Beating the clock – inducing labour

Having a baby is the most natural thing in the world. Or is it? Today’s new mothers are more likely than ever to go through labour that has been artificially induced. In fact, the trend for inducing labour has reached epidemic proportions over the last two decades.

According to the Department of Health figures for year ending March 2014, 25 per cent of all births are induced in England. That’s more than double what it was back in 1989 when it was only nine per cent.

In most cases, the synthetic hormone prostaglandin is used to kick start the process when the baby is overdue or there is a medical problem which means the baby needs to be delivered urgently. It can be given in gel form, a pessary or a tablet directly into the vagina. Oxytocin is used later on if the prostaglandin has not been enough to keep the contractions going and is given via an intravenous drip.

There are lots of sound medical reasons why so many more births are induced than in the past.  If a pregnant woman has a medical condition such as diabetes or high blood pressure, then inducing birth early will be safest for mum and baby.

The fact is that the average age of pregnant mothers has increased dramatically and a record number of women over the age of 40 are giving birth for the first time. These women are far more likely to suffer from problems such as diabetes and pre-eclampsia. So the rates of inductions simply reflect an older pregnant population. More mums are overweight too, which puts them at greater risk of diabetes, when their babies get too much sugar in the womb. They may need an early induction too.

In my experience, doctors do not want to encourage more inductions. In fact, hospitals are trying to keep the numbers as low as possible in order not to waste resources. Today, most women who are healthy will not be offered an induction unless they are nearly two weeks past their due date. We know that, after this length of time, the placenta starts to run down and the baby in the womb may be deprived of food and oxygen.

Nowadays we use induction techniques which are much better than in the past. We use different hormones at different stages which mimic the hormones released by the body. Prostaglandin gel at the beginning helps to soften and ripen the cervix and bring contractions on gradually. Then, we may use an oxytocin drip later in labour to make sure that the contractions gain strength, without becoming too violent. This means that complications such as a ruptured womb are very rare.

Patrick O’Brien

Patrick O’Brien is a consultant obstetrician at University College Hospital and spokesperson for the Royal College of Obstetricians
Patrick O’Brien

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