Birth is a natural process but sometimes it may need a little help.

Induction

Induction is the start of labor by medical means. Medication may be used to soften the cervix or stimulate contractions. The doctor may also use a tool to open an area of the amniotic sac.

Labor may be induced because:

  • Pregnancy has gone 2 or more weeks past your due date
  • Water has broken, but true labor contractions have not started
  • A condition is threatening the health of you or your baby such as:
  • Your baby has a medical reason to be delivered, such as intrauterine growth restriction, and a C-section is not needed

Augmentation

Labor that started naturally may slow or stop on its own. Medicine or rupturing the amniotic sac may help to restart labor. This is called augmentation.

Fetal Heart Rate Monitoring

Fetal heart rate tracks the baby's heart rate. It provides information on how the baby is doing. An abnormal heart rate can be a sign that something is wrong and that action may be needed. Tracking fetal heart rate is not necessary with a healthy pregnancy and normal labor. It may cause more stress than good. The baby's heart rate will be checked on and off. Continuous fetal heart rate monitoring is the standard for high-risk pregnancies.

Monitoring can be done externally or internally. One method of external monitoring uses 2 flat sensors that are placed on your abdomen. One sensor uses ultrasound to monitor your baby’s heart rate. The other measures your contractions.

Internal monitoring creates a more accurate measure of your baby’s heart rate. The cervix must be dilated at least 2 centimeters and the amniotic sac ruptured before using internal monitoring. A sensor is strapped to your thigh. A thin wire is inserted into your uterus. An electrode is attached to the skin on the baby’s head. It measures the baby’s heart beat.

External Fetal Monitoring
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Episiotomy

An episiotomy is a small incision into the perineum. The perineum is the area between the vagina and the anus. It stretches as the baby’s head is delivered. The episiotomy is closed with stitches once the baby is delivered. Episiotomies are more common during a woman’s first delivery.

Episiotomies were more routinely done in the past. Today, few doctors routinely do an episiotomy. They can result in greater damage than a natural tear. Controlled pushing and massage to the perineum can help reduce or prevent tearing.

Assisted Delivery

Labor can sometimes stall at the end of labor. These steps may help to speed up delivery of the baby.

Forceps Delivery

The forceps look like a long pair of tongs. They may be used if the baby is not moving down the birth canal and there is a medical need to speed the delivery. The area will be numbed with medicine if it is not already numb. The forceps are gently inserted along either side of the baby’s head. They will gently grip the baby’s head to help pull the head out as the mother pushes. The risks of a forceps delivery are low. The baby may have some bruising or swelling on the head or face. This will fade in a few days. A mother may require an episiotomy or have a severe tear in the perineum during a forceps delivery. A rare complication is bleeding in the baby’s skull.

Vacuum Extractor-assisted Delivery

A vacuum extractor has a cup on the end which attaches to the top of the baby’s head. This lets the doctor pull gently while the mother pushes during contractions. The risk to mother and baby is low. The baby may have temporary bruising or swelling on the scalp.

Assisted Delivery—Forceps and Vacuum
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RESOURCES:

Office on Women's Health
https://www.womenshealth.gov

The American Congress of Obstetricians and Gynecologists
http://www.acog.org

CANADIAN RESOURCES:

The Society of Obstetricians and Gynaecologists of Canada
https://sogc.org

Women's Health Matters
http://www.womenshealthmatters.ca

REFERENCES:

Birth plans. Kids Health—Nemours Foundation website. Available at: http://kidshealth.org/en/parents/birth-plans.html. Accessed January 29, 2021.

Gulmezoglu A, Crowther C, Middleton P. Induction of labour for improving birth outcomes for women at or beyond term. Cochrane Database Syst Rev. 2012;(6):CD004945.

Labor induction. The American College of Obstetricians and Gynecologists website. Available at: http://www.acog.org/~/media/For%20Patients/faq154.pdf?dmc=1&ts=20121226T0908058985. Accessed January 29, 2021.

Labor induction and cervical ripening. EBSCO DynaMed website. Available at: http://www.dynamed.com/topics/dmp~AN~T115335/Labor-induction-and-cervical-ripening. Accessed January 29, 2021.

Last reviewed September 2020 by EBSCO Medical Review Board  Last Updated: 1/29/2021