Indications for stimulation of labor. Contraindications to induction of labor. Contraindications to artificial stimulation

Article by Sara Wickham, translation by Ekaterina Zhitomirskaya. Published in the AIMS magazine (AIMS - Alliance for the Improvement of Maternity Services - public British organization "Union for the Improvement of Maternity Services") AIMS JOURNAL Vol:26 No:2 2014 6-8

In modern Western culture Most women know about induction of labor before they become pregnant.

They know that stimulation is offered if it is believed that it would be safer for the baby to be born rather than remain in the womb. I also suspect that many women know that one of the main reasons for prescribing stimulation is the stage of pregnancy after which the baby is considered “post-term.” Also, many women know other women who have had labor induced, so they are aware of other stated reasons for induction. These reasons may include the woman’s age, if it is higher than “usual”, and premature rupture of water, and/or health problems, as well as complications of pregnancy, in which induction of labor may be necessary
But that's not all. The decision whether or not to agree to induce labor has many more aspects that also make sense to take into account. I've spent the last few months researching this topic. The result was the recent publication (revised and expanded) of my book Inducing Labor: making informed decisions (Wickham S (2014) Inducing Labor: making informed decisions. AIMS, London). In May, for the launch of this book in Bristol, I prepared a talk entitled “10 facts about induction of labor that every woman should know.” I did not intend to dwell on well-known things (see above), instead I wanted to draw your attention to some facts, circumstances and assumptions that are less known and which may make sense to take into account when we make a decision about stimulation. In reality, of course, there is much more to know, so my list of ten facts is just a starting point for discussion, and not comprehensive information on the issue.

1. It's not like a normal birth.

This is clear to some, but I know from experience that it is not for everyone. Induced labor is very different from labor that begins spontaneously. Certainly, personal experience Each woman's birth experience is different, but there are differences that are almost universal. First, to induce labor, a woman is injected with a synthetic hormone, which causes more pain than in spontaneous labor. And this pain comes faster. Synthetic hormones, unlike our own hormones, do not cause the release of painkillers into the blood that are produced during normal childbirth. female body. In addition, stimulation may have its side effects, which means that such a woman will be monitored more closely. This closer monitoring can result in a woman's mobility being limited, which increases tension and therefore pain, which in turn can make the woman feel like the situation is out of control.

2. It hurts

I started talking about this in point 1, but there are other sources of pain that I think women should be aware of before making a decision. For example, contractions induced by a prostaglandin gel or balloon, which are often used in the first stage of labor induction, can quickly become painful without any visible effect. This gives a negative experience of childbirth, in addition, in such a situation it is easy to get tired and/or lose your presence of mind much earlier than in the early stages of spontaneous labor. Contractions caused by oxytocin can also be very strong, and often the woman has less time to adjust to them than in spontaneous labor. More frequent vaginal examinations and other manipulations (such as using a balloon) may cause additional pain.

3. “The service comes as a package”

I wrote a lot about this on my website (), so I won’t repeat myself too much. But the fact that they continue to ask me whether physiological management of the third period (birth of the placenta), as well as refusal of CTG and/or vaginal examination if labor has been induced, is possible, makes me think that this is not a well-known fact. It's not that anyone wants to stop a woman from taking right decision. But the drugs that are used to induce labor are quite powerful. They block the release of their own hormones, and this can cause problems for the woman and the child. And the effect of these drugs that stimulate labor needs to be assessed, monitored and, if necessary, compensated. If a woman feels that these stimulation side effects are not what she needs, then it may be better to ask herself whether the stimulation is even necessary.

4. Detachment of membranes is not so harmless

Nowadays, in many places it is customary at some stage of pregnancy to offer women to “detach” or “manually separate” the membranes in the hope that this will reduce the number of women who need drug stimulation. Even if we ignore the assumption that all women who are offered stimulation will agree to it, we must understand that separation of the membrane can cause discomfort, bleeding and irregular contractions, with some studies showing that this procedure speeds up the onset of labor by only 24 hours. The authors of a review published in Cochrane concluded: “Routine use of manual membrane stripping from 38 weeks does not appear to provide significant clinical benefit. Carrying out this manipulation to induce labor should be considered in conjunction with the woman’s discomfort and other side effects of the procedure” (Boulvain M, Stan CM, Irion O (2005) Membrane sweeping for induction of labor. Cohrane Database of Systematic Reviews 2005, Issue I. Art. No .: CD00451. DOI: 10.1002/14651858.CD000451.pub2).

5. “Natural stimulation” is an oxymoron.

I have also written about this elsewhere, and this article can be read on my website (Wickam S (2012) When is induction not induction? Essentially MIDRIS 3(9): 50-51), but the main idea is easy to state: either we We are waiting for the natural onset of labor, as it happens in natural laws, or we are trying to intervene and induce labor before it starts on its own. Sometimes there are good reasons for inducing labor, but if a woman takes castor oil or asks her midwife to manually separate the membranes every day, or chooses some other “folk” method of stimulation, then she is going to induce her labor using non-medicinal means. Please note, I'm not trying to say there's anything wrong here, but I do think that since we live in a culture that devalues women's bodily functions, it's important to be clear about what our intentions are.

6. This is NOT the law.

While I was writing the book, I was surprised to learn that the AIMS hotline received a call from a woman whose midwife said, “We need to induce you 24 hours after your water breaks. This is the law." This woman agreed to have labor induced, which turned out to be very traumatic for her. I want all women to know that there are no laws that dictate what a pregnant woman should or should not do. This is very worrying for both me and AIMS. Any physician who makes such a statement should be reported to higher authorities. Any woman who is receiving threats in any way or simply making similar allegations is asked to contact AIMS for information and other support.

7. It's not "just a drop"

I am always alarmed when I hear midwives or doctors underestimating the recommended intervention. I especially dislike the expression “a drop” or “let’s help a little” when used in relation to intravenous drips of oxytocin. This is a powerful drug, and it should be treated as such. It can cause fetal distress, and in some clinics it is generally accepted to increase the dose of oxytocin until the child reacts with distress (!), and only then stop increasing the dose - it is believed that this is how the proper level of oxytocin is determined. But even when the dose of oxytocin is stopped being increased once effective contractions are established, this drug must be treated with caution, and professionals should not underestimate, whether intentionally or not, its effect.

8. The female body will not let you down. Stimulation and system - easily

The name speaks for itself. Stimulation does not always work, and it is not the woman’s fault. I would like to reassure all the women whose labor was unsuccessfully induced that there is nothing wrong with them and their bodies. This is another case where some of the expressions used in the rod block are clearly worth reconsidering.

9. The risks of postmaturity occur later, are lower, and are more difficult to prevent.

Below is the data I use both here and in the book. This is a summary of the results of a study that examined the risk of stillbirth at different stages of pregnancy. If you look at the values - and I especially ask you to compare the risks
at 37 and 42 weeks of pregnancy - you will see that the increase in risks does not occur as early as many people think, and that the increase in risk is not as strong as is often assumed. In fact, the outcome of labor in women who waited for spontaneous onset labor activity, and in women who gave birth with stimulation were so similar that no single study comparing labor with stimulation and spontaneous labor was able to demonstrate a benefit of stimulation. It was only when these studies were put together that it became possible to notice subtle differences. However, the quality of one of the studies (the one that tipped the scales) leaves much to be desired. Based on this, I would like to ask whether there is any real benefit from the current protocols offering induction of labor after 40 but before 42 weeks. The book says much more on this topic, including a complete review of the literature on the topic.

Risk of unexplained stillbirth
at 35 weeks 1:500
at 36 weeks 1:556
at 37 weeks 1:645
at 38 weeks 1:730
at 39 weeks 1:840
at 40 weeks 1:926
at 41 weeks 1:826
at 42 weeks 1:769
at 43 weeks 1:633

Adapted from Cotzias CS, Paterson-Brown S, Fisk NM (1999) Prospective risk of unexplained stillbirth in singleton pregnancies at term population based analysis. BMJ 1999; 319:287. doi: dx.doi.org/10.1136/bmj.319.7205.287

10. The risks for older women are not as certain as is commonly believed.

The final point refers to the statement that as women age, the risks increase and therefore their labor should be induced. Indeed, some studies suggest a correlation between increasing maternal age and increased rates of some complications, but there are several reasons to treat these findings with caution. Women of an “older” age are examined more often and are more likely to undergo various interventions, and this in itself can cause complications. “Older” women more often have health problems, and it is difficult to say whether the cause of complications is the woman’s health status or her age. Studies that have looked at this issue do not always separate one from the other, and those studies that have done so have involved women who gave birth a long time ago and cannot be compared with women today. Thus, there is an extremely lack of material in this area, and modern research on this topic, unfortunately, has only led to the fact that younger women are increasingly being stimulated and are more early stages, so there is no particular benefit for women from the results of such studies either.

A day or two after my report, I asked some colleagues what facts they would add to the list, and they suggested many interesting points. These were not ten facts, but dozens and almost hundreds of things that we would like women to know about. But at least this is a start. You can find more information about this (and much more) in the book Induction of Labor: Making an Informed Decision, published by AIMS. Our current goal is to get this information to as many women as possible before they make the decision to undergo stimulation.

Sarah Wickham is a midwife, teacher, author and researcher who has had a wide and varied practice and has been involved in midwifery education, research, publishing articles and books.
Sarah currently organizes "Recipes for a Normal Birth" workshops for midwives and other birth professionals, writes books for AIMS, speaks at various seminars and conferences, consults extensively and writes a twice-weekly column on her website www.sarawickham.com. where you can read many of her articles. Her last book— “Induction of labor: make an informed decision.”

You live in anticipation of the magical moment - the birth of your baby. The expected due date has already arrived, but the baby is in no hurry to be born. Doubts, fears and uncertainty appear in your head. What to do? How to speed up labor?

Before we commit, let's figure out what's what. So, pregnancy lasts for 40 weeks. Timely birth is considered from 38 to 42 weeks. Of course, some doctors try not to delay until the last minute, because it negatively affects the child’s development. Therefore, drug induction of labor is usually performed at 41 weeks. .

Stimulation of the labor process is carried out by a doctor only after a comprehensive and thorough examination, which includes:

Controlling the baby's movements. The movements should be regular and constant.
Ultrasound control. The amount of amniotic fluid and the general condition of the fetus are assessed.
CTG control. The contractile characteristics of the uterus and the well-being of the fetus are assessed.
Doppler indicators make it possible to assess the state of blood flow in the umbilical cord and the maturity of the placenta.
Blood test. Determined by a pregnant woman. In post-term pregnancy, the level of hormones (progesterone, estriol, lactogen) is below normal. A fairly informative indicator is the hCG level.

If during the examination all indicators are normal, then, accordingly, the pregnancy develops properly.

Indications for artificial induction of labor

Post-term pregnancy is dangerous for the baby. An aging placenta cannot provide adequate nutrition with necessary substances and saturate the fetus with oxygen. As a result, oxygen starvation occurs. In addition, they become denser, so the risk of birth injury increases. Aspiration of amniotic fluid may occur, in other words, it begins to linger in the lungs, which can lead to irreparable consequences.
Suspension or complete cessation of labor. This is characterized by the cessation of contractions and insufficient dilatation of the cervix. These points are noted by the doctor while observing the birth.
Premature placental abruption.
Rhesus - conflict. If the treatment has insufficient effect, and the antibody titer is constantly increasing.

What methods are used to induce labor?

Oxytocin - used for weak labor and for artificial induction of labor. The drug is mainly administered by injection. Its effect does not affect readiness for the drug. Usually the drug is used in combination with antispasmodic drugs.

Prostaglandins are hormones that stimulate smooth muscles and the cervix to give birth. It is quite popular to insert suppositories or a viscous gel containing these hormones into the vagina.

Amniotomy - opening process amniotic sac. This method is carried out during the examination and has absolutely no effect on the condition of the fetus. Induction of labor by amniotomy is the safest method affecting uterine activity.

How to induce labor yourself so as not to “go past” your due date?

It is believed that it is the baby who produces the hormones oxytocin and prostaglandins, which, entering the mother’s blood, begin to stimulate labor. Perhaps a lack of hormones or a failure in the chain of reactions contributes to the inhibition of labor.

Let's look at the methods used to induce labor independently.

A decoction of raspberry leaves. This remedy is recognized as official medicine. The decoction contracts the muscles of the uterus and pelvis.
Nipple massage. This massage promotes the release of oxytocin, which causes uterine contractions.
Unprotected sexual intercourse. Sperm contains prostaglandins, which soften the muscles of the uterus and promote the onset of labor.
Enema. With the help of a simple procedure, you can push the already ready uterus to the birth process.
Physical activity. Long walks, light exercise, washing windows and mopping floors without using a mop help open the uterus and tone its muscles. However, excessive loads are harmful.

I would like to note that induction of labor is an artificial process, which carries a certain risk. Such births are always more painful than natural ones, and the baby experiences extreme stress during the process. Of course, there are also serious cases when additional stimulation is simply necessary. But if expectant mother If she gets ready and is mentally ready for childbirth, she most likely simply won’t need stimulation.

The time has come to give birth, but the baby is in no hurry to be born and labor still does not begin - about 10% of women whose pregnancy has exceeded 40 weeks face this problem. Waiting inactively for contractions and the onset of labor can be very dangerous, and therefore the baby needs to be rushed and labor must be provoked. There are artificial ones for this, including, but if there are no pathologies, the doctor does not mind, and time allows you to use home methods to induce labor.

Stimulation of labor is the induction of labor artificially, which is used at different stages of pregnancy, in particular when the child is postterm, and in addition to intensify weak labor in a woman in labor directly during childbirth. Such procedures are different and can be used if the duration of labor is unreasonably increased - delayed, or (expulsion of the fetus).

____________________________

· Self-induction of labor at home

Home methods of stimulating labor are led by an old, but long-established scientific method - nipple stimulation. Nipple massage increases the production of oxytocin in the body, a hormone that stimulates labor and largely determines the course and successful outcome of labor. By the way, it is precisely this circumstance that doctors explain the fact that putting a newborn to the breast immediately after birth speeds up the process of birth of the placenta (baby place) and reduces the risk of postpartum hemorrhage. Alas, unfortunately, this method of stimulating labor does not provide a 100% guarantee, but it does not cause any harm (of course, if you do not become particularly zealous and do not injure your nipples).

To bring labor closer, there are a lot of methods recommended by obstetricians for independent use. So, inducing labor at home:

Method of stimulating labor No. 1: acupressure. Find a point located 4 fingers above the inner ankle joint. Try pressing and pressing it with your index finger and thumb at different angles. Repeat three times, maintaining pressure for 10-15 seconds.

Method of inducing labor No. 2: intestinal stimulation. Contraction and emptying of the intestines causes the release of prostaglandins into the blood, which soften the uterus. To engage the intestines in this way, you can use castor oil, an enema, and other methods at home.

Method of inducing labor No. 3: sex. Sex is no less relevant for inducing contractions, along with the method of nipple stimulation, the benefits of which we have already written above. Massage the nipples for 10-15 minutes, use various creams, oils and liquids for this. During the massage, the production of oxytocin can provoke uterine contractions and bring labor closer. Sex is perhaps the most effective and most enjoyable way to stimulate labor at home.

Method of inducing labor No. 4: physical activity. If labor is “delayed,” you should increase physical activity - lie down less, move more. In general, the vertical position should be predominant during this period - this will help speed up the dilation of the cervix and the descent of the fetus, since the weight of the child is involved. Traditional methods of stimulating labor contain a recommendation to walk up and down the stairs every day, alternately with your left and right sides. This ensures active movement of your pelvis in different directions.

Method of inducing labor No. 5: folk recipes. Folk methods of inducing labor also contain culinary tricks. Perhaps it will suit you home recipe“stimulating birth drink”: you need to take 1 glass of apricot or orange juice, mix with 1 glass of sparkling water or dry champagne, add 2 tbsp. spoons of ground almonds and the same amount of castor oil. The ingredients need to be thoroughly mixed in a blender. You need to drink the entire cocktail within an hour maximum, but gradually, in small sips. If it’s really your time to give birth, contractions will start in 2-3 hours, or you’ll simply have a breakdown. And as you remember, bowel movements are also indicated.

Surely, your dominant feeling at the moment is fatigue from these “endless” nine months of waiting. But still, you should look at this situation with optimism. Now you can afford everything that was previously strictly prohibited due to the risk of premature stimulation and termination of pregnancy, namely: long walks, sex with your husband, a glass of red wine. Many old prohibitions are folk methods of inducing labor, which are sometimes more effective than some medical ones.

· Traditional methods of inducing labor

If the pregnancy is post-term, the mother is probably ready to do anything to ensure that contractions finally begin. In addition to the methods listed, there are folk methods of stimulating labor, which came from the ancient times of the popularity of all kinds of healers and astrologers. Of course, I don’t presume to judge the effectiveness, and sometimes even the adequacy, of these recipes: some look ridiculous, others are just funny. But, “you never know,” as they say, maybe they will help you, but if not, they will amuse you a little.

1. To “lure” the baby into light and warmth, they suggest placing a cool heating pad on the stomach and a warm one between the legs. It would also be a good idea to provide a source of bright light in the perineal area. It is understood that the baby will strive for warmth and light, and the birth process will begin.

2. According to popular beliefs, the energy of trees helps a child to be born faster. To do this, it is recommended to hug a birch or oak - trees with strong energy- and communicate with nature. It is especially insisted that in no case should it be chestnut, poplar, aspen or willow - they are supposedly capable of having the opposite effect.

3. If labor is “delayed,” perhaps the explanation lies in the alignment of the stars! This means that the “X-hour” has not yet arrived, or rather the corresponding lunar day on which your child was conceived. If you know exactly the date of conception, then you can calculate the estimated days of birth, you need to check lunar calendar and find out the constellation where the moon was that day. The baby should appear to the world precisely when the moon is in the same constellation. Something like that.

While being carried away by mystical and real methods of inducing labor, do not forget about medical recommendations. If he assures that the pregnancy is going according to plan, and you have a lot of time to wait, and the examination confirms that the baby feels comfortable, do not rush things. In fact, only 4% of babies are born on their expected due date.

· Herbs to stimulate labor

In reality, there are a lot of means, but most of them are used extremely rarely during childbirth. Their use is often aimed at combating bleeding in the postpartum period, which occurs due to uterine hypotension - insufficient uterine contraction. Such remedies include the following herbal preparations, which are freely sold in pharmacies:

1. ergot,

2. nettle,

3. shepherd's purse grass,

4. common barberry.

Today, despite scientific progress, there is no method that would suit both doctors and patients equally, unfortunately. Therefore, the final choice of the method of labor stimulation should remain with the doctor, who takes into account the current situation, the individual characteristics of the woman, and the conditions of the pregnancy. And no matter how much you would like to speed up delivery, you should not take any medications, even herbs, without the approval of a doctor!

· Other ways to induce labor at home

The desire to give birth safely cannot remain a dream that is not supported by concrete actions. Any moderate physical activity during pregnancy has a beneficial effect on the course of labor, physical exercise that strengthen the perineal muscles, abdominal muscles, yoga,, the ability to relax. There are also methods that have not been fully researched, but have a positive effect, so-called unconventional methods of stimulating labor, for example, acupuncture.

In addition, the mother in labor will be provided with significant assistance, about correct behavior during contractions and pushing. They will reduce fear, and, therefore, will be able to help a woman adequately perceive and influence the process of giving birth to a child. These skills are very effective natural self-stimulation of labor.

If you have the opportunity to choose the conditions in which you will give birth, then give preference to a maternity hospital where you can walk during the first period of labor (of course, if there are no contraindications). It has been proven that the supine position increases the duration of labor; for the safe and rapid dilatation of the cervix, the pressure of the fetus on it is important. Studies conducted in the USA have shown that having freedom of movement (sitting in various positions, walking) is no less effective than.

Be sure to try to familiarize yourself with the room in which you plan to give birth - this also has a beneficial effect on the birth process. Probably the key factor here is the loss of fear of uncertainty, uncertainty, the unknown.

And lastly, remember: no pregnancy can last forever, and perhaps there are days, or even a few hours left until the long-awaited meeting with your baby. Have an easy birth, good health to you and your blood!

Yana Lagidna, especially for MyMom . ru

And a little more about what home methods to induce labor are:

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 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 take place with the use of stimulant drugs (both for medical reasons and for personal preference). 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.

Terms. 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 the heart rhythm, the amount of amniotic fluid and assess the biophysical condition of the fetus according to 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. The deadline for natural childbirth is 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 score low on Bishop's 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. Recently, scientists have found that it does more harm than good, and is often the reason for inducing artificial labor.

During an uncomplicated continuation of pregnancy, 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 medications.

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 a health condition, such as high blood pressure or diabetes, that could put your baby at risk.
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 adjust 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 first.

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 is a 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 in accordance with 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 a healthy baby is born. 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.

Whether early delivery is the best option 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 danger to the baby arises at an earlier stage of 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 outpacing all others in frequency is oxygen starvation of the 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 the absence of contractions, stimulating labor with medication helps to avoid the risk of infection of 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 back pain, severe sleep disturbances or heavy physical exertion.

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 than the dose used for drug stimulation of labor.

Separation of the fertilized egg

Even before the artificial stimulation of labor through medications became widespread, the best way to induce spontaneous contractions was considered to be the separation of the fertilized egg in 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. The use of 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 should not be used at all.

Physical activity

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 enjoy additional treatments such as prenatal acupuncture or reflex zone massage. But, unfortunately, this cannot be said to be a reliable way to induce 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 of aromatic oils for an aroma lamp or, mixed with almond oil, used for massage. If you apply this mixture on the abdominal wall and massage the uterus from the upper end, it will help your baby to finally hit the road.

Stimulating bath

A bath that stimulates contractions can make you feel better. To do this, add four drops of essential oil, such as clove oil, cinnamon leaves or ginger root, 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 the negative effects of 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 the readiness of your cervix and the health of the baby.

Separation of membranes

The doctor will examine your cervix and use your 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. Most pregnant women go into labor in part due to high levels of 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 help during such births. Inducing labor is a long process, and if this is your first baby, several procedures may be needed. For example, in lately Often the uterus is prepared and only then Pitocin is administered. 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 childbirth will take place naturally, no stimulation 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 births were too rapid.

Induction of labor is the artificial induction of labor, used at various stages of pregnancy, including in the case of post-term pregnancy, as well as the activation of weak labor directly during childbirth. This procedure can be used if the duration of labor unjustifiably increases, which is possible in the case of prolongation of the first stage of labor (cervical dilatation), as well as the second stage (expulsion of the fetus).

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At the same time, not every “delay” in childbirth needs to be stimulated, so doctors are obliged to analyze the situation, understand the reasons and act accordingly.

Medical indications for artificial stimulation of labor are:

1. truly post-term pregnancy, especially if pathological changes in the placenta or signs of abnormalities in the fetus are detected;
2. premature placental abruption, due to a direct threat to the child’s life;
3. premature rupture of water in a pregnant woman, due to the increased risk of infection entering the cervix;
4. sometimes - late toxicosis;
5. some diseases of the mother, for example, severe diabetes, etc.

Induction of labor during post-term pregnancy

The duration of pregnancy is 40 weeks, after which the baby should be born. However, the onset of the 40th week does not always precede childbirth; there are women who seriously “overstay” the prescribed pregnancy period. Only 10% of pregnant women reach the 42nd week. You shouldn't worry too much if you happen to be one of them. In 70% of cases, this is not actually a post-term pregnancy, but a banal error in ascertaining its timing, or the estimated date of birth was incorrectly calculated. It is possible that everything goes strictly according to the schedule established by nature.

However, relying blindly on possible error not worth it. In order not to miss a truly post-term pregnancy, constant medical supervision. In this regard, it is reasonable to use a child’s ultrasound with Doppler sonography and pulse examination. In addition, amnioscopy is recommended - examination of the fetal bladder with a special amnioscope device inserted into the cervical canal. Using this method, you can determine whether there is meconium (the baby’s original feces) in amniotic fluid, assess the insufficiency of the amount of amniotic fluid, the lack or complete absence of cheese-like fetal lubrication, identify the peeling of the lower membranes of the amniotic sac from the uterine walls. These examination methods will allow you to make the right decision about further development pregnancy and subsequent childbirth naturally or through artificial methods of stimulating labor. Sometimes the failure of labor to occur can be the psychological attitude of a pregnant woman: for example, a mother decided to give birth to a baby under New Year or please your spouse with an heir on his birthday. Then a serious conversation with the expectant mother may be enough - like this natural stimulation childbirth, and then everything will go “like clockwork.”

There are a number of indicators by which a truly post-term pregnancy is judged:

1. absence of “front waters” - enveloping the baby’s head;
2. the volume of amniotic fluid has sharply decreased;
3. amniotic fluid is cloudy, contaminated with meconium feces;
4. flakes of fetal cheese-like lubricant are not observed in the amniotic fluid;
5. the bones of the baby’s skull are too hard;
6. immature cervix;
7. there are signs of aging of the placenta.

If these symptoms are confirmed, the doctor will suggest artificial induction of labor or a cesarean section.

Post-term pregnancy itself threatens complications during childbirth: bleeding, weakness of labor, acute fetal hypoxia, with all the ensuing consequences. Monitoring the baby's condition is necessary due to the danger of aging of the placenta. As a result of this process, placental blood flow deteriorates significantly and nutrients reach the baby in smaller quantities. In addition, the production of amniotic fluid decreases over time. Such conditions are simply undesirable for the child and his development. Using an ultrasound scan, the doctor can find out that the placenta is thinned and deformed, in which case the pregnant woman must be prescribed hormonal therapy. This procedure is necessary to approach the onset of labor.

A symptom of the onset of a period when it is already necessary to give birth is a decrease in the amount of amniotic fluid, as a result of which the woman stops gaining weight, or even her body weight decreases. A post-term pregnancy can be indicated by decreased or, on the contrary, increased activity of the fetus, as a result of a lack of oxygen due to improper blood circulation in the uterus.

When it is confirmed that a pregnant woman is carrying her baby to term, labor is induced. When they are born, post-term babies look somewhat sickly: they are thin, but hyperactive, their skin is wrinkled, dry and flaky, without a layer of fruit lubricant covering the skin of a newborn born on time. Children who have stayed too long have long nails and hair, and their eyes are open. The umbilical cord is yellowish or even greenish.

Reasons for inducing labor

While monitoring the progress of labor, the doctor pays close attention to the following points and signs of the need for third-party intervention in the process:

1. The presence of contractions, their duration, frequency and strength. These signs can be reliably assessed by palpation of the abdomen (uterus), the results of the readings of a tocodynamometer device, which allows you to accurately record the duration and frequency of contractions, as well as a special intrauterine catheter that determines the pressure in the uterus against the background of contractions (in practice it is used extremely rarely).
2. Cervical dilatation is the criterion that most accurately determines the normal course of labor. Cervical dilatation is usually measured in centimeters. The minimum dilation is considered “zero” - 0 cm, in cases where the cervix is closed, the maximum is 10 cm, that is, fully dilated. However, even this indicator is not absolutely reliable, because the measurement, as a rule, is made “by eye”. Even the same doctor may have different dilatation values, not to mention cases when different doctors examine the same woman. The fact is that the guideline in determining the degree of dilatation of the cervix is the width of the doctor’s fingers: 1 finger corresponds to approximately 2 cm, 3 fingers - about 6 cm, and so on. The normal speed of dilatation in the active phase of labor is considered to be 1-1.5 centimeters per hour. When this process occurs more slowly, they may begin to use some kind of labor stimulation. However, the actions of doctors are based not only on the degree of dilation, but also on the condition of the pregnant woman.
3. Promotion of the presenting part of the baby (usually the head). Fetal advancement or prolapse is determined by palpation of the mother's abdomen and/or vaginal examination.

If a woman has a normal pelvic size, the position of the fetus is correct (head down presentation), there are no factors preventing the birth of a child through the natural birth canal, the cause of a protracted form of labor may be:

1. a woman’s fear of pain;
2. painkillers;
3. sedatives;
4. position of the woman in labor on her back;
5. some diseases of pregnant women.

Doctors' actions

It should be noted that the frequency of use of drug stimulation is growing from year to year. The main reasons for this “popularity” are still the state of health of modern pregnant women, as well as the desire of doctors to minimize possible risks for the fetus. If you find the use of medications inappropriate, you should discuss with your doctor to ensure that they are only used during your labor if absolutely necessary. In addition, different maternity hospitals have their own “favorite” methods of artificial stimulation. Therefore, I recommend that you find out in advance which methods of inducing labor are preferred by the obstetricians of your chosen maternity hospital.

So, what are the ways to stimulate labor? Formally, they can be divided into two main groups:

1. stimulating uterine contractility;
2. affecting the dilation of the cervix.

In addition, it is possible to use sedatives. Often, fear of pain during childbirth can slow down labor. In some situations, muting negative emotions can restore the normal natural course of labor.

The need for a cesarean section is explained by the fact that post-term babies have a rather large head, and while in the womb, they are no longer supplied with sufficient nutrition and oxygen. In addition, there is a risk that the baby will draw in the original feces, which is quite unsafe for his health. C-section, however, as well as stimulation of labor will be used in any case if:

1. The woman in labor suffers from hypertension or diabetes;
2. The amniotic fluid, as a result of the release of original feces into it, will have a green tint;
3. Fetal growth has slowed down significantly.

Stimulation of labor by affecting the contractile activity of the uterus
Among obstetricians, the most popular stimulants in this group are:

1. amniotomy;
2. synthetic analogs of natural hormones, usually oxytocin.

Amniotomy

This is the name given to the process of opening the amniotic sac. The autopsy is performed through a vaginal examination using a sterile plastic hook-like instrument. This procedure is painless, because the fetal bladder has no pain receptors. It is assumed that amniotomy contributes to the process of mechanical irritation of the fetal head of the birth canal. In addition, opening the amniotic sac indirectly stimulates more active production of prostaglandins, which enhance labor. Data on the effectiveness of amniotomy are conflicting. It is believed that amniotomy alone, without combination with other methods of inducing labor, reduces its duration. However, it is not always effective. Therefore, when doctors decide that a woman in labor needs induction of labor, and the amniotic sac is still intact, they will first perform an amniotomy, and only then, if necessary, will use birth-stimulating drugs.

Risks of amniotomy

When amniotomy occurs without complications, it has absolutely no effect on the child’s condition. This method is generally considered safe, due to the rarity of any complications, but they do exist.

Roughly speaking, amniotomy is cutting a well-inflated balloon. Therefore, both with amniotomy and with spontaneous rupture of the bladder, prolapse of the umbilical cord is possible. This complication threatens acute oxygen deficiency of the fetus as a result of compression of the umbilical cord by the baby’s head and birth canal. In this situation, emergency medical intervention is required.

The surface of the fetal bladder is covered with blood vessels, including quite large ones. Therefore, there is a risk that cutting the bladder, which is carried out blindly, may damage such a vessel. As a result, bleeding may begin, sometimes even threatening the baby's life.

To avoid complications, if possible, they try to do an amniotomy after the baby’s head descends into the pelvis and compresses the amniotic sac and its vessels. This helps prevent bleeding and prolapse of the umbilical cord.

In cases where amniotomy fails to intensify labor, the risk of infection of the uterus and fetus, which is no longer protected by amniotic fluid and amniotic sac, increases significantly.

Oxytocin

This is an artificially synthesized analogue of the hormone that is produced by the pituitary gland. Oxytocin is able to stimulate contractions of uterine muscle fibers. Apply medicinal product oxytocin:

1. for the purpose of artificially inducing labor;
2. with weakness of labor at any time during labor;
3. in cases of postpartum hemorrhage;
4. to stimulate lactation.

In order not to provoke severe complications, oxytocin is not used in case of abnormal fetal position, as well as to stimulate labor in women with a clinically narrow pelvis, when the parameters of the pelvic ring are too small for spontaneous childbirth.

Oxytocin is used in the form of tablets, but more often it is a solution for intravenous, intramuscular and subcutaneous injections. Intravenous drip administration of the drug is the most common, however, it has a significant drawback: a woman with a connected “drip” is severely limited in her movements.

Side effects of oxytocin

Different women react differently to the same doses of the drug oxytocin, so there are no standard regimens for use. The dosage is selected individually, as a result of which there is always a danger of overdose with the possible appearance of side effects.
The drug oxytocin has no effect on the dilatation of the cervix. In most cases, under the influence of oxytocin, labor pain intensifies; therefore, it is usually used in combination with antispasmodics that relax the muscles of the uterus.

The drug is not used in cases where the birth of a baby naturally, through the birth canal, is undesirable or impossible, with increased sensitivity to the drug, when the position of the fetus is incorrect, with placenta previa, as well as in cases of scars on the uterus, etc.

The most common side effect of oxytocin is increased contractility of the uterus, which can lead to poor circulation in it and, ultimately, to a lack of oxygen in the baby.

Stimulation of labor by affecting the cervix

Often the reason for the slow progress of labor is resistance, or immaturity of the uterus - in other words, unpreparedness for the dilation of the cervix. The most common method that helps the uterus “mature” is based on the use of prostaglandins.

Prostaglandins

These hormones have a pronounced effect on a woman’s reproductive function. Prostaglandins are found in small quantities in almost all tissues of the human body, but their highest concentration is in the seminal fluid of a man and the amniotic fluid of a woman. Prostaglandins have a stimulating effect on smooth muscle in general, and on the fallopian tubes, cervix and uterus itself in particular.

Drugs in this group are introduced into the body in different ways. However, doctors try to minimize the systemic effect of these drugs (after tablets, intravenous solutions). This is explained by a wide list of side effects. First, the effects of prostaglandins are similar to those of oxytocin in that they actively stimulate the uterus, overstimulating its uterine contractions. As a result of its use, the following are possible: nausea, vomiting, fever, diarrhea, etc. In addition, prostaglandins are more expensive. In this regard, their use is often reduced to artificial termination of pregnancy in the early stages, artificial induction of labor in almost full-term or full-term pregnancy, and not to stimulate labor during childbirth.

Currently, local prostaglandins are widely used, in the form of a viscous gel or suppositories inserted into the cervical canal or vagina. Its popularity is explained by the fact that this method minimizes side effects and has a significant effect on cervical dilatation. In addition, local administration of this stimulant does not interfere with the woman’s movements.

Other means of inducing labor

In fact, there are many means and drugs that enhance labor, but most of them are rarely used during childbirth. Often their use is aimed at combating postpartum hemorrhage that occurs due to uterine hypotension - insufficient contraction. These remedies include herbal preparations, in particular:

1. ergot,
2. common barberry,
3. shepherd's purse grass,
4. nettle,
5. spherophysin, etc.

Many funds have lost their positions in recent years, for example, artificially synthesized hormones estrogens– their effectiveness is significantly inferior oxytocin. In addition, there are methods that have not been fully studied, but have an impact on the course of childbirth, so-called unconventional methods, for example, acupuncture.

Despite scientific progress, today, unfortunately, there is no method that suits obstetricians and patients equally. Therefore, the choice of the method of labor stimulation remains with the doctor, who, taking into account the current situation, the conditions of the pregnancy, and the individual characteristics of the woman, will make a decision.

Actions of a woman

The desire to have a successful birth should not remain just a dream, not supported by any specific actions. During pregnancy, any moderate physical activity, exercise that strengthens the abdominal muscles, perineal muscles, yoga, the ability to relax, breathing exercises - all this has a beneficial effect on the course of labor. In addition, knowledge about the course of the birth process and correct behavior during childbirth will provide significant assistance; it will reduce fear, and, therefore, help the woman to adequately influence the process of giving birth to a baby. The listed knowledge and skills are quite effective natural stimulation of labor.

If you have the opportunity to choose the conditions for childbirth and the maternity hospital itself, prefer to choose those where you can walk during childbirth (of course, if you have no contraindications to this). The supine position, as has already been proven, increases the duration of labor, since one of the conditions for the rapid and successful dilatation of the cervix is the pressure of the fetus on it. Studies conducted in the USA have shown that freedom of movement (walking, sitting in various positions) is no less effective than drug stimulation. Another unique natural stimulation of labor.

Try to become familiar with the room in which your birth will take place. Surprisingly, this also has a beneficial effect on the birth process. The key factor in this is probably the loss of uncertainty and fear from unfamiliar surroundings and, in general, from the unknown.

Self-induction of labor at home,

Heads folk methods of inducing labor, an old, but long-established scientifically proven method - nipple stimulation. This massage increases the body’s production of oxytocin, a hormone that stimulates labor and largely determines the course and successful outcome of childbirth. By the way, it is precisely this circumstance that explains the fact that putting a newborn to the breast immediately after birth speeds up the process of giving birth to a baby and reduces the risk of postpartum hemorrhage. Unfortunately, this method does not provide a 100% guarantee, but it also does not cause harm (of course, if you do not overdo it and do not injure your nipples).

In general, in order to bring labor closer, there are many techniques recommended by obstetricians for independent use. So, inducing labor at home:

1. Try pressing at different angles with your thumb and forefinger on a point that is located 4 fingers higher than the inner ankle joint. Repeat 3 times, continuing the pressure for 10-15 seconds.
2. Contraction and emptying of the intestines provokes the release of prostaglandins, which soften the uterus. To do this, you can use an enema, castor oil, etc.
3. Sex is no less relevant, as is the method of nipple stimulation, which has been written about many times before. Massage your nipples for 10-15 minutes using various creams, liquids and oils. As a result of the production of oxytocin during massage, uterine contractions may occur.
4. If labor is “delayed,” walk up and down the stairs every day, alternately, sometimes with your right side, sometimes with your left. This will ensure active movement of the pelvis in different directions.
5. Stimulation of labor at home, also contains folk recipes. Perhaps the recipe for a “stimulating birth cocktail” will help you: take 1 glass of orange or apricot juice, mix with 1 glass of soda or dry champagne, add 2 tbsp. spoons of castor oil and the same amount of ground almonds. Beat the ingredients in a blender. You need to drink the entire cocktail, in small sips, gradually, within a maximum of an hour. If the time to give birth has really come, contractions will begin in 2-3 hours, otherwise you will experience distress. And bowel movements, as you remember, are also indicated.

Probably the dominant feeling for you at the moment is fatigue from the “endless” nine months of waiting. However, you should still look at the situation with optimism. From now until the birth, you can allow yourself everything that was previously prohibited due to the stimulating effect on the birth process, namely: long walks, a glass of red wine, sex with your husband. All of these are also traditional methods of stimulating labor, which are sometimes very effective.

If your pregnancy is post-term, you are probably ready to literally do anything to finally have contractions. In addition to the listed methods, there are plenty of folk methods for stimulating labor, which came from the times of the popularity of healers and astrologers. I cannot judge their effectiveness, and in some cases even their adequacy. Some of them look simply ridiculous, others are funny. But, as they say, “what the devil never jokes,” maybe they will help you, and if not, then at least they will amuse you a little.

1. To “lure” the baby into the light and warmth, it is suggested to put a cool heating pad on the stomach and place a warm one between the legs. In addition, you need to provide a source of bright light in the perineal area. It is understood that the child will strive for light and warmth, and the birth process begins.
2. According to popular beliefs, the energy of trees helps a child to be born sooner. To do this, you need to hug an oak or birch - trees with strong energy- and communicate with nature. At the same time, he insists that in no case should it be chestnut, aspen, willow or poplar - they, supposedly, can have the opposite effect.
3. If this does not help, then perhaps the explanation is in the location of the stars! It’s just that the lunar day on which your baby was conceived has not yet arrived. If you know the exact date of conception, use the lunar calendar to find out the constellation in which the moon was then located in order to presumably calculate the days of birth. The child must appear to the world on the day when the moon is in the same constellation.

While getting carried away with all this, do not forget about the doctor’s recommendations. If he assures you that everything is going according to plan, the examination confirmed that the baby feels comfortable, and you have a lot of time to wait - do not rush things. Only 4% of babies are born exactly on the expected date of birth.

Lastly, remember: no pregnancy can last forever, you are definitely already at the finish line and there are days, and perhaps hours, left until the long-awaited meeting with your blood. Good luck to both of you and have an easy birth! Let this acquaintance pass in the most pleasant way possible! Health to your baby and you!