, in this state of affairs, inducing labor artificially becomes inevitable. At normal quantity amniotic fluid, post-term pregnancy is not a problem.

If the ultrasound results say that everything is going well and there are no risks. there is no need to remove CTE. The so-called oxytocin test is also an unnecessary measure. Recently, scientists have found that it does more harm than good, and is often the reason for inducing artificial labor.

If the pregnancy continues uncomplicated, the doctor should check the amount of amniotic fluid with ultrasound every three days. During these examinations, the child's heart sounds are also monitored.

After a week has passed beyond the estimated due date, a CTG is additionally recorded. If the pregnant woman is nursing for more than seven days, the doctor discusses with her the possibility of inducing labor with the help of medications.

The absence of deviations in the volume of amniotic fluid and in the cardiac activity of the child allows us to conclude that it is well supplied - under such conditions, further post-term pregnancy is possible, if the mother herself is not against it. But now it is advisable to monitor the child’s condition, including CTG, every two days. No later than 12-14 days after the calculated date of birth, the pregnancy, however, must end, since otherwise the risks for the child may increase significantly.

Labor cannot begin, stimulation is needed

Sometimes labor does not start on its own. If this happens to you, your doctor may start (induce) labor with medications.

Situations in which labor stimulation is possible:

The baby is post-term. The pregnancy is approaching 42 weeks.
The waters broke (the membranes burst), but labor did not begin.
An infection has developed in the uterus.
The doctor fears for the child, since growth has stopped, the child is not active enough, and there is little amniotic fluid.
You have health conditions such as high pressure or diabetes, which could endanger the baby.
The problem with the Rh factor is that your blood and the baby's blood are incompatible.

If you were hoping that labor would begin on its own, but the doctor insists on induction, try to look at it positively. It may be more convenient to know exactly when the baby will appear than to wait for nature to take its course. You will be better prepared physically and mentally before heading to the hospital.

Stimulation of labor. The doctor can induce labor in several ways, but the cervix should soften, thin and dilate. If this does not happen, the doctor can take steps to start the process.

Medicines. Can be used to soften and dilate the cervix medicines. These drugs also often help initiate labor, eliminating the need for other stimulants such as oxytocin. If cervical priming is required, you may want to go to the hospital the day before the stimulation to give the medications time to take effect.

Mechanical methods. One method is to insert a thin catheter containing a balloon filled with water through the cervix into the uterus. This irritates the uterus, and it begins to push the balloon through the cervix, softening and expanding it from 2 to 4 cm.

Rupture of membranes. In this case, the amniotic sac enveloping the baby ruptures and fluid begins to flow out. Normally, this is a sign that the baby will be born very soon. One result of this rupture is increased uterine contractions.

One way to speed up labor is to artificially rupture the membranes. In this case, the doctor inserts a long and thin plastic hook through the neck and makes a small tear in the membranes. You will feel the same as during a normal examination, and warm liquid will flow out. This is not dangerous for you or the child.

Oxytocin - a way to stimulate labor

The usual way to induce labor is to use the drug oxytocin, a synthetic analogue of the hormone oxytocin. Normally, during pregnancy, the body produces small amounts of oxytocin. During active labor, its level increases.

Oxytocin is usually given intravenously after the cervix has thinned and dilated somewhat. A catheter is inserted into a vein in the arm, and small doses of medication are regularly released into the blood using a special pump. These doses may be adjusted during stimulation to regulate the strength and frequency of contractions until they stabilize. If the dose is chosen correctly, you will feel contractions in about half an hour. Contractions may be more regular and stronger than during natural childbirth.

Oxytocin is one of the most commonly used drugs. It can stimulate labor that might not start on its own, and it can also push contractions forward if they slow down during labor and the process does not progress. Uterine contractions and the baby's heart rate are monitored to reduce the risk of complications.

If stimulation is successful, you will feel signs of active, progressing labor, such as prolonged contractions that become stronger and more frequent, dilatation of the cervix, and rupture of the amniotic sac - if it has not ruptured before.

The reasons for inducing labor must be serious. If your or your child’s health is at risk, the doctor may decide on further intervention, a caesarean section. Induction may take several hours, especially during the first birth.

Oxytocin

This natural hormone, produced by the hypothalamus, which is located in the neurohypophysis. Its function is to stimulate the muscles of the uterus at the time of childbirth. It also promotes contraction of the mammary glands during lactation.
There is also synthetic oxytocin, which is administered intravenously to stimulate labor. Its use must be carried out under certain conditions and strict dosage control. Continuous monitoring of the fetus allows you to see if the baby is suffering when contractions begin or intensify.
Synthetic oxytocin is sometimes given immediately after birth to shrink the uterus, expel the placenta, and reduce bleeding.

Artificial induction of labor

Artificial stimulation of labor (induction).

Most births begin with spontaneous contractions, and the baby is born. healthy child. However, during preventive examinations at last weeks During pregnancy, it sometimes turns out that the child’s life support is no longer at an optimal level. In this case, the doctor must, after weighing all the circumstances, decide whether the pregnancy should be continued until spontaneous labor contractions occur or whether it would be better for the mother and child if premature labor is induced artificially with the help of medications.

Will there be an early delivery? the best way out from the situation, depends on

what week of pregnancy the woman is in. If complications appear shortly before the calculated due date, then labor is induced artificially even if there is a relatively small risk. All the child’s organs have already formed, and he can breathe independently with his small lungs. If the danger for the baby arises for more early stage pregnancy, the doctor will try to delay the birth of the child as long as possible.

Reasons for artificial induction of labor

There are various reasons for inducing labor with medication.

The most common of them and far ahead in frequency of all others is oxygen starvation child, for example, due to placental insufficiency.
If preventive examinations, such as ultrasound, CTG or Doppler sonography, indicate a threat to the further successful development of the child, then premature birth gives him an excellent chance to be born healthy.
In some cases, the child reaches very large sizes. If the observed developmental process gives reason to conclude that the baby's weight will increase significantly in the remaining two weeks, inducing a premature birth with the consent of the expectant mother may be very appropriate. This solution reliably guarantees that the child will be born healthy and without major complications.
In case of premature rupture of the membranes and absence of contractions, stimulation of labor by medication helps to avoid the risk of infection for the child.
Twins themselves are often born earlier than expected. If there is insufficient supply of one or both of them, labor is induced prematurely.
If the baby is sick and cannot be treated in the womb, premature delivery will improve his health. First of all, this applies to children suffering from severe anemia.
Maternal diseases such as gestational hypertension or diabetes may also require early induction of labor.
If the expectant mother suffers greatly from various physical and mental disorders, it is possible to artificially induce premature birth when the child has finished maturing, that is, after the 37th week of pregnancy. The reason for making such a decision may be, for example, severe pain in the back, severe sleep disturbances or heavy physical exertion.

Labor is induced either by prostaglandins or by the administration of oxytocin.

Methods of artificial stimulation of labor

Which method of artificial stimulation of labor the doctor will choose depends on the well-being of the fetus and the condition of the cervix. If the child is already in danger and the uterine os is still closed, childbirth most often occurs by caesarean section.

Stimulation of labor by administration of oxytocin is carried out provided that the uterine os is already sufficiently soft and slightly open. This means that the uterus is preparing for the onset of contractions. The advantage of this method: stimulation does not last long, and you can quite accurately calculate how long labor will take. With the start of oxytocin administration, the child’s heart contractions are constantly monitored using CTG; for this, a portable cardiotocograph is usually used.
In the case of an immature uterine os, prostaglandins are used to stimulate labor. A pregnant woman does not receive these medications in the form of injections. They are used locally in the form of a gel, pessaries or tablets, which must be absorbed in the area of the uterine pharynx. Under the influence of prostaglandins, the uterine pharynx softens and begins to open. Contractions usually occur within two to three hours. If there are no contractions, then after six hours the procedure is repeated.

With this method of stimulation, constant monitoring of the child via CTG is not required. It is quite enough to take a CTG every two hours, starting from the moment contractions appear.

Stimulation with prostaglandins should always be carried out in a hospital setting, since it is quite difficult to predict when contractions will begin. Once the cervix has matured, the further process of labor can be supported by the administration of oxytocin. If after two days there are still no contractions, you should consider whether it is advisable to try again or whether it is better to take a break. Sometimes a caesarean section may be necessary in this situation - primarily if it turns out that your baby's health is at stake.

Induction of labor with misoprostol. This drug was initially approved only for the treatment of stomach tumors. But for 20 years now, in some countries it has been recommended for inducing labor, although, strictly speaking, it has never received the appropriate approval.

Misoprostol causes few side effects and has the advantage that it can be taken in tablet form. Before starting stimulation, the doctor should inform you in detail about the effect that this medicine has - be sure to ask again if anything is unclear to you!

Alternative methods of inducing labor

Artificial opening of the amniotic sac

When the amniotic sac ruptures and amniotic fluid begins to leak, its volume in the uterus decreases. As a result, contractions often occur, from which labor contractions develop. But this method can only be recommended for multiparous women and only if the cervix is dilated.

Sexual intercourse

Having regular intercourse late in pregnancy will reduce the likelihood that you will have to carry your baby to term. It is believed that sex has a dual effect: firstly, it promotes the production of the contraction hormone oxytocin, and secondly, semen contains prostaglandins, which also cause contractions. However, the amount of prostaglandins during a single ejaculation is very small - significantly less dose, used for drug stimulation childbirth

Separation of the fertilized egg

Even before artificial induction of labor through medications became widespread, in the best possible way causing spontaneous contractions was considered separation ovum at the lower pole. This operation can be performed only after the 40th week of pregnancy and provided that the cervix is already slightly dilated. At the same time, the obstetrician penetrates her with his finger. Using rotating movements, he massages the internal uterine os and carefully separates the membranes from the uterine wall. The use of this method requires extreme caution, since the manipulation, which is very painful in itself, can also cause bleeding. Therefore, you should think carefully before starting it at all.

Nipple stimulation

When nipples are stimulated, the hormone oxytocin is released, which causes contractions. But the effect of the hormone is manifested only in the case of maturation of the uterine pharynx. Studies have shown that the effect is so insignificant that this method It's not worth resorting to at all.

Exercise stress

Excessive physical stress, for example, climbing stairs, leads to a more intense redistribution of blood supply (blood from the placenta rushes to the muscles) and in some cases provokes the onset of contractions. However, this method is unlikely to be recommended. Slow movement, e.g. a short walk, in the initial phase of labor it is much more pleasant. TO physical activity It is better not to resort to exercises that require large energy expenditures - you need to save your energy for the upcoming birth.

Additional therapeutic measures

Some women like additional procedures, such as prenatal acupuncture or massage reflex zones. But, unfortunately, it cannot be said that this is reliable way cause contractions.

Using herbs to stimulate contractions

Sometimes a decoction of cinnamon, ginger and cloves is prepared and used to soak tampons. With an immature uterine os, such actions lead to prolonged contractions of the uterus, which can result in oxygen starvation of the child. Therefore, we will not recommend this method. However, the herbs listed above can be used in the form aromatic oils for aroma lamp or, mixed with almond oil, use for massage. If you apply this mixture to abdominal wall and you will massage the uterus from the upper end, this will help your baby finally hit the road.

Stimulating bath

A bath that stimulates contractions can make you feel better. To do this, you need four drops of essential oil, such as clove oil, cinnamon leaf oil or ginger root, add to 250 ml of cream, mix and pour into a filled bath. The water temperature should not exceed 37 °C.

Castor oil

Castor oil, which is used industrially in the production of varnishes and dispersion paints, is also used in the production of cosmetics.

If this oil is taken internally, it will cause intestinal upset, which in turn will lead to contractions. Contractions provoked in this way with an immature uterine os do not bode well. They will not be the beginning of labor, but will only manifest themselves in prolonged contractions of the uterus, which negatively affect the oxygen supply of the fetus. Therefore, an attempt to induce labor without monitoring the child via CTG can be very dangerous for him.

Nausea, diarrhea and intestinal cramps are common unwanted side effects.

On top of everything else, the taste of castor oil is so unpleasant that it is usually taken with wine or vodka, and on top of that the child has to deal with negative action alcohol.

To summarize, this method is unacceptable.

Onset of labor with artificial stimulation

Doctors have several methods to induce labor. What your doctor chooses depends on various reasons, such as cervical readiness and baby health.

Separation of membranes

The doctor will examine the cervix and use a finger to separate the amniotic sac from the walls of the uterus. For many women, their water breaks after this and cramps begin. Once the membrane is separated, prostaglandin is released and contractions begin. This method is only suitable for you if your cervix is dilated.

Cervical preparation

Before inducing labor, your doctor may use something called the Bishop Score to find out if your cervix is ready for labor. The doctor will examine your cervix to see how much it has dilated and effaced and whether the baby has descended into the pelvis. Research shows that induced labor is more effective if the cervix is dilated, so if your cervix isn't ready for it, your doctor may use some substances to speed up the process, such as prostaglandin E suppositories, prostaglandin gel, prostaglandin on a special device, or prostaglandin tablets. Some women who use these products go into labor within 24 hours without any further intervention. Other medications that help dilate the cervix are kelp (kelp sticks that absorb water from the cervix, causing it to dilate) or a catheter flask (which is inserted into the uterus and gradually dilates the cervix).

Amniotic sac puncture

The doctor may use a gynecological instrument, similar to a crochet hook, to make a small hole in the amniotic sac. (This is called an amniotomy.) The procedure mimics what sometimes happens on its own when your water breaks before labor begins. This can be uncomfortable if your cervix is less than a centimeter dilated, but other times it doesn't hurt at all. If contractions do not start 24 hours after your water breaks, your doctor will likely induce labor with Pitocin or other medications to reduce the risk of infection.

Pitocin drip

Pitocin is a synthetic form of oxytocin, the hormone that causes contractions. Most pregnant women go into labor in part due to high levels of oxytocin in the blood; your doctor wants to simulate this process by using Pitocin.

If labor is induced by this drug, you will be admitted to the hospital where an IV needle will be inserted into your arm. Pitocin usually takes about 30 minutes to start working, so your doctor will likely take your time and monitor how you and your child respond to the drug. There is no guarantee that labor will go quickly with Pitocin; contractions may be strong and each contraction may last 1 minute or longer. Many women said that breathing exercises They also help with such births. Inducing labor is a long process, and if this is your first baby, several procedures may be needed. For example, recently it is common to prepare the uterus and only then administer Pitocin. Ask your doctor what procedures will be performed on you and be prepared to wait patiently.

My obstetrician wants to induce labor. For what reason does this happen?

Induction of labor

There are many reasons why it is necessary to induce the birth of a baby earlier than expected. In some cases, caesarean section is practiced. A priori, the child and mother can tolerate childbirth well and, if the obstetrician-gynecologist believes that childbirth will take place naturally, no stimulation required. But sometimes there are reasons to stimulate labor.

The fetus has stopped developing: it receives little nutrition. Examination shows that the placenta is not fully performing its functions, and the uterus is no longer a healthy protection for the baby.
The due date for childbirth has passed, the amount of amniotic fluid is reduced, and the baby moves less.
The due date has arrived, the amniotic sac has ruptured, and the amniotic fluid is colored.
The expectant mother has diabetes and is treated with insulin. All the preconditions are that when the due date comes, the child will be too large.
The mother suffers from preeclampsia. Neither complete rest nor medications help her, her life and/or the life of the child is in danger.
The baby (Rh positive) is anemic because the mother (Rh negative) produces antibodies against red blood cells.
The obstetrician-gynecologist is afraid that the mother will arrive at the maternity hospital too late due to the distance from where she lives or the previous birth was too rapid.

Childbirth is difficult physiological process expulsion of the fetus from the uterine cavity. After the cervix dilates in the first stage of labor, the baby begins to move through the birth canal due to uterine contractions - contractions. In the second period, contractions are joined by pushing (contractions of the abdominal muscles and diaphragm), as a result of which the baby is born. After which the placenta separates quite quickly and the placenta comes out. Here it is, a happy ending!

To begin normal labor, two main conditions are needed: a mature cervix and sufficient strength and duration of contractions. Typically, the cervix “ripens” (i.e. becomes soft, shortens to 1 cm or less, and dilates more than 1 finger) by 38–39 weeks of pregnancy. As labor begins, the cervix continues to open and efface. This occurs due to contractions, as well as pressure from the fetus on her. An important role is played by the amniotic sac, which “wedges” into the opening of the cervix, facilitating its dilatation. For the successful completion of the first stage of labor, uterine contractions must be strong enough, prolonged and occur with a certain frequency.

In cases where contractions are not intense enough, short-lived or rare, they speak of weakness of labor. This condition is also indicated by a low rate of cervical dilatation (normally 1 cm per hour). This condition is also diagnosed through observation, CTG (cardiotocography) and vaginal examination.

There are primary and secondary weakness of labor. Primary is manifested by contractions of weak strength, disruption of their rhythm and duration from the very beginning of labor. The second option is characterized by the appearance of the same changes, but not immediately, but after some period of time after the development of normal labor.

What is the danger of weak labor?

Many expectant mothers are perplexed - is induction of labor really necessary? After all, you can often hear discussions about how in the old days they gave birth for several days, and nothing - everyone treated it normally. But it is important to understand that this situation is not at all the norm and threatens to develop serious complications. For a baby, the danger of weak labor is an increased risk of developing severe oxygen starvation, which can lead to neurological disorders and disorders cerebral circulation in a newborn. In addition, when protracted labor it is possible for amniotic fluid to enter the fetal lungs, leading to inflammation of the lungs and impaired breathing of the child after birth. These consequences often require long-term observation and treatment of the baby in the future.

There is a threat from mom birth injuries, and as a result of insufficient contraction of the uterus in the postpartum period, bleeding may begin.

Therefore, in all cases of development of weakness of labor, it is necessary to stimulate it - increasing the strength, duration and frequency of contractions.

Stimulation during labor: let's try without drugs

Most often, the concept of “labor stimulation” in expectant mothers is associated with the use of special medicines, but, in addition to this, there are a number non-drug methods normalize labor activity:

The active behavior of the woman in labor contributes to the intensification of labor.
Stimulation of the areolas (nipple circles) and nipples of the mammary glands leads to the release of the hormone oxytocin, which enhances uterine contractions.
Labor activity intensifies when the woman is positioned on her side, the same as the position of the fetus.
Amniotomy (opening the amniotic sac) is an effective measure to activate contractions. This is explained by the fact that after the discharge of amniotic fluid, the volume of the uterus decreases, which allows it to contract more efficiently. In addition, amniotomy activates the formation of prostaglandins - substances that are powerful stimulants of uterine contractions. This manipulation is painless, since there are no pain receptors on the surface of the membranes.

Drug stimulation during labor

Before starting drug stimulation during labor, it is very important to assess the condition of the woman in labor. When she is tired, it is prescribed medicated sleep, which lasts about 2 hours. Positive effect due to the fact that during this period labor does not stop, and the cervix continues to open. Often, after a rested woman in labor wakes up, labor activity returns to normal, and the need for labor stimulation may no longer be necessary. If this measure does not help, then, as a rule, the doctor decides on drug stimulation during labor.

Today, prostaglandin group drugs and oxytocin are used for this purpose.

Prostaglandins are biologically active substances that trigger regular labor. They promote the opening of the cervix and increase its contractions. Prostaglandins are used with the development of primary weakness of labor or with the development of secondary weakness of labor, if the dilation of the cervix is not more than 6 cm. These drugs also have side effects - nausea, vomiting, increased blood pressure, increased heart rate, bronchospasm (difficulty breathing due to a decrease in the lumen of the bronchi). Taking this into account, contraindications for prescribing such drugs are bronchial asthma, increased blood and intraocular pressure (glaucoma), severe liver and kidney diseases. These drugs are administered intravenously.

Oxytocin (from the Greek oxys - fast, tokos - childbirth) is a synthetic analogue of the hormone oxytocin, which is responsible for the contractility of the uterus. Since the most common cause of weakness in labor is insufficient production of one’s own oxytocin, the administration of this substance helps correct the situation and normalize the birth process. Sensitivity to oxytocin increases towards the end of the first stage of labor, so it is most effective for secondary weakness of labor and weakness of pushing. It is also administered intravenously.

The administration of these drugs requires constant supervision by an obstetrician-gynecologist and midwife. Careful monitoring of the contractile activity of the uterus and the condition of the fetus is necessary. It is important to prevent an overdose of prostaglandins and oxytocin, which causes uterine hypertonicity, which, in turn, leads to disruption of the uteroplacental circulation and intrauterine suffering of the baby, premature detachment placenta.

Along with stimulation of labor, they usually administer antispasmodics to weaken the spasm of the cervix during contractions and soften it. Intensified contractions when the cervix is tight leads to its rupture. To prevent oxygen starvation of the fetus, drugs are prescribed that improve uteroplacental blood flow and increase the resistance of fetal brain cells to oxygen deficiency.

In case of persistent weakness of labor, combined with other diseases, and if natural childbirth is impossible, a cesarean section is indicated.

Conditions for labor stimulation are:

Correspondence of the size of the fetal head to the mother’s pelvis, which shows the possibility of the fetus moving through the pelvic cavity during childbirth;
Satisfactory condition of the baby (according to cardiotocography data, ultrasound examination, Dopplerometry of uteroplacental blood flow). If the fetus is oxygen starved, labor stimulation cannot be performed, as this can lead to vasospasm, disruption of the uteroplacental circulation and deterioration of the child’s condition.
Absence of amniotic sac. Labor stimulation is not performed when the amniotic sac is intact. It's threatening severe complication– placental abruption due to excessive intrauterine pressure. Typically, when labor weakness develops, an amniotomy (puncture of the amniotic sac) is first performed, and then the woman in labor is observed for 2 hours. If labor has not returned to normal during this time, drug stimulation is prescribed.

Is it possible to avoid stimulation during labor?

Prevention of the development of weakness of labor is largely a normal pregnancy. Essential for the expectant mother good sleep– at least 8 hours a day, rational balanced diet, favorable conditions psychological comfort. An important role is played by the absence of chronic foci of infection, good physical shape, preparation at school for pregnant women and support from relatives. Gymnastics classes for pregnant women, breathing exercises, swimming in the pool, yoga, and walks in the fresh air are recommended. Also, the expectant mother needs to take vitamins (B6, ascorbic and folic acid), which have the properties of increasing the energy potential of the uterus.

Such different concepts

It is important to understand that labor stimulation and labor induction are two completely different procedures. Labor stimulation is always an intensification of existing contractions, when labor began on its own, but then there was a disruption in its normal development, and it began to weaken. Labor induction is carried out when it is necessary to induce labor when there are no contractions yet.

Causes of weakness of labor:

previous abortions, miscarriages, uterine curettage, inflammatory diseases female genital organs, uterine fibroids, hormonal disorders and chronic diseases;
the age of the primigravida is less than 18 and more than 35 years;
a large number of births (4 or more);
reasons leading to overstretching of the uterus (large fetus, polyhydramnios, multiple pregnancy), preventing the full contraction of the myometrium - the muscles of the uterus;
hereditary predisposition, which can be traced through the female line;
complications of pregnancy - postmaturity, placental insufficiency (i.e., the inability of the placenta to meet the needs of the developing fetus);
A woman’s fear of pain, lack of psychological attitude towards childbirth.

When can labor stimulation not be performed?

Contraindications for labor stimulation are the presence of a scar on the uterus, incorrect position of the fetus, oxygen deprivation, clinical narrow pelvis(a situation where the size of the fetal head does not correspond to the size of the mother’s pelvis), placenta previa (when the placenta blocks the exit from the uterus), severe gestosis, fatigue of the woman in labor.

When the pregnancy becomes post-term, it is necessary to hasten the birth of the child - stimulation of labor in inpatient conditions- it is safe and effective procedure. So that our readers have a rough idea of what awaits them in the maternity hospital, what kind of manipulations and medications, we have prepared this material.

How to understand that your body is ready for childbirth

A woman will never understand this on her own. She may often experience preparatory contractions - but this is not at all a sign that the cervix is ready for childbirth. The most important thing is that it is mature enough. In this case, childbirth will be as safe, comfortable and natural as possible.

But in last years Doctors are observing a tendency that in women, especially first-time mothers and those with various chronic diseases and obstetric pathologies, by the expected date of birth the cervix is completely unprepared for dilatation. This happens, among other things, due to hormonal imbalance, too high progesterone - a hormone that prolongs pregnancy. Doctors use this information for drug stimulation of labor; it is carried out exclusively in the maternity hospital, since the drugs used for this are very serious and are not sold freely in pharmacies.

But besides this kind of medicinal preparation, other methods are also used. We will describe them in our material. But let's return to our neck.

At 39-40 weeks, all women undergo a gynecological examination at the antenatal clinic or maternity hospital in order to determine the degree of maturity of the cervix. If the cervix is not at all mature, you need to take measures to prepare it now, otherwise you will face great difficulties in childbirth, and possibly a caesarean section.

During the examination, the doctor pays attention to the length of the cervix (he can determine the length of the vaginal part only, but this is quite enough), the degree of its dilatation, and softness. If the neck is closed, tight and long, it’s time to take action. Many women think that an examination to diagnose the condition of the cervix is not necessary (after all, it is very painful), and that an ultrasound measuring its length with a vaginal sensor is quite enough. But that's not true. To be ready for childbirth, it is important to feel the cervix. Yes, it's a little painful. But what else will happen during childbirth... Try to relax during the examination, and painful sensations will be minimal.

How to stimulate labor with antispasmodics

Experienced women know that in the third trimester of pregnancy they need to use antispasmodics as little as possible, since they will most likely not prevent premature birth with frequent hypertension, but, on the contrary, provoke them. The thing is that antispasmodics relax muscles, reduce their tone, including a very tight cervix.

The most effective and well-known substance used for this purpose in Russia is Hyoscine butyl bromide - this is a drug familiar to many under the name “Buscopan”. Can be prescribed from 38-39 weeks in the form of rectal suppositories for prenatal preparation of the cervix. Many studies and statistics prove their effectiveness. For the majority of expectant mothers who used Buscopan before childbirth, their first period proceeded quickly and easily, the cervix dilated without problems. Buscopan is also sometimes prescribed in the form of intramuscular injections, but already in a hospital setting.

In second place in terms of efficiency are rectal suppositories with belladonna. They have antispasmodic, analgesic and anti-inflammatory effects. Good for reducing organ tone abdominal cavity. Prescribe 1-2 suppositories per day.

And finally, “Papaverine Hydrochloride” (rectal suppositories) and “No-shpa” (droverine) - orally and intramuscularly. More weak drugs for almost natural stimulation of labor, which also has a blood pressure-lowering effect.

If all this does not help or time is running out, more serious measures are taken in the hospital. Read about them below.

Induction of labor with a Foley catheter

The Foley catheter is a urological instrument, but it has long been “favored” by obstetricians and gynecologists, who use it to dilate the cervix. Cheap and cheerful, as they say. And it can be carried out in any maternity hospital remote from civilization. This is a method for mechanical impact on the cervix.

The catheter is inserted into the woman's cervical canal. The procedure is not painful, but it may be a little unpleasant. Next, it is filled with 30-60 grams of liquid. This leads to dilation of the cervix. And if the effect is persistent, then within 12-24 hours the catheter falls out on its own, and the cervix, dilated by 3-4 cm, turns out to be sufficiently mature for doctors to begin active stimulation of labor. Unfortunately, contractions do not always appear on their own after such mechanical action on the cervix. The pregnant woman has her amniotic sac pierced and, if necessary, given an IV with Oxytocin.

Modern Foley catheter maternity hospitals to stimulate labor, it is used quite rarely, since after it there is a high risk of weak labor and cesarean section. In addition, there is almost always a need for other types of stimulation.

Preparation of the cervix with kelp

This is similar to the Foley catheter, a mechanical way of dilating the cervix. But it is preferred. Laminaria - ordinary seaweed, or rather two types of them, used in obstetrics. The doctor injects these algae in the form of several sticks into the woman’s cervical canal. There they are saturated with moisture and increase in volume during the day by about 3-5 times, thereby slowly expanding the cervix. The length of one stick is 6-7 cm, and the initial diameter is 2-3 mm. The length of kelp does not change under the influence of moisture. Only the volume is growing.

The disadvantages of kelp for stimulating labor are the following:

severe pain experienced by many women during the introduction of algae into the cervical canal;
unpleasant sensations during the entire time they are there;
sometimes the sticks become dislodged in the vagina, making them useless;
it takes a lot of time to achieve the effect - about a day;
there is a risk of uterine infection and algae allergy.

But all these complications are quite rare, so kelp is one of the most commonly used means of induction (stimulation) of labor by obstetricians.

Gel for inducing labor

The gel contains prostaglandins - substances that induce labor. Yes, exactly those contained in male sperm. It's not for nothing that they say that sex is long term pregnancy often provokes labor.

However, prostaglandin in the form medical product should only be used in conditions maternity hospital because it has a number of side effects. For example, blurred vision, drowsiness, tinnitus, change heart rate, dizziness, surges in blood pressure, etc. Prostaglandins have a lot of contraindications in the form chronic diseases heart, kidney, asthma, glaucoma, etc.

Prostaglandins are prescribed for an immature cervix. Administered intramuscularly or in the form of a gel. The second option is preferable, as it is effective when small doses. Typically, the gel begins to be administered one day before the expected birth. And the onset of labor is stimulated by amniotomy (puncture of the amniotic sac) and oxytocin.

The gel is quite effective, but sometimes it does not work... For example, it is ineffective during pregnancy less than 37 weeks (sometimes there is a need for stimulation for such early), obesity in expectant mother, over 30 years of age.

How labor is stimulated with pills in the maternity hospital

Mifepristone is a so-called antigestagen drug. It is used not only to induce labor, but also for abortion in the first weeks of pregnancy, emergency contraception, and in some countries for the treatment of uterine fibroids.

For stimulation, mifepristone (miropristone) tablets are given in the maternity hospital, which the woman takes only in the presence of a doctor. This drug is strictly prescription and quite dangerous if you use it yourself in violation of the instructions. Since mifepristone is used for medical termination of pregnancy, all expectant mothers who want to keep the child should stay away from it, according to at least, up to 40 weeks - full term.

The regimen for taking the drug is as follows: 1 tablet of the drug with a dosage of 200 mg is taken on the first day and exactly 24 hours later another tablet is taken. How long after the second dose does mifepristone cause labor in women? Usually within 2 days, maximum within 3 days. If, after this time, the birth canal remains immature, the woman is given prostaglandins (gel) vaginally. Although in this case there are often failures and a caesarean section has to be performed, since time is running out and the cervix does not ripen.

Before inducing labor on her own, a pregnant woman must be sure that the gestational age is correctly assessed. Consult your doctor about the compliance of the changes detected on ultrasound and CT with the established period. When the body is ready for childbirth, it can be used natural methods obstetrics.

Reasons for inducing labor

Pregnancy is more than 40 weeks. After this period, the placenta ages, and the child’s nutritional efficiency decreases.
Multiple pregnancy after 38 weeks. By this time, children have already matured, and their further intrauterine development can provoke problems during childbirth.
For medical reasons in case of Rh conflict, heart problems, diabetes mellitus.
Presence of scars on the uterus.
Narrow pelvis.
Allergy to prostaglandins.
Leakage of amniotic fluid.
Increased intraocular pressure.

How to induce labor using folk recipes

Physical exercises help lower the baby and put pressure on the baby's head on the cervix.

Walking should be done in the morning, when the surrounding air is as free from pollution as possible. It is advisable for a pregnant woman to take an umbrella with her to lean on if she experiences back pain. It will also come in handy if it rains.
Climbing up staircases helps the fetus move down quickly. Due to the constant movements of the hips, the small pelvis expands, and the child takes the most comfortable position.
Swimming breaststroke helps contract the abdominal and back muscles. Staying in water additionally helps relieve swelling in the legs.
Squatting long time. The baby will begin to move through the birth canal faster with an open pelvis. The method is used in the case of a high position of the child in late pregnancy.
Induce labor by rocking on a swing. To use this method, you need to find a safe swing and swing on it for a few minutes a day.

Kinds medical methods stimulation of labor:

Stimulating uterine contractions
Affecting the dilation of the uterus.

Stimulation of uterine contraction by prostaglandin E2 (enzoprost). The substance is inserted into the vagina, but does not enter the amniotic sac. When the cervix dilates, the process of labor begins. Prostaglandin suppositories stimulate the production of prostaglandin in the body. Their action begins within 30 minutes, which gives the woman the opportunity to prepare for childbirth.

The opening of the fetal bladder is carried out with a special hook. The procedure is painless, since the bladder has no nerve endings. The effusion of water leads to increased pressure inside the uterus, which stimulates labor. Amniotomy does not affect the condition of the child, since the fetus is not affected during the manipulation.

The drug Oxytocin is used to stimulate contractile activity. Most often administered intramuscularly or intravenously. The hormone does not affect the dilatation of the cervix. It only enhances labor. Contraindications to the use of oxytocin: inability to give birth naturally, increased sensitivity to the drug, the presence of scars and placenta previa.

When labor is not induced

If the baby's head exceeds the lower size of the mother's pelvis.
Poor fetal condition as assessed by cardiac monitor.
Hypertension or other health problems in a pregnant woman.
Incorrect position of the child.

Before inducing labor, a woman should get a good night's sleep and psychologically prepare for labor.