Labor induction is the use of medications or other methods to bring on induce labor. Rcog press national collaborating centre for womens and childrens health 2008. Traditionally, induction is carried out during the daytime when labour wards are often already busy. General induction of labour guidelines and conditionspecific guidelines containing induction of labour recommendations were searched.
Induction of labour iol in maternity care is often not an area of priority in maternity services, which often results in protracted delays, a poor patient experience, and patient complaints. Caesarean section cs rates among women undergoing iol at this inner city district general hospital were noted to be higher than other units nationwide. Induction of labour is not riskfree and many women find it to be uncomfortable. This article was originally published as wickham s 2016. Induction of labour made no clear difference to the number of women who needed a caesarean section, or an instrumental delivery.
Although currently available guidelines do not recommend this, induction of labour is increasingly being used at the request of pregnant women to shorten the duration of pregnancy or to time the birth of the baby according to the convenience of the mother andor healthcare workers. Induction of labour is one of the most frequent interventions in pregnancy. International consensus bodies do not currently support induction of labour in women without diabetes at term for suspected fetal macrosomia acog practice pattern no. Induced labour has an impact on the birth experience of women. When labour was induced using pharmacological methods. As a general rule, iol is performed when it thought that the baby will be. Induction of labour refer to online version, destroy printed copies after use page 3 of 30 flow chart. Induction of labour can place more strain on labour wards than spontaneous labour. Induction of labour can take a long time as it is an artificial process.
Induction of labour at term in older mothers, london. Royal college of obstetricians and gynaecologistsroyal. Induction of labour iol is the process of starting labour artificially. Labor induction may be recommended if the health of the mother or fetus is at risk. Factors and outcomes associated with the induction of labour in latin america. Induction of labour clinical guideline july 2008 funded to produce guidelines for the nhs by nice rcog press 2008 rcog press published by the royal college of obstetricians and gynaecologists. If gestational diabetes is the only abnormality, induction of labour before 41 weeks of gestation is not recommended. An induction of labour may be recommended when you or your baby will benefit from birth being brought on sooner rather than waiting for labour to start naturally. Conditions that may affect the safety and efficacy of induction of labour are included, e. Pdf rcog evidencebased clinical guidelines induction of labour. Indication maternal andor fetal benefit contraindications as for vaginal birth communication with woman. General principles related to the practice of induction of labour.
Summary clinical practice guideline on induction of labour. Does induction really reduce the likelihood of caesarean section. Standardised maternal guideline for induction of labour. Questioning induction of labour in older women part 1. As most mothers requiring induction of labour have an underlying medical problem, safe delivery in the appropriate setting is a priority. When labour was induced, 57 per cent of women went on to have a spontaneous vaginal birth, 22 per cent of women had an instrumental birth and 21 per cent gave birth by caesarean section. Royal college of obstetricians and gynaecologists rcog. Clinical guideline for the management of induction of labour iol, including oxytocin infusion page 4 of 31 1. To purchase further copies and for a complete list of rcog press titles, visit. Pelvic organ prolapse pev001 zika virus and pregnancy pev002 english spev002 spanish patient education infographics. Criteria for confirmation of fetal lung maturity should be met in these circumstances see guideline 14. Induction of labour, evidencebased clinical guideline number 70.
Induction of labor refers to techniques for stimulating uterine contractions to accomplish delivery prior to the spontaneous onset of such contractions. The risks and benefits of induction of labour as an intervention for specific. It is typically recommended when allowing the pregnancy to continue is believed to be at least as risky for the mother andor fetus as delivery. Rcog 2016 patterns of maternity care in english nhs trusts.
We conducted a systematic search of national and international englishlanguage guidelines published between 2008 and 2018. Royal college of obstetricians and gynaecologists and royal college of midwives joint statement no. Induction of labour nice clinical guideline 70 rcog. Pdf an evidencebased guideline produced by the rcog with funding from the nhs executive and the national institute for clinical excellence nice. As the baby was not delivered after 1 hour of active second stage and the baby was in the occipitoposterior position, the mother consented to a trial of instrumental delivery in theatre. Women may also experience increased pain from induction1. The advantages and disadvantages of pharmacological methods and mechanical methods such as the osmotic cervical dilator dilapan. Information you can trust from the leading experts in womens health care. It may be less efficient and is usually more painful than spontaneous labour. Owing to the nature of the intervention it was not possible to blind the women or caregivers to treatment allocation.
Background and introduction the average age of childbirth is rising markedly across western countries. The rcog greentop guideline recommend counselling women of a 23 fold increased risk of uterine rupture and around 1. Labor induction is contraindicated in patients with transverse fetal position, umbilical cord prolapse, active genital herpes infection, placenta previa, and women who have had a previous myomectomy. Oral misoprostol appears to be less effective than vaginal misoprostol,however, oral route is associated with less incidence of. Clinical guideline for the management of induction of labour iol, including oxytocin infusion. While it is not always unwelcome, it is associated with increased labour pain and further interventions. Induction and augmentation of labour guideline northern devon. Rcog evidencebased clinical guidelines induction of labour.
Evidencebased information on induction of labour from royal college of obstetricians. Responsibilities of the most responsible health practitioner for induction by cervical ripening 5. Labor is induced to stimulate contractions of the uterus in an effort to have a vaginal birth. This edition of the icog newsletter has been therefore dedicated to the important topic of protocols in induction of labour so that. A physician capable of performing a cesarean should be readily available any time induction is used in the event that the induction isnt successful. An overview of the past, current and future trends for.
In victoria in 2012 and 20, 25 per cent of labours were induced. Who recommendation on induction of labour for women with. There appear to be benefits from induction, but there may also be some disadvantages. Use of misoprostol in obstetrics must be restricted to rcts. Induction of labour is not recommended in women with an uncomplicated pregnancy at gestational age less than 41 weeks. Target group these guidelines are mainly intended for use by midwives and doctors conducting deliveries at level 1 standardised maternal guideline for induction of labour with misoprostol guideline. Women having induction of labour should receive propess irrespective of cervical findings unless the cervix is found to be 3cm dilated, fully effaced and well applied to the presenting part. However, there may be rare but clinically significant risks for the baby born under water. Induction of labor more than 22% of all gravid women undergo induction of labor in the united states, and the overall rate of induction of labor in the united states has more than doubled since 1990 to 225 per 1,000 live births in 2006 1. Who recommendation on sweeping of membranes for reducing. Induction of labour nice clinical guideline 70 nhs. Procedures women allocated to induction were scheduled for the. In special situations, labor is induced for nonmedical reasons, such as living.
Induction of labour at term is not recommended for suspected fetal macrosomia. Whilst most women will go into labour spontaneously by week 42 of gestation, roughly 1 in 5 pregnancies will require an induction. Induction of labour is also one such potential technique which can be questioned for its appropriateness as an unnecessary interference with a natural process unless we can present a viable justification for it. Furthermore, recommendations regarding the monitoring and the optimal timing of the labour induction of pregnancies complicated with intrauterine growth retardation are discussed. Methods of term labour induction for women with a previous caesarean. Balloon catheters for induction of labor at term after previous cesarean section. Indications for the induction of labor 1,2 should take into account maternal and fetal conditions, gestational age, cervical status, and other factors. Induction of labour in the presence of one previous. There is limited evidence that more women in the induction of labour group had severe perineal damage. Antenatal care routine care for the healthy pregnant woman national collaborating centre for womens and childrens health commissioned by the national institute for health and clinical excellence march 2008 this is a partial update of the 2003 guideline. Labor may be induced for nonmedical reasons after 39 weeks gestation. New or amended sections are indicated by a grey bar in the margin.
Information for healthcare professionals version 9 pdf. Oxytocin augmentation and induction of labour infusion. You will have a vaginal assessment by the midwife after 6 hours, it may be necessary to have. Labour did not start spontaneously and so she underwent induction of labour. Induction of labour iol including oxytocin infusion v10.
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