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Induced Labor: When is it Necessary?

Posted Aug 24 2008 1:49pm
MICHELLE LAMOTHE, MD: Hello, and welcome to our web cast. I'm Dr. Michelle La Mothe. For most pregnant women who are ready to deliver their babies, labor starts spontaneously without the need for any intervention. However, for some women, labor needs to be induced using special medications. Joining me today to discuss induction of labor are two experts. To my left, Dr. Adrianne Moore Assistant Professor of Obstetrics and Gynecology at the Weill Cornell Medical College. And her colleague, Dr. Steven Hockstein, Assistant Professor of Obstetrics and Gynecology also at the Weill Cornell Medical College in New York City. Welcome to you both.

Let's discuss the reasons for the induction for labor. Would you like to start on that question, Dr. Moore?

ADRIANNE MOORE, MD: There are several reasons for inducing labor. One of them is if the baby is not growing well, for example, and would be better off outside than in. Another common reason for inducing labor is when the pregnancy goes past the due date. And some physicians will induce the labor at 41 weeks, and others will wait until 42 weeks.

MICHELLE LAMOTHE, MD: Dr. Hockstein, tell us some of the medical approaches used to induce labor.

STEVEN HOCKSTEIN, MD: Well, there are several medications that are commonly used to induce labor. If the cervix is already dilated somewhat or ripe, as we call it, you can just begin oxytocin, which is a medication given through an IV. And that brings on contractions.

If the cervix is still not dilated at all when you've reached the end of the pregnancy, medications can be applied directly to the cervix and the vagina. There are prostaglandin tablets that are placed in the vagina. There are prostaglandin gels which are applied to the cervix. And they help soften and change the cervix chemically so that 12 hours later, when oxytocin has started, the cervix can dilated more easily.

MICHELLE LAMOTHE, MD: So an induction can take a long period of time. Somebody just doesn't have one of these gels or mediations placed in the cervix and then immediately goes directly into labor and delivery. It can take some time.

STEVEN HOCKSTEIN, MD: Yes. And it's often done overnight. For the woman whose cervix is not yet ready to go into natural labor, usually, these medications are given over a 12-Hour period. If, however, a woman's body was getting ready to go into labor anyway, sometimes it's quite easy to get her into labor, and it doesn't take long at all. It really depends on what's going on.

MICHELLE LAMOTHE, MD: Now, what about breaking the water - that the physician can break a pregnant woman's water. What help is that?

STEVEN HOCKSTEIN, MD: When the bag of water breaks, and that's the membrane surrounding the baby, which holds in the amniotic fluid, there's a release of prostaglandins. And whether it happens naturally, or whether the patient's physician breaks the bag of water, these chemicals are released, and contractions become more regular and become more intense.

MICHELLE LAMOTHE, MD: So they help things get going and move along.

STEVEN HOCKSTEIN, MD: Yes.

MICHELLE LAMOTHE, MD: What are the risks, Dr. Moore - what are the risks of inducing labor?

ADRIANNE MOORE, MD: Primarily, there are two risks. One is that there's a chance that the labor will not end in a vaginal delivery, but will end up having to be a Caesarian section. And the other risk in using some of these medications, and the reason that it needs to be closely monitored, is that sometimes the contractions can become too strong, and problems for the baby or for the mother.

MICHELLE LAMOTHE, MD: So we've learned that the induction process can be done many different ways, and it can take over 12 hours in many cases. Well, what are your thoughts in the elective induction of labor? Is it always a good thing? Do you recommend it?

STEVEN HOCKSTEIN, MD: I try to avoid in my practice - elective induction of labor.

MICHELLE LAMOTHE, MD: Why is that?

STEVEN HOCKSTEIN, MD: Because it is associated with an increased risk for Caesarian section. And that has been shown, and I've tried to avoid Caesarian section in my practice. There are certainly many times when induction of labor is appropriate. It's a balance between risks - the risk of continuing the pregnancy versus the risk of inducing labor and Caesarian section. And when a pregnancy has gone beyond its date - perhaps 41 to 42 weeks, when there may be complications with the baby - the amniotic fluid is low, for example - there's a whole host of reasons where induction is perfectly indicated. And despite the increased risk of Caesarian section, it is more important to deliver the baby.

MICHELLE LAMOTHE, MD: So there are times clearly when it's appropriate. And Dr. Moore, do you have any thoughts also on the elective induction of labor that you'd like to add?

ADRIANNE MOORE, MD: I would entirely agree with Dr. Hockstein that it is preferable to avoid the elective inductions.

MICHELLE LAMOTHE, MD: So when it's medically necessary, it can be safely done and can help a mother and her physician delivery a healthy baby. But it's not something to go looking for if it's not medically necessary?

Well, I thank you very much for your thoughts in helping us understand the induction of labor. And thank you for joining us. I'm Dr. Michelle La Mothe.

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