home Thyroid How labor is stimulated in the maternity hospital with medications and exercises. Stimulation of labor (stimulation of labor at home)

How labor is stimulated in the maternity hospital with medications and exercises. Stimulation of labor (stimulation of labor at home)

Wise nature gives a woman nine months to prepare to become a mother. And now, finally, the long-awaited moment has arrived. In obstetrics, it is believed that the process of labor and childbirth in first-time women should last eighteen hours, in second-time women – twelve. But sometimes contractions that are strong at first subside, and doctors note that labor is weak in the woman in labor. It is in this case that gynecologists resort to stimulation. Obstetrics statistics in Russia show that only seven women out of a hundred require stimulation. Artificial induction of labor should take place in a hospital (maternity hospital) with the direct participation of a gynecologist.

When do doctors prescribe induction of labor?

Weak labor activity, which does not allow the cervix to fully open, forces obstetricians to resort to artificial stimulation of labor. In primiparous women, stimulation begins after six hours from the onset of contractions, in multiparous women - after three hours.
Obstetricians resort to urgent stimulation when full-fledged contractions weaken over time, become short-lived, and the cervix does not open.
Stimulation is prescribed if the waters have broken, but contractions have not occurred.
Stimulation is used for polyhydramnios. More often, a large number of water speaks of a large child or twins.
If the woman in labor is exhausted due to prolonged contractions.
A woman in labor often needs stimulation if she has a history of diabetes mellitus or suffers from chronic diseases of the heart, liver, or kidneys, which worsened during pregnancy.
The woman in labor has severe late toxicosis or her placenta is not working satisfactorily, as a result of which the fetus is starving.
Stimulation is prescribed for early rupture of the membranes.

At what week of pregnancy are doctors forced to resort to stimulation?

Labor is stimulated artificially if the fetus is ripe, but contractions still do not occur. Obstetricians resort to artificial stimulation if more than two weeks have passed after the expected due date - at 42 weeks of pregnancy. However, as recent statistics show, about 4% give birth to children on their own (without stimulation) and after 42 weeks of pregnancy. The decision on the need for artificial stimulation is made by the doctor!

Contraindications

The fetal head is too large. Anatomical structure does not allow a pregnant woman to give birth on her own without additional stimulation.
The fetus shows signs of hypoxia.
Pathology in the position of the fetus in the uterus.
The mother had previously undergone a caesarean section.

Methods of inducing labor in the maternity hospital: amniotomy, oxytocin, prostaglandins

Translated from English, “labour” (labor pains) means “work.” And no one will challenge such a definition. After all, childbirth is indeed a painful and rather tiring job, which not every woman is able to cope with. In order not to harm the child, doctors quite often resort to stimulation. We will talk about three stimulation methods that obstetricians most readily use.

Amniotomy

Amniotomy is the surgical opening of the amniotic sac. This simple operation is carried out using a jaw - a medical instrument that resembles a hook.

When is aminotomy prescribed:

In post-term pregnancy.
At serious problems with the heart of a woman in labor.
With gestosis (complications in the form of edema, cramps, sharp increase pressure, etc.).
During exacerbation of chronic diseases in the prenatal period.
When the fetal bladder protrudes into the cervix.

After this procedure, contractions begin within 12 hours. In the absence of labor, doctors prescribe medications or resort to surgery - caesarean section. Quite often this manipulation is carried out directly during childbirth.

Amniotomy is usually divided into:

Prenatal – challenge premature birth. For example, when the amniotic sac prolapses.
Early - contractions have begun, and the cervix is dilated less than six cm.
Timely - the cervix is completely open, and contractions are weak.
Belated - there are attempts, and amniotic sac didn't explode.

Contraindications for this manipulation:

Pathological presentation of the fetus.
The fruit is heavy (more than three kg).
Gestational age is less than 38 weeks
The presence of vaginal herpes in a woman in labor.
Intrauterine hypoxia.
Multiple pregnancy.
Integrity violation uterine wall– scars.

This operation is performed in the maternity hospital. The doctor uses a jaw to make a small hole in the fetal membrane. Controlling the quantity amniotic fluid, the obstetrician gradually widens the hole with his hands. After this procedure, the pregnant woman should lie down for at least half an hour. The doctor monitors the condition of the mother and fetus and records the onset of contractions.

This procedure, as shown medical statistics, safe. However, obstetricians emphasize that childbirth occurs quite quickly.

Prostaglandins

PGs are active biological substances that are effectively used to stimulate labor. These substances activate the production of the hormone oxytocin.

Today, drugs containing PGs are produced and used in a wide variety of dosage forms. These can be vaginal tablets, solutions, vaginal gels. Vaginal gel with prostaglandin E2 is more popular among obstetricians. This gel is available in a syringe (disposable). The drug is injected into the cervix or vaginal vault. The birth process, as a rule, begins 30-60 minutes after administration of the drug.

Prostaglandin can be administered intravenously to a woman in labor - by drip.

Vaginal gel can be used even with existing chronic diseases in a woman in labor, it does not affect the health of the fetus.

Oxytocin

This hormone is produced in the hypothalamus, then it enters the posterior lobe of the pituitary gland, and from there into the blood. The level of this hormone increases significantly in the ninth month of pregnancy. Its maximum amount is released at night. It is not surprising that most newborns are born at night. Oxytocin tones the uterus and causes the cervix to dilate. It is also responsible for enhancing lactation.

If labor is weak, oxytacin is prescribed to stimulate and speed up labor.

Oxytocin:

Gives tone to the smooth muscles of the uterus.
Increases and strengthens the frequency of its contractions.
Opens the entrance to the uterus.
Gives additional strength to a woman.

The introduction of the hormone after childbirth helps:

Contraction of the mammary glands.
Active secretion of milk from the breast.
Proper development of the central nervous system in a child.
Sometimes this hormone is used to stop uterine bleeding.

Oxytocin has psychotropic effect, it calms the woman in labor, causing her a feeling of pleasure. Thanks to this hormone, a woman ceases to be afraid of childbirth.

Contraindications to the use of oxytocin:

Pathological position of the fetus.
Large fetal head.
Tumor of the cervix or its immaturity.
Uterine scars.
Undesirable use of this medication with uterine fibroids, fetal hypoxia.

Progress of this procedure

Oxytocin is administered by drip strictly according to a specific scheme. For uterine bleeding, it is administered intramuscularly up to three times a day.
During a caesarean section, the hormone is injected directly into the uterine muscle itself.
The effect of the drug occurs within three to five minutes.

IN last years very often oxytocin is administered intravenously using an electronic infusion pump. This device is able to accurately calculate the required amount of the drug entering the blood of the mother in labor. Thanks to this device, it became possible intravenous administration microdoses of the hormone, which allowed doctors to control the strength and intensity of contractions.

Possible consequences of labor stimulation for the baby and mother

All of the above types of stimulation contribute to a return to the natural process of childbirth; they only correct minor deviations. Some mothers mistakenly consider stimulation of labor not only harmful, but also dangerous.

Undoubtedly, the decision on the need to induce labor is made by obstetricians. First, a thorough examination is carried out, the results are analyzed, and all the pros and cons are weighed. And only after this, obstetricians decide which technique is best suited for a particular woman in labor. Many women believe that inexperienced doctors begin to perform stimulation in advance so that the woman gives birth before the end of their shift. Sometimes it happens. But, as a rule, stimulation is used only in cases where it is vitally necessary.

Even doctors have different attitudes towards stimulation. Some say “For” with both hands. Others, citing possible complications, believe that these techniques should be used only in critical cases. They confirm their opinion by the fact that children born with the help of stimulation are more likely to suffer from various neurological problems.

TO negative points can be attributed:

Painful contractions.
Restriction in the movements of the woman in labor. The woman is given an IV and is forced to lie in the same position.
Quite rarely, but it still happens that stimulation leads to fetal hypoxia.

I would like to note that the correctly chosen technique and drugs, a timely decision to start stimulation, saved the lives of many babies and their mothers.

In most cases, stimulation helps speed up labor without causing any complications.

Is it possible to use traditional methods of inducing labor at home?

Many women ask if there is safe ways carrying out stimulation at home? Of course have. You can trigger the onset of labor through physical activity. For example, walking up and down the stairs. Or start rubbing your nipples. But how advisable is it to induce labor? Maybe we should wait until it starts natural process. After all, the initially expected date of birth is far from exact date. Before you begin any actions aimed at inducing labor, you must consult a doctor, undergo a CTG and an ultrasound.

Methods of artificial stimulation at home

Nipple massage. When nipples are stimulated, the body begins to more intensively produce the hormone oxytocin. We wrote about the action of this hormone above. The massage consists of rotational movements that involve the entire palm. You need to massage each breast for fifteen minutes. The entire session should last one hour. You need to do it three times a day.
A reliable way for stimulation is intimate intimacy.
Some women benefit from eating spicy foods, but for most, such foods cause heartburn. Therefore, this method must be used with great caution.
To speed up the process of childbirth, our grandmothers drank a decoction of raspberry leaves. In some countries, women use pineapple pulp and seaweed for the same purpose.

What absolutely cannot be done to stimulate labor?

Do not take any pills, do not give injections and do not give IVs at home.
Independent use medicinal methods stimulation can lead to irreparable consequences.

The preliminary date of birth, calculated by the doctor during registration, coincides with reality in 25% of cases. Therefore, for some women, contractions come as a surprise, for others - a long-awaited harbinger. Obstetricians allow natural stimulation of labor for a period of 38 weeks or more, in the absence of pregnancy pathologies. But drug intervention in a hospital is prescribed only if fetal maturity is established and there are no signs of labor at the same time.

PDR is not the basis for making a decision on stimulation. A justifiable reason exists for a period of 40 obstetric weeks, after the conclusion of a gynecologist, based on the results of examinations. It is safe to induce labor naturally. A special menu is used (spicy, herbs, oils), stimulation of sex hormones (sex, orgasm). The main thing is not to overdo it and carry the baby to term.

During the first birth, 69% of babies are not born on time due to immaturity of the cervix. Therefore, during pregnancy, in the absence of risks of miscarriage, stimulation of the muscles of the reproductive system with Kegel exercises is recommended. The training technique reduces the risk of injury for mother and baby.

To make a decision about stimulation, it is necessary to undergo examination for pregnant women before childbirth: ultrasound, CTG, OAM, OAC. The results will assess the condition of the fetus, the readiness of the placenta, and identify risks. The formal diagnosis of postmaturity is established only after 42 weeks, but doctors do not take risks and act on the uterus earlier.

At what week is labor induced? More often, stimulation is permitted at 38 weeks for boys, and at 39 weeks for girls. During this period, the formation of the fetus is completed, the lungs are ready for direct oxygen consumption.

In half of the cases, stimulation is prescribed in the week after PDR. Only 3% of women carry their fetus to term beyond 42 weeks, according to doctor's orders. During this period, the risks of infection and fetal hypoxia are increased.

Indications for stimulation:

It is allowed to accelerate the approach of childbirth at home if no pathologies of pregnancy and fetus are detected. For example, if amniotic fluid leaks, exposure to the uterus is carried out only in a hospital. If you induce the onset of labor at home for the natural birth of a baby after caesarean section, risks increase birth injuries, fetal hypoxia and uterine rupture.

Contraindications

It is not allowed to induce contractions for up to 38 weeks, without indications. Light and vascular system The baby is finally formed in the last 3 weeks of pregnancy, when every day counts. Premature interruption of the pregnancy process ahead of schedule threatens serious complications, including death.

The disadvantage of inducing labor is the lack of natural readiness of the uterus, muscle failure. If the tissues have not matured as a result of the body’s natural preparation, pressure on the canals will lead to painful symptoms, contractions up to 12 hours, ruptures, and fetal injuries.

Contraindications:

previous cesarean section;
malposition;
discrepancy between the pelvic bone ring and the diameter of the fetal head;
signs of the onset of labor, with in good condition fetus

If there is scarring on the uterus, stimulation is excluded due to the risk of rupture. In 65% of cases, a repeat operation is prescribed; the rest are allowed to have a natural birth after 5-7 years (if the scar is well established). At the same time, obstetricians categorically prohibit stimulation of the third birth after a cesarean section, the risk of suture rupture is 50%.

Incorrect position or discrepancy between the circumference of the fetal skull and the pelvis also excludes natural way. The head will not be inserted into the cervical canal and will not be able to move forward with attempts.
If the cervix is open, the fetus is ripe, stimulation with drugs in the hospital is recommended from 40 weeks. Droppers, injections and tablets at home are not acceptable.

Stimulated labor is more painful than natural labor, since the birth canals have not yet matured, and the uterus is already pushing out the fetus. As a consequence - ruptures, fetal hypoxia, bleeding.

Contractions should not be brought closer if CTG of the baby is normal. The preparation time is individual for each organism. Only 4% of women give birth on their estimated due date (with a margin of error of 1-3 days), and only 7% actually need to induce contractions.

Natural stimulation methods

To bring contractions closer, you need to speed up the opening of the cervical canal so that the fetal head, under the pressure of the water, moves down, stretching the amniotic sac. This scenario is preceded by softening of the walls of the uterus. The stronger the blood flow and the more intense the production of the hormones prostaglandin and oxytocin, the earlier labor will begin. But if nature hesitates at 38-39 weeks, the mother, with the permission of the doctor, can begin natural stimulation of labor.

How to speed up your due date naturally:

Nipple stimulation. Applying pressure to the chest helps the cervix open. You need to press on the nipples, twist them for 10-15 minutes, every hour, and first apply a moisturizer. Mild arousal promotes the production of oxytocin, which stimulates labor naturally.

Husband therapy. Similar, but more strong effect, occurs after having sex. Under pressure from the penis, blood flow in the tissues increases, the walls of the vagina contract, transmitting the impulse to the uterus. Orgasm will enhance the effect.

Obstetricians do not deny the effect of stimulating labor with sperm due to the content of prostaglandins in it. The substance enhances secretion, expands blood vessels, stimulates uterine contractions. After sex, the “birch tree” position is recommended, then the sperm will penetrate deeper.

Acupuncture. Natural way to induce labor - technique acupressure. Between big and index finger, on the membrane you need to feel the connecting part and massage the central point for 60 seconds, with a break of 1 minute, 3 times per procedure. Repeat 5-6 times a day.

Water procedures. Hot water and steam increase blood circulation in the pelvic organs. But the air temperature in the bathhouse before childbirth should not exceed 60 C. The procedure is permissible only if the pregnancy proceeds without deviations. Sauna is not allowed if violation blood pressure. But a bath with water heated to 37.7 C is acceptable for stimulating labor. You can add 5-7 drops lavender oil, which softens the cervix and relieves pain.

Gymnastics. According to most mothers, physical activity brings contractions closer. If you take a long walk at 37-38 weeks, the likelihood of early labor doubles. Therefore, in maternity hospitals, visitors often observe pregnant women who “wrap up” their mileage by walking up and down the stairs.

Exercise to stimulate labor is recognized as an alternative to walking. Exercises on a fitball are recommended - sitting, raising your straightened legs alternately, holding each for 10-15 seconds. A way for the lazy is to lie on your back, placing a pillow under your pelvis, above head level. Lie down for 15 minutes, 3 times a day. A popular method is a squatting position with your back straight (3 minutes). Pregnant on later Swimming is allowed and beneficial, 30 minutes daily. Recommended for abnormal fetal position.

Stimulation of labor with fingers performed only by an obstetrician. The doctor inserts his hand deep into the vagina and makes circular movements. Massaging the cervix will bring the opening of the birth canal closer. Manual stimulation of labor is not carried out after the water has broken due to the risk of infection.

Can a cough cause premature labor? Yes, if the symptom is severe and long-lasting. The cough reflex involves the walls of the abdominal cavity. Due to excessive abdominal tension, during dry severe cough, rises uterine tone, provoking the risk of miscarriage. The symptom is especially dangerous in the first and third trimester.

Can stress trigger labor? Yes, in 17% of cases the cause of prematurity is jar of Hearts, sudden jump cortisol levels. The stress hormone stimulates the immune response, awakens the reaction to eliminate additional stress on the body, and get rid of the fetus. Premature birth due to stress in half of the cases results in complications for the woman.

Nutritional stimulation

The method is based, firstly, on the consumption of foods rich in prostaglandins or analogues. Due to the low concentration of the substance, stimulation has a cumulative effect and works in conjunction with motor and drug therapy. Laxative products promote labor because they irritate the intestinal walls. Spasms are transmitted to the uterus, provoking contractions.

How to induce labor naturally:

spicy food;
herbs;
beet;
a pineapple;
water from boiled eggs.

Chili peppers, garlic, cumin, hot seasonings enhance gastrointestinal motility. When processing food, the intestines are irritated, as more intense contractions are required, the reflex is transmitted neighboring organ- uterus. This folk method is prohibited for pregnant women with stomach diseases. Consuming baked beets or beet juice works the same way.

The most common types of herbs to induce labor folk remedies– raspberries, nettles, barberries, ergot. Dry leaves are brewed with boiling water, infused for 20 minutes, taken half a glass, 2 times a day. It is useful to drink warm tea with raspberry leaves, with a slice of lemon and mint. The drink relaxes and stimulates contraction of the uterine walls. There is a diuretic effect.

Decoctions are effective for bleeding to stimulate the uterus after childbirth. Due to the activation of contractions, dead endometrial cells are pushed out, accelerating healing.

Can raspberry jam induce labor? No, they only work fresh leaves raspberries Even if you make jam without getting rid of the leaves, the substances that synthesize the production of prostaglandin will not be preserved.

The substance bromelain contained in pineapple is similar in action to prostaglandin. It is believed that eating 500-600 g of fetus per day will help the cervix open.

Water from boiled eggs is believed to stimulate labor due to calcium production. The secreted substance envelops the walls of the uterus, nourishes the tissues, increasing their elasticity. Contractions are less painful, and after childbirth the vagina remains elastic.

Drug stimulation

Today from ways traditional medicine women go to medical drugs. Moreover, the main active substance more often natural component. Effective way hasten labor by taking oils (castor oil, primrose, flax) with a laxative effect. The product is added to food, one teaspoon per day. Stimulants are purchased at a pharmacy or used only in the maternity hospital.

candles;
enema;
seaweed;
acupuncture;
artificial hormones.

Under influence glycerin suppositories, the pelvic organs are stimulated. The drug has a special consistency and dissolves inside, irritating the intestinal wall. An affordable inexpensive option is Glycerin, Microlax. Antispasmodic suppositories Buxopan and NoShpa relieve pain and soften uterine tissue. Increased elasticity helps avoid injury during childbirth.

Enema as a stimulant effective only in a hospital setting when a large volume container is used. It is used in combination with other methods: droppers, injections.

Algae for opening the neck are called kelp. Elastic sticks similar to a tampon are rolled out of the stems and leaves of the plant. The product is inserted into the vagina, dissolves (it is better to take horizontal position). Under the influence of secretion, the substance in tampons is synthesized into prostaglandin. Algae induces labor within 48 hours and is effective when the cervix is weakly dilated.

Acupuncture is an oriental medical technique. The specialist uses acupuncture to target specific points responsible for transmitting impulses to certain areas of the brain. This includes stimulating the segment that produces the necessary hormone, and contractions begin naturally.

From artificial hormones In hospitals, Dinoprost, Desaminooxytocin, Oxytocin (intravenous, drip) are most often prescribed. Doctors do not recommend Sinestrol to induce labor due to side effects. The cervix opens, but the substances in the drug irritate the inner walls of the uterus and provoke inflammation of the endometrium.

Efficiency traditional methods denied by every second obstetrician-gynecologist. But forums and blogs are filled with arguments from accomplished mothers about the effectiveness own ways stimulation. The main thing is not to rush to check the veracity of these stories and remember that the key to a successful birth is naturalness.

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 to get 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 heartbeat, the amount of amniotic fluid and assess the biophysical state of the fetus using 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 birth- 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 you scored a small number of points according to the Bishop system, 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. With a normal amount of 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. Scientists have recently discovered that it brings more harm than benefit, 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 medicines.

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. Medicines may be used to soften and dilate the cervix. 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 in the last weeks of 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 baby reaches a very large size even before the 38th week. 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 large physical exercise.

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 medication became widespread, separation was considered the best way to induce spontaneous contractions. 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. Application 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, such as a short walk, is much more pleasant in the initial phase of labor. It is better not to resort to physical activity that requires large energy expenditures - you need to save your strength 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. This requires four drops essential oil eg oils of cloves, cinnamon leaves 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. For most pregnant women, labor begins partly due to high level 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 the birth will take place naturally, stimulation is not 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.

You should not induce labor until at least 40 weeks. Once it starts, you can apply natural ways, which will not harm, but will only set the body up for the process.

Dosed physical activity after 40 weeks - yoga, Nordic walking, breathing exercises and exercises on a gymnastic ball are very useful, but only with the permission of a doctor. You can simply do some general cleaning or walk up and down the stairs.

If physical activity causes severe malaise, fatigue, swelling, increased blood pressure or other unpleasant symptoms, their intensity should be reduced or abandoned altogether to avoid more serious consequences.

Sex is especially useful on the eve of childbirth for two reasons:

A man's sperm contains prostaglandins, which have positive influence on the cervix. Under their influence, it softens, shortens, and opens.

Nipple stimulation on the chest sends signals to the brain to release oxytocin, the level of which quickly increases in the blood. It is also useful for preparing the body for childbirth. It is recommended to irritate both nipples alternately or together several times a day for 3-5 minutes.

The nerve plexuses of the intestines and uterus are interconnected. Irritation of some leads to activation of others. This can be used to “wake up” the uterus. It is recommended to include the following foods in your diet:

Exist active points, massage which will also be favorable for the onset of labor. It is recommended to do this several times a day for 3-5 minutes. Here are the two most commonly used points:

Can be used at home device for DENAS therapy, influencing the abdominal area, cervical-collar area.

Homeopathy medications will help based on Pulsatilla and Caulophyllum. However, they should be used only as prescribed by a homeopathic doctor or at least a gynecologist.

Indications for induction of labor in the maternity hospital:

post-term pregnancy - after 41 weeks;
if there is no need for a caesarean section;
complications of pregnancy requiring delivery in the absence of labor, for example, with oligohydramnios, suspicion of some malformations in the fetus;
somatic diseases of a woman that require earlier delivery, for example, cardiovascular pathologies.

Mother's assessment upon admission to the maternity hospital using the Bishop scale

Conditions for holding:

live fruit;
absence of significant bleeding from the genital tract, detachment;
the size of the fetus and the woman’s pelvis corresponds to the normal course of natural childbirth;
readiness of the birth canal for the onset of contractions, especially for the cervix - its length should be no more than 2 cm and the opening should be no less than 1.5-2 cm.

After stimulation, contractions are somewhat more painful, so additional pain relief is often required.
More than 1/3 of inductions ultimately result in a caesarean section. "
The incidence of complications such as weak contractions, placental abruption, fetal hypoxia, and injuries to the birth canal of the woman and child is higher during induced labor than during natural labor. However, the use of drugs and some methods is carried out on an initially abnormal pregnancy.
All medications reach the fetus. The baby still experiences a lot of stress in utero.

Methods of inducing labor:

Amniotomy. This is a stimulation method as close as possible to the physiological process. It can be performed both before the onset of contractions and during them. When performing an amniotomy, the membranes of the fetal bladder are opened with a special instrument. At this moment the front waters pour out. By their number, color, smell, one can judge the intrauterine state of the baby. This is a painless procedure that is performed on a gynecological chair.

Cook's catheters(you can replace them with regular urine ones if you don’t have them). The doctor inserts a catheter into the cervical canal up to the internal os and fills its end with saline solution. A part of the catheter remains outside and hangs freely. For convenience, it is attached to the pregnant woman’s thigh. Thus, the filled catheter puts pressure on the cervix, promoting its structural changes. The catheter is installed for 12 hours, after which it is removed. Sometimes it can fall out on its own - this means that the cervix has opened to such an extent that it can no longer hold it. Usually after the catheter it is necessary to use additional methods stimulation.
Laminaria– pressed seaweed. Kelp is introduced into the cervical canal and left for 8-12 hours, after which it is removed. During this time, they gradually swell as they are in a moist environment, exerting mechanical pressure on the cervix and leading to its opening.

Using kelp to dilate the cervix

Stimulation drugs in the maternity hospital:

Prostaglandins. In addition to stimulating contractions, they promote transformation of the cervix, therefore they are used when the birth canal is not yet completely ready for childbirth (for example, a long or tight cervix, a small opening). The effect is mild, contractions are not so painful.
Oxytocin. It is used if the cervix is already ready for contractions, since the drug only stimulates its contractions. It is administered intravenously or via lineamate, a special device that regulates the rate at which the drug enters the bloodstream.

Desaminooxytocin. It is usually used to stimulate contractions during pushing or as an addition to basic medications. The drug is not used alone to induce labor, as it is difficult to dose and control contractions, and it is less effective compared to other drugs.

If oxytocin drugs, prostaglandins are used, and an amniotomy is performed, then three hours are given for the development of effective labor. After this time, if it is insufficient, other drugs can be added, or some drastic decision is made, for example, indications for a cesarean section are identified.

Read more in our article about inducing labor in the maternity hospital.

Read in this article

Methods of natural stimulation of labor

Once the 37th week has arrived, you don’t have to worry about labor starting. But you shouldn’t try to stimulate labor, as there may still be almost five weeks ahead—day 42, inclusive.

After the 40th week has arrived, you can think about methods of natural stimulation of labor. They definitely won’t harm, but can help the body tune in to the birth process.

Dosed loads are useful throughout pregnancy. They will help control body weight and make the body more resilient. After 40 weeks, it is still possible and beneficial to do yoga, Nordic walking, breathing exercises and exercises on a gymnastic ball. But this is all with the doctor’s permission and if the pregnancy proceeds physiologically. Any deviations may result in a ban on this type of activity.

If you don't want to do something special exercises, you can simply do some general cleaning at home or walk up and down the stairs, for example, if a pregnant woman is in the hospital.

Expert opinion

If physical activity causes severe malaise, fatigue, swelling, increased blood pressure or other unpleasant symptoms, you should reduce its intensity or even stop altogether to avoid more serious consequences.

Sexual contact

Sex is allowed throughout the entire gestation period if the pregnancy proceeds without complications. Intimate relationships on the eve of childbirth are especially useful for two reasons:

A man's semen contains prostaglandins, which have a positive effect on the cervix. Under their influence, it “prepares for childbirth” - it softens, shortens, and opens. This effect is only possible with a certain hormonal background women, so you should not be afraid of sexual intercourse until full-term pregnancy.
During arousal, oxytocin is released in a woman's body. It promotes contraction of the uterus, which will thus prepare for real contractions.

Watch this video about whether sex will help speed up labor:

Nipple stimulation on the chest

The areola areas of the breasts are very sensitive. When they are irritated, signals are sent to the brain to release oxytocin, the level of which quickly increases in the blood. It is also useful for preparing the body for childbirth.

Special diet

The nerve plexuses of the intestines and uterus are interconnected. Irritation of some leads to activation of others. This can be used to “wake up” the uterus. It is recommended to include the following foods in your diet:

Acupuncture and similar methods

There are active points, massage of which will also be favorable for the onset of labor. Here are the two most commonly used:

on the palmar surface of the hands between the thumb and index finger;
outside the ankle at a distance of 5-7 cm from the “bone” upward.

You can also use such a device for DENAS therapy at home, affecting the abdominal area and the cervical-collar area.

Herbal infusions and decoctions

Plants can also help stimulate labor. The most commonly used are the following:

nettle;
ergot;
shepherd's purse;
barberry.

Recipes can be for preparing infusions, tinctures, and decoctions. Sometimes it is recommended to add to prepared solutions Castor oil or do microenemas with it. It irritates the intestinal walls, and this in turn leads to reflex stimulation of the uterus. However, it should be borne in mind that castor oil can provoke intestinal colic.

Other methods

Homeopathy medications are also used to stimulate contractions. For example, based on Pulsatilla and Caulophyllum. However, medications should be used only as prescribed by a homeopathic doctor or at least a gynecologist.

Indications for induction of labor in the maternity hospital

After 40 weeks, and in some cases even earlier, women are sent as planned to the maternity hospital for hospitalization, where doctors draw up a plan for future labor and determine its time, if it has not occurred before this point. The main indications for inducing labor are as follows:

post-term pregnancy - after 41 weeks;
gestosis, if there is no need for a cesarean section;
complications of pregnancy that require delivery in the absence of labor, for example, stimulation is often used for polyhydramnios and oligohydramnios, suspicion of some malformations in the fetus;
somatic diseases of a woman that require earlier delivery, for example, diabetes mellitus, cardiovascular pathologies.

Conditions for holding

Any method of inducing labor is used if there are conditions from the obstetric situation for implementation. They are as follows:

live fruit;
stable, controlled condition of the woman;
absence of significant bleeding from the genital tract;
the size of the fetus and the woman’s pelvis corresponds to the normal course of natural childbirth;
readiness of the birth canal for the onset of contractions, especially for the cervix - its length should be no more than 2 cm and the opening should be no less than 1.5-2 cm.

Advantages and disadvantages

Almost all women are quite categorical about any kind of stimulation of contractions, as they consider it a non-physiological process. Indeed, each method has its own advantages and disadvantages.

The advantages of inducing labor include the following:

it is possible to reduce the duration of labor;
in case of weak contractions, they become stronger, which prevents possible suffering of the fetus, and the risk of complications for the woman becomes less;
This way, in many cases, a caesarean section can be avoided.

The disadvantages of the procedure are the following:

After stimulation, contractions are somewhat more painful, so additional pain relief is often required. This is due to the fact that during natural childbirth without the use of any drugs, the muscle fibers do not contract all at once, but one at a time. When stimulated, it immediately affects more than 50% of the myometrium, which sometimes even provokes unbearable pain.
More than 1/3 of inductions ultimately result in a caesarean section. “Forced fights” are not always productive. After long trials with contractions, a woman can be operated on different indications, ranging from ineffective stimulation to bleeding, acute hypoxia, etc.
The frequency of complications such as weak contractions, placental abruption, fetal hypoxia, and injuries to the birth canal of the woman and child is higher during induced labor than during natural labor. However, it should be noted that the use of drugs and some methods is carried out in an initially abnormal pregnancy - after all, labor is induced if there are some indications for this.
All medications used to enhance uterine contractions reach the fetus. The baby still experiences a lot of stress in utero.

According to scientific data, drug-induced labor several times often have the following consequences:

placental abruption during childbirth;
fetal hypoxia (lack of oxygen);
serious injuries to the birth canal;
often end with a cesarean section.

Considering that any stimulation of labor has not only advantages, but also significant disadvantages, in each case one should take a differentiated approach to determining the indications.

Watch this video about what stimulation of labor leads to:

Methods of inducing labor and how it all happens

There are many stimulation options. In each case, it is necessary to choose the most optimal, “soft” one - this is the doctor’s task.

Amniotomy

This is a stimulation method as close as possible to the physiological process. It can be performed both before the onset of contractions and during them. The role of the amniotic sac is important until approximately 6-7 cm of cervical dilatation; it works “like a wedge”, exerting gentle pressure on the cervix, causing it to open.

When performing an amniotomy, the membranes of the fetal bladder are opened with a special instrument. At this moment the front waters pour out. By their number, color, smell, one can judge the intrauterine state of the baby. Amniotomy is a painless procedure that is performed in a gynecological chair.

What kind of catheter is used

The essence of this effect is as follows:

The doctor inserts a catheter into the cervical canal to the internal os and fills its end part, which expands into a balloon, with saline solution.
A part of the catheter remains outside and hangs freely. For convenience, it is attached to the pregnant woman’s thigh.
Thus, the filled catheter puts pressure on the cervix, promoting its structural changes.

The catheter is installed for 12 hours, after which it is removed. Sometimes it can fall out on its own - this means that the cervix has opened to such an extent that it can no longer hold it.

Expert opinion

Daria Shirochina (obstetrician-gynecologist)

Before installing the catheter, two hours later, and immediately after its removal, it is necessary to record a CTG (fetal heartbeat) to prevent possible complications.

After the catheter is removed, the issue of further stimulation is decided. Rarely do women experience spontaneous contractions; additional methods are usually required. For example, when good result and opening of the cervix, an amniotomy is performed. Prostaglandins, oxytocin and other stimulants may be prescribed.

Laminaria

They are compressed algae. They have an effect similar to a catheter. Kelp is introduced into the cervical canal and left for 8-12 hours, after which it is removed. During this time, they gradually swell as they are in a moist environment, exerting mechanical pressure on the cervix and leading to its opening.

A drug

This hormonal drug, is available in the form of tablets for oral administration and placement into the vagina or rectum, a gel for vaginal or cervical use, and a solution for intravenous infusion.

Prostaglandins, in addition to stimulating contractions, promote the transformation of the cervix, therefore they are used when the birth canal is not yet completely ready for childbirth (for example, a long or tight cervix, a small opening).

The effect of prostaglandins is milder, contractions are not as painful.

How long will it take for it to work?

Each case of labor stimulation has its own criteria by which one can judge whether the method works or not.

If oxytocin drugs, prostaglandins are used, and an amniotomy is performed, then three hours are given for the development of effective labor. After this time, an examination is carried out and the effectiveness of stimulation is assessed. If it is insufficient, other drugs can be used, or some drastic decision is made, for example, indications for a cesarean section are identified.

The effectiveness of installing a cervical catheter and laminaria is assessed by structural changes in the cervix. If she is already ready for real birth, further stimulation is carried out, but with medications.

Useful video

Watch this video about stimulating labor in the maternity hospital:

Good day to everyone who came to see me!

I guess that there is not long left until the cherished deadline. You are thinking about where to put the crib, distributing responsibilities for caring for the unborn child...

Well, it's time to discuss some issues that you haven't thought about before.

Today we will focus on how labor is stimulated in the maternity hospital. Sometimes a baby needs an extra boost to be born. If everything works out this way for you, then understanding the situation will save you from panic.

A few minutes to read the article and you will be in the know!

I will list the cases in which obstetricians induce labor:

Post-term pregnancy.
Amniotic fluid leaked prematurely
Primary weakness of contractions.
Secondary weakness of contractions.
Conditions in which a woman will no longer be able to bear a child, and therefore it is necessary to urgently induce labor.

For clarity, let's run through this list.

Post-term pregnancy

The deadline for the baby to be born is 41 weeks.

Childbirth at 42 weeks is already a risk for mother and fetus. The baby may grow too big, and it will be difficult for the mother to give birth to him. On the other hand, the placenta is already aging, and the baby lacks oxygen and nutrients.

Therefore, after 40 weeks, the expectant mother is usually offered to go to the hospital to observe her and, if necessary, to speed up the birth.

Premature rupture of amniotic fluid

The amniotic sac has ruptured and the water has broken, but contractions do not begin. Mom and baby are in danger: an infection can penetrate through a defect in the amniotic sac.

Doctors will do everything to deliver the little one in the next 12 hours.

Primary birth weakness

This is a case when labor has begun, but for some reason the contractions are not going well. They are rare, weak and short. Their strength is not enough to open the cervix.

In such a situation, labor may be delayed, and the baby will suffer from lack of oxygen. That's why doctors use special drugs to stimulate contractions.

Secondary birth weakness

It's practically the same. The difference is that the contractions started normally, and then at some point stopped or weakened. Perhaps the birth was delayed, or the child somehow did not lie down well.

Conditions in which it is no longer possible to bear a child

There may be different variants. For example, fetoplacental insufficiency is a condition when the placenta fails to cope with its function and the fetus suffers from lack of nutrition.

Or severe gestosis in a pregnant woman. Or some kind of disease expectant mother, in which further pregnancy is dangerous for her...

Fortunately, all this rarely happens. And I won’t continue so as not to scare you.

Difficult decision

Before deciding to induce labor, obstetricians evaluate several factors:

How ready is the cervix for childbirth?
What condition is the child in?
How is mom feeling?
Are there any contraindications for labor stimulation?

Labor cannot be induced if:

There is a scar on the uterus.
During her previous birth, the woman had severe ruptures.
Placenta overlaps internal os uterus.
The umbilical cord has fallen out and is about to be born before the baby.
The fetus lies incorrectly, obliquely or across the uterus.
The woman has some disease that makes it impossible to give birth naturally.

As you can see, everything is not so simple. Doctors need to weigh all the risks and choose the right remedy.

How do doctors induce labor? What kind of magic pills and do they have IVs?

Now you'll find out.

Physician assistants

Amniotomy - opening of the amniotic sac

Normally, the membranes should rupture when the cervix is fully dilated.

But sometimes doctors themselves open the amniotic sac to speed up labor. This simple action helps intensify (or even induce) contractions.

The mechanism is something like this: after the anterior amniotic fluid is released, the fetal head descends and presses on the internal os of the uterus. This causes a reflex increase in labor activity.

Obstetricians rarely use amniotomy alone. But in combination with other methods it gives an excellent effect.

Prostaglandins

Prostaglandins are substances that are produced in our body and control many processes. There are many prostaglandins, but two act on the birth process: prostaglandin E2 and prostaglandin F2α.

These strange names scientists gave them, although our assistants deserve better! Judge for yourself.

Prostaglandin E2 is produced in the “baby” part of the placenta and in the cervix. It makes the neck mature and - attention! – starts the birth process.

Prostaglandin F2α is produced in the “mother’s” part of the placenta and in the muscles of the uterus. it maintains the strength of contractions when they have already begun.

Pharmacologists have synthesized both of these substances, and now they are in the arsenal of obstetricians in the form of tablets, gels, suppositories or solutions.

In case of postterm pregnancy or in cases where it is necessary to urgently induce labor, prostaglandin E2 comes to the rescue.

It is inserted into the cervical canal or into the vagina in the form of a gel or suppositories. As a result, the cervix ripens and dilates in literally a matter of hours, and then labor occurs.

At primary birth weakness Prostaglandin F2α helps. They usually give it an IV.

Oxytocin

This is a hormone that increases the tone of the uterus. Oxytocin is the oldest drug for labor stimulation. But recently, obstetricians have been using it carefully.

It turned out that the administration of oxytocin has a bad effect on the child; his adaptive capabilities are reduced.

Therefore, doctors resort to oxytocin only in extreme cases and try to combine it with prostaglandins to reduce the dose.

That's all, actually. In each specific case, obstetricians act according to the situation, guided by special protocols.

These are documents that describe medical tactics, indications and contraindications for all manipulations and medicines. Protocols exist to protect doctors from making mistakes. And obstetricians strictly adhere to them.

I wish you and your baby a happy, immediate natural birth! Let today's information serve only for your peace of mind.

Well, I’m not saying goodbye to you - I still have a lot of topics for useful articles. Therefore, do not forget to click on the button - you will receive notifications about new products by email!

Hugs,

Anastasia Smolinets