Obstetric & Gynaecology Malaysia


What is labor induction?

Labor induction is the use of medications or other methods to start (induce) labor.

Why is labor induced?

Labor is induced to start contractions of the uterus for a vaginal birth. Labor induction may be recommended when there are concerns about the health of the woman or the fetus. It also recommended when labor has not started on its own at due date, as baby has an increased risk of dysmaturity syndrome, shoulder dystocia d/t macrosomia or meconium aspiration syndrome, because the amount of amniotic fluid may decrease, ie oligohydramnios (AFI <8cm) causing the umbilical cord to be pinched when the uterus contract.

Are there other reasons to have labor induction?

Yes. In addition to some conditions for which labor induction is recommended, new research (2018 ARRIVE study) suggests that induction for healthy women at 39 weeks in their first full-term pregnancies may reduce the risk of cesarean birth.

Why would I want to avoid a cesarean birth?

Cesarean delivery is surgery and comes with certain risks, including

  • bleeding, infection, and injury to the bowel or bladder
  • longer recovery time than vaginal delivery

Cesarean delivery also increases risks for future pregnancies, including placenta problems, rupture of the uterus, and hysterectomy.

Can I have an induction at 39 weeks?

You and your obstetrician–gynecologist (ob-gyn) or other health care professional may talk about induction at 39 weeks if

  • this is your first full-term pregnancy
  • you are carrying only one fetus
  • you and your fetus are healthy

Can induction be done before 38 weeks?

When a woman and her fetus are healthy, induction should not be done before 38 weeks. Babies born at or after 38 weeks have the best chance at healthy outcomes compared with babies born before 38 weeks. When the health of a woman or her fetus is at risk, induction before 38 weeks may be recommended.

This is my first full-term pregnancy. Why else would I consider induction at 39 weeks?

You might consider induction at 39 weeks to reduce the risk of certain health problems. Healthy women whose labor is induced at 39 weeks may have lower rates of preeclampsia and gestational hypertension than women who do not have induction at 39 weeks.

How is induction done?

There are several methods to start labor if it has not started naturally. The ways to start labor may include:

What is “ripening the cervix”?

Ripening the cervix is a procedure that helps the cervix soften and thin out so that it will dilate (open) during labor. Before inducing labor, your ob-gyn may check to see if your cervix is ready using the Bishop score. With this scoring system, a number ranging from 0 to 13 is given to rate the condition of the cervix. A score of 6 or less means that your cervix is not yet ready for labor. If the cervix is not ready, ripening may be done.

What is “stripping the membranes”?

To “strip the membranes,” your obstetrician sweeps a gloved finger over the thin membranes that connect the amniotic sac to the wall of your uterus. This also is called “sweeping the membranes.” This action is done when the cervix is partially dilated. It may cause your body to release natural prostaglandins, which soften the cervix further and may cause contractions and some vaginal bleeding. Women who has S&S may have contractions later or slight bleeding with mucus plug/show or may go into labour within 48 hours, though not a common event.

How is cervical ripening done?

Ripening of the cervix may be done in the following ways:

  • Medications that contain prostaglandins(Prostin3mg)- inserted into the vagina~6-12 hours
  • Using a thin catheter tube 12Fr(white) 4mm that has an inflatable balloon of 30mls on the end. The tube is inserted into the cervix and kept 12 to 24 hours for balloon to drop out from the cervix The balloon rubs against and stretches the neck of the womb (cervix) to produce a hormone called prostaglandin. The prostaglandin causes the cervix to become shorter and soften (ripening). This prepares the cervix for labour and allows your obstetrician to break your waters.

What is oxytocin?

Oxytocin is a hormone that causes contractions of the uterus=nipple stimulation/ breastfeeding. It can be used to start labor (induction) or to speed up labor(augmentation) that began on its own. Contractions usually start about 30 minutes after oxytocin is given.

What is “rupturing the amniotic sac”?

To rupture the amniotic sac, an ob-gyn makes a small hole in the sac with a special tool. This procedure, called an amniotomy, may be done after a woman has been given oxytocin. Amniotomy is done to start labor when the cervix is dilated and thinned and the fetus’s head has moved down into the pelvis. Most women go into labor within hours after the amniotic sac breaks (their “water breaks”).

What are the risks of labor induction?

With some induction methods, the uterus can be overstimulated, causing it to contract too often. Too many contractions may lead to changes in the fetal heart rate. Other risks of cervical ripening and labor induction can include infection in the woman or her fetus.

Is labor induction always effective?

Sometimes labor induction does not work. Early labor is the time when a woman’s contractions start and her cervix begins to open. Women who have induction at 38 weeks should be allowed up to 24 hours or longer for the early phase of labor. They also should be given oxytocin at least 12–18 hours after stripping of the membranes. If a woman’s labor does not progress, it may be considered a failed attempt at induction.

What happens if induction does not work?

If your labor does not progress, and if you and your fetus are doing well after attempting induction, you may be sent home. You can schedule another appointment to try induction again. If your labor starts, you should go back to the hospital. If you or your fetus are not doing well after attempting induction, a cesarean delivery may be needed.