Birth is a natural process – at least, it should be and in nearly all cases it is. Occasionally, however, things can go wrong. When they do, and providing mother and baby are in a suitable environment (the maternity ward of a hospital clinic), then modern medical facilities can do an enormous amount to prevent illness and preserve life. There is no doubt that up-to-date medical and surgical involvement in(termed ‘intervention’), as described in this article, have contributed to the still-falling perinatal disease and death rates in developed countries – you are more likely to have a road accident than a accident.
On the other hand, in many countries there is a growing awareness that such intervention should not be regarded as routine, or used for debatable reasons such as ‘just in case something goes wrong’ or to simplify staff timetables and attendances on the maternity ward. Modern attitudes see the mother as being in charge, with her wishes, comfort and dignity being respected. Surgical and other intervention in theprocess should belong on the sidelines until asked for by the mother or required for genuine medical reasons.
Sometimes a mother is advised to have herstarted artificially, before the natural start of her contractions or the breaking of the waters. There are several reasons for such advice. It is for the benefit of the mother when she has or of * or elevated blood pressure, or when she is suffering from a disorder such as diabetes or a heart condition which may worsen and endanger health if the continues. It is for the benefit of the baby when the pregnancy is more than 10-14 days overdue or when problems have occurred such as bleeding, incompatibility, developmental abnormalities or hydramnios, in which there is an excess of amniotic fluid around the foetus.
Before the induction, the obstetrician tries to ensure that the baby will be mature enough to survive comfortably when delivered. The majority of inductions are within two to four weeks of the expected delivery date, and so are unlikely to cause problems for the baby. As with other surgical intervention techniques, it is a question of weighing up the benefits to mother and baby as opposed to the potential risks involved. The usual method of inducingis by injecting a solution of the hormone via a drip into an arm vein. Oxytocin is the hormone produced naturally by the pituitary gland to stimulate uterine contractions during a normal birth. The amount of hormone is gradually increased until regular, strong contractions are obtained and labour is on its way. The procedure is usually combined with surgical rupture of the amniotic membrane around the baby (which occurs naturally when the waters break). To do this the obstetrician carries out a vaginal examination and then makes a tear in the membrane. If the labour is to be monitored a foetal scalp electrode is often attached at the same time.
In most cases of induction, labour starts quickly and progresses normally, and the baby is delivered within 24 hours of rupturing the membrane. Induction is safe and effective, but it should always be discussed fully so that the mother knows why it is being done and what will happen.
In some countries the frequency of induced labours was rising steadily until a few years ago. A school of opinion advocated that is was beneficial for all concerned to induce labour at term. However problems have emerged from this practice. For example the dates may be wrong and the baby induced prematurely, or the induction may be prolonged resulting in a long and risky first stage of labour, even leading to an originally unnecessary Caesarean section to deliver the baby. The pendulum is now swinging away from induction-as-routine, towards induction only for certain cases and after due consideration.