Published: Aug. 12, 2013
Updated: Aug. 12, 2013
Chad Grotegut, MD, an ob/gyn at Duke Medicine, discusses labor induction and augmentation, and breaks down new research on labor practices and autism risk.
What is labor induction and labor augmentation?
Labor induction is the process in which we stimulate contractions using medications or other procedures to help a woman go into labor if she hadn’t previously been in labor.
In augmented labor, a woman is already in labor and having contractions, but her cervix is not changing and her labor is not progressing, so we use medications or procedures to make these contractions more frequent and longer to progress the labor.
As induction and augmentation rates have risen in the past 10 to 15 years, some neonatal complications have decreased, including the risk for stillbirth.
What are some of the most common reasons for inducing labor?
Our goal for inducing labor is to prevent complications that can occur to the baby or mother as a result of the baby remaining in utero. The most common reasons for labor induction are grouped into three main categories: maternal medical conditions, fetal conditions, and post term pregnancy.
Maternal medical conditions include diabetes, hypertension, pre-disposition for blood clotting disorders and others issues that put the mother at risk. Women with these medical conditions have increased risk for stillbirth, so the goal is to have them deliver when they reach term in an effort to decrease the risk of stillbirth. There are also maternal conditions such as preeclampsia or maternal heart conditions where continuing pregnancy is harmful for the mother.
Fetal conditions that may require labor induction include growth abnormalities, abnormal placental function, and other congenital anomalies. The goal here is to decrease the risk of stillbirth by inducing at term.
Post-term pregnancy – or pregnancy progressing longer than 41 to 42 weeks – is also associated with stillbirth, neonatal death and poor neonatal outcomes. Again, the goal of inducing women who progress past their due date is to reduce the risks of these adverse outcomes.
Finally, there may be some people who choose to induce labor on a certain date based on convenience or for other social reasons. This only happens after 39 weeks, when it’s safe for the baby
What medicines are used to induce or augment labor?
For labor augmentation, where a woman is already in labor and we try to increase the strength or frequency of contractions, the primary medication used is oxytocin. Oxytocin is available as a drug (Pitocin) but is the same natural hormone that is made in our brains. When given during labor, it makes contractions stronger and closer together. We may also rupture the membranes, or “break the water,” to augment labor.
When inducing or initiating labor, the use of oxytocin is less, but a large majority of women who induce receive oxytocin at some point in the labor. For women who have a cervix that is not dilated, we prepare the cervix for labor in other ways, sometimes with a class of drugs called prostaglandins or with balloon devices that dilate the cervix. Once the cervix is ready, we may go to other options like rupturing the membranes or using oxytocin.
Oxytocin is the most widely and commonly used medicine for labor induction and augmentation, and is considered a safe medication when used properly.
How do you decide whether to induce and/or augment labor?
In considering whether to induce or augment a woman’s labor, we always weigh the risks of continuing the pregnancy versus the potential maternal or fetal risk of the procedure. Labor induction has merit when the benefits of proceeding with delivery outweigh the risk of continuing the pregnancy. Healthcare providers evaluate each woman individually to determine if she is an appropriate candidate for augmentation or induction.
A new study published in JAMA Pediatrics looked at the relationship between labor induction and augmentation and the risk for autism. What did the study find?
Our study found that labor induction and augmentation are associated with an increased risk for having children with autism. This does not mean that labor induction and augmentation cause autism. It simply demonstrates an association between the two, but we don't know what’s causing this increased risk. We don’t know if it’s the mom’s medical conditions or fetal conditions that warrant labor induction or augmentation, the medications used, events that occur prior to or during labor, or something else all together that might explain the association.
There are clear benefits to labor induction and augmentation for both moms and their babies. Given that we need more research to determine what is actually causing this increased risk for autism, the results from our study should not be used to change current practices in labor and delivery.