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This is created for a Advanced Writing Course in the Sciences. Please refrain from moving until April 21, 2015. [[User:Kim ENGW3307|Kim ENGW3307]] ([[User talk:Kim ENGW3307|talk]]) 18:55, 20 March 2015 (UTC)

[[User:Kim ENGW3307|Kim ENGW3307]] ([[User talk:Kim ENGW3307|talk]]) 20:28, 2 April 2015 (UTC)


{{Infobox interventions |
  Name        = Labor induction |
  Image       = |
  Caption     = |
  ICD10       = |
  ICD9        = {{ICD9proc|73.0}}-{{ICD9proc|73.1}} |
  MeshID      = |
  OPS301      = |
  OtherCodes  = |
  HCPCSlevel2 =
}}
'''Labor induction''' is the artificial stimulation of [[childbirth]]. Induction performed without medical indications is termed elective induction of labor. Labor induction is suggested by physicians when waiting for natural labor to proceed is harmful to either the infant or the mother. Methods of inducing labor include pharmacological medications, physical approaches and natural approaches. 

==Medical uses==
Commonly accepted medical indicators for induction include:
* [[Postterm pregnancy]], i.e. if the pregnancy has gone past the 41st week.
* [[Intrauterine fetal growth retardation]] (IUGR).
* There are health risks to the woman in continuing the pregnancy (e.g. she has [[pre-eclampsia]]).
* [[Premature rupture of the membranes]] (PROM); this is when the membranes have ruptured, but labor does not start within a specific amount of time.<ref>Allahyar,J. & Galan, H. "Premature Rupture of the Membranes."; also American College of Obstetrics and Gynecologists.</ref>
* Premature termination of the pregnancy ([[abortion]]).
* Fetal death in utero and previous history of stillbirth. 
* Twin pregnancy continuing beyond 38 weeks.
* Previous health conditions that puts risk on the woman and/or her child such as [[diabetes]], [[high blood pressure]].

== Methods of induction ==

===Medication===

* [[Intravaginal administration|Intravaginal]], [[endocervical administration|endocervical]] or [[extra-amniotic administration]] of [[prostaglandin]], such as [[dinoprostone]] or [[misoprostol]].<ref name="pmid15043790">{{cite journal |author=Li XM, Wan J, Xu CF, Zhang Y, Fang L, Shi ZJ, Li K |title=Misoprostol in labor induction of term pregnancy: a meta-analysis|journal=Chin Med J (Engl)|volume=117 |issue=3 |pages=449–52 |date=March 2004 |pmid=15043790 |doi=}}</ref> Prostaglandin E2 is the most studied compound with a wide range of dosage forms and delivery options.  The use of misoprostol has been extensively studied but normally in small, poorly defined studies. Only a very few countries have approved misoprostol for use in induction of labor. 
* [[Intravenous]] administration of synthetic [[oxytocin]] preparations. A high dose does not seem to have greater benefits than a standard dose.<ref>{{cite journal|last1=Budden|first1=A|last2=Chen|first2=LJ|last3=Henry|first3=A|title=High-dose versus low-dose oxytocin infusion regimens for induction of labour at term.|journal=The Cochrane database of systematic reviews|date=Oct 9, 2014|volume=10|pages=CD009701|pmid=25300173}}</ref>
* Use of [[mifepristone]] has been described but is rarely used in practice.<ref name="pmid16647925">{{cite journal |author=Clark K, Ji H, Feltovich H, Janowski J, Carroll C, Chien EK |title=Mifepristone-induced cervical ripening: structural, biomechanical, and molecular events |journal=Am. J. Obstet. Gynecol. |volume=194 |issue=5 |pages=1391–8 |date=May 2006 |pmid=16647925 |doi=10.1016/j.ajog.2005.11.026 |url=}}</ref>
* [[Relaxin]] has been investigated,<ref name="pmid11406079">{{cite journal |author=Kelly AJ, Kavanagh J, Thomas J |title=Relaxin for cervical ripening and induction of labor |journal=Cochrane Database Syst Rev |volume= |issue=2 |pages=CD003103 |year=2001 |pmid=11406079 |doi=10.1002/14651858.CD003103 |url=}}</ref> but is not currently commonly used.
* [[Antiprogesterone]], [[relaxin]], [[nitric oxide donors]], oxytocin, prostaglandins are drugs used in this medical practice.

===Mechanical and physical approaches===

* "Membrane sweep", also known as membrane stripping, or "stretch and sweep" in Australia and the UK – during an internal examination, the practitioner stimulates the cervix to separate the membranes around the baby from the cervix.  This causes a release of prostaglandins which can help to kick-start labor.
* [[Artificial rupture of the membranes]] (AROM or ARM) ("breaking the waters"). 
* [[Extra-amniotic saline infusion]] (EASI),<ref name=Guinn2004>{{Cite journal | last1 = Guinn | first1 = D. A. | last2 = Davies | first2 = J. K. | last3 = Jones | first3 = R. O. | last4 = Sullivan | first4 = L. | last5 = Wolf | first5 = D. | title = Labor induction in women with an unfavorable Bishop score: Randomized controlled trial of intrauterine Foley catheter with concurrent oxytocin infusion versus Foley catheter with extra-amniotic saline infusion with concurrent oxytocin infusion | doi = 10.1016/j.ajog.2003.12.039 | journal = American Journal of Obstetrics and Gynecology | volume = 191 | issue = 1 | pages = 225–229 | year = 2004 | pmid = 15295370 | pmc = }}</ref> in which a [[Foley catheter]] is inserted into the [[cervix]] and the distal portion expanded to dilate it and to release prostaglandins. There is no direct effect on the uterus.

== When to induce ==
There contradicting results found in the outcomes associated with labor induction. The American Congress of Obstetricians and Gynecologists has recommended against elective induction before 41 weeks if there is no medical indication and the cervix is unfavorable.<ref name="ACOGfive">{{Citation |author1 =  American Congress of Obstetricians and Gynecologists |author1-link = American Congress of Obstetricians and Gynecologists |title = Five Things Physicians and Patients Should Question |publisher = [[American Congress of Obstetricians and Gynecologists]] |work = [[Choosing Wisely]]: an initiative of the [[ABIM Foundation]] |page = |url = http://www.choosingwisely.org/doctor-patient-lists/american-college-of-obstetricians-and-gynecologists/ |accessdate = August 1, 2013}}, which cites
*{{cite book |title=Guidelines for perinatal care |publisher=American Academy of Pediatrics |location=Elk Grove Village, IL |isbn=978-1581107340 |author1=American Academy of Pediatrics |author2=American College of Obstetricians and Gynecologists |authorlink1=American Academy of Pediatrics |authorlink2=American College of Obstetricians and Gynecologists |edition=7th ed.}}
*{{Cite journal | author=ACOG Committee on Practice Bulletins| doi = 10.1097/AOG.0b013e3181b48ef5 | title = ACOG Practice Bulletin No. 107: Induction of Labor | journal = Obstetrics & Gynecology | volume = 114 | issue = 2, Part 1 | pages = 386–397 | year = 2009 | pmid = 19623003 | pmc = }}</ref>  Induction of labor in those who are either at or after term improves outcomes for the baby and decreases the number of [[C-sections]] performed.<ref>{{cite journal|last1=Mishanina|first1=E|last2=Rogozinska|first2=E|last3=Thatthi|first3=T|last4=Uddin-Khan|first4=R|last5=Khan|first5=KS|last6=Meads|first6=C|title=Use of labour induction and risk of cesarean delivery: a systematic review and meta-analysis.|journal=CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne|date=Jun 10, 2014|volume=186|issue=9|pages=665–73|pmid=24778358}}</ref> However, recent studies contradict this view.  One recent study indicates that labor induction at term or post-term reduces the rate of caesarean section by 12%, and also reduces fetal death.<ref name="cmaj.ca">Ekaterina Mishanina et al., "Use of labour induction and risk of cesarean delivery: a systematic review and meta-analysis", April 2014, Canadian Medical Association Journal, [http://www.cmaj.ca/content/early/2014/04/28/cmaj.130925]</ref>  On the other hand, other studies have shown that non-indicated, elective inductions before the 41st week of gestation are associated with an increased risk of [[caesarean section]].<ref name="ACOGfive"/> Randomized clinical trials have not been used to study this question. It has been found that women who undergo labor induction without medical indicators are not predisposed to cesarean sections.<ref>Heinberg EM, Wood RA, Chambers RB. ''Elective induction of labor in multiparous women. Does it increase the risk of cesarean section?'' 2002. J Reprod Med. 47(5):399-403. </ref> Doctors and patients should have a discussion of risks and benefits when considering an induction of labor in the absence of an accepted medical indiction.<ref name="ACOGfive"/> 

A [[Bishop Score]] is used to determine the odds of having a vaginal delivery after labor induction. However, recent research has questioned the relationship between the Bishop score and a successful induction, finding that a poor Bishop score actually may improve the chance for a vaginal delivery after induction.<ref name="cmaj.ca"/> A Bishop Score is done to assess the progression of the cervix prior to an induction. In order to do this, the cervix must be checked to see how much it has effaced, thinned out, and how far dilated it is. The score goes by a points system depending on five factors. Each factor is scored on a scale of either 0-2 or 0–3, any score that adds up to be less than 5 holds a higher risk of delivering by cesarean section.<ref>Doheny, K. (2010, June 22). Labor Induction May Boost C-Section Risk. HealthDay Consumer News Service. Retrieved from EBSCOhost.</ref>

== Risks of Inductions ==

===Neonatal Risks===
Newborns birthed earlier than 39 weeks have higher rates of morbidity due to respiratory problems.<ref name=Jensen>{{cite journal|last1=Jensen|first1=Jr|last2=White|first2=Wm|last3=Coddington|first3=CC|title=Maternal and Neonatal Complications of Elective Early-Term Deliveries|journal=Mayo Clinic Proceedings|date=2013|volume=88|issue=11|pages=1312-1317|doi=10.1016/j.mayocp.2013.07.009}}</ref> Higher rates of [[NICU]] admission in gestational ages 37-38 are observed as compared to those born after 39 weeks. <ref name=Jensen/> In women carrying their first child, cesarean sections decrease the occurrence of birth asphyxia, trauma, and meconium aspiration. Secondary respiratory distress and pulmonary hypertension is increased with cesarean sections. <ref name=Ramachandrappa>{{cite journal|last1=Ramachandrappe|first1=Ashwain|last2=Jain|first2=Lucky|title=Elective Cesarean Section: It's Impact on Neonatal Respiratory Outcome|journal=Clinical Perinatology|date=2008|volume=35|issue=2|page=373|doi=10.1016/j.clp.2008.03.006}}</ref> Inducing labor before 39 weeks in the absence of a medical indication, like [[hypertension]], IUGR, or [[pre-eclampsia]], increases the risk of complications with [[respiration]], [[infection]], [[feeding]], [[jaundice]], [[neonatal intensive care unit]] admissions, and perinatal death.<ref>{{cite web|url=http://www.npr.org/templates/transcript/transcript.php?storyId=138473097|title=Doctors To Pregnant Women: Wait At Least 39 Weeks|accessdate=2011-08-20|date=2011-07-18}}</ref> During 41st week of gestation, infant mortality and maternal risk of injury is increased. <ref>Tim A. Bruckner et al, ''Increased neonatal mortality among normal-weight births beyond 41 weeks of gestation in California'', October 2008, American Journal of Obstetrics and Gynecology, [http://www.ajog.org/article/S0002-9378(08)00558-9/abstract]</ref> Due to the increasing risks of advanced gestation, induction appears to reduce the risk for cesarean delivery after 41 weeks gestation and possibly earlier.<ref name="cmaj.ca"/><ref>{{cite journal|last=Caughey|first=AB|author2=Sundaram, V |author3=Kaimal, AJ |author4=Gienger, A |author5=Cheng, YW |author6=McDonald, KM |author7=Shaffer, BL |author8=Owens, DK |author9= Bravata, DM  |title=Systematic review: elective induction of labor versus expectant management of pregnancy.|journal=Annals of internal medicine|date=Aug 18, 2009|volume=151|issue=4|pages=252–63, W53-63|pmid=19687492|doi=10.7326/0003-4819-151-4-200908180-00007}}</ref>

===Maternal Risks===
Labor inductions can lead to an increased likelihood of [[caesarean section]] delivery for the baby.<ref>Roberts, Tracy, Peat, 2000 ''Rates for obstetric intervention among private and public patients in Australia: population based descriptive study'' Christine L Roberts, Sally Tracy, Brian Peat, "British Medical Journal", v321:140 July 2000</ref> Studies in this field show contradicting results.  One study indicated that while, overall caesarean section rates from 1990–1997 remained at or below 20%, elective induction was associated with a doubling of the rate of caesarean section .<ref>Yeast, John D., ''Induction of labor and the relationship to caesarean delivery: A review of 7001 consecutive inductions.'', March 1999, American Journal of Obstetrics and Gynecology, [http://pt.wkhealth.com/pt/re/ajog/abstract.00000447-199903000-00026.htm]</ref> Another study showed that elective induction in women who were not post-term increased a woman's chance of a C-section by two to three times.<ref>Kathleen R. Simpson and Kathleen E. Thorman, "Obstetric 'Conveniences' Elective Induction of Labor, Cesarean Birth on Demand, and Other Potentially Unnecessary Interventions," ''Journal of Perinatal and Neonatal Nursing'' 19, no. 2 (2005):134–44</ref> A more recent study indicated that induction may increase the risk of caesarean section if performed before the 40th week of gestation, but it has no effect or actually lowers the risk if performed after the 40th week.<ref>Caughey AB, Nicholson JM, Cheng YW, Lyell DJ, Washington E. ''Induction of labor and caesarean delivery by gestational age''. Am Journal of Obstetrics and Gynecology . 2006;195:700–5.[http://www.ajog.org/article/S0002-9378(06)00888-X/abstract]</ref><ref>A Gülmezoglu et al, ''Induction of labor for improving birth outcomes for women at or beyond term'',2009,The Cochrane Library, [http://mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD004945/frame.html]</ref>

[[Postpartum hemorrhage]] is a common maternal outcome of induced labor with both oxytocin or prostaglandin. <ref name=Khireddine>{{cite journal|last1=Khireddine|first1=Imane|last2=Le Ray|first2=Camille|last3=Dupont|first3=Corinne|last4=Rudigoz|first4=Rene-Charles|last5=Bouvier-Colle|first5=Marie-Helene|title=Induction of Labor and Risk of Postpartum Hemorrhage in Low Risk Parturients|journal=Public Library Of Science|date=2013|volume=8|issue=1|page=e54858|doi=10.1371/journal.pone.0054858}}</ref> [[Uterine hyperstimulation]] increases the potential risk of fetal distress. [[Umbilical cord prolapse]] can result in still-birth as well as a severe damage in the oxygen supply to the fetus in distress. The prevalence of obesity in women plays an important role in the use of labor inductions for preventative measures. Labor induction as well as maternal age is the prime risk factor to a developing [[amniotic fluid embolism]]. <ref>{{cite journal|last1=Stolk|first1=Keon|title=Severe maternal morbidity and mortality from amniotic fluid embolism in the Netherlands|journal=ACTA Obstetricia et Gynecologia|date=2012|volume=91|pages=991-995}}</ref>

==Global Trends==
There is an overall increase in labor inductions in the world but rates vary in different regions. In the United States and the United Kingdom, a fifth of all births are delivered by elected labor inductions.<ref name=ACOG>{{cite journal|title=ACOG Practice Bulletin No. 107: Induction of Labor|journal=Obstetrics and Gynecology|date=2009|volume=114|issue=2|pages=386-397|doi=10.1097/AOG.0b013e3181b48ef5}}</ref> Elected early term inductions have tripled in the US with emphasis on the extreme increase in Non-Hispanic White women that did not experience medical indicators to induce labor. <ref name=Murthy>{{cite journal|last1=Murthy|first1=Karna|last2=Grobman|first2=William|last3=Lee|first3=Todd|last4=Holl|first4=Jane|title=585: Racial/Ethnic Differences in Labor Inductions at Early-Term Gestation|journal=American Journal of Obstetrics and Gynecology|date=2011|volume=204|issue=1|page=S233}}</ref>. In Latin America, approximately 11% of all births were induced. <ref name=Africa>{{cite journal|last1=Bukola|first1=Fawole|last2=M'Mimunya|first2=Machoki|last3=Jean-Jose|first3=Wolomby|last4=Kidza|first4=Mugerwa|last5=Isilda|first5=Neves|title=Unmet Need For Induction of labor in Africa: a secondary analysis from the 2004-2005 WHO global Maternal and Perinatal Health Survey|journal=BioMed Central|date=2012|volume=12|page=722}}</ref> In Africa, the rates are even lower. The lack of standardized technology in developing countries may contribute to the lower rates.

==Elective Induction of Labor== 

=== Reasons ===
As mentioned in [[The Business of Being Born]], many physicians create an intimate relationship with their pregnant patients in order to prepare them for the delivery. Since birth is spontaneous and unplanned, women might choose to induce labor to feel most comfortable in the presence of the same physician that prepared them for this experience. The financial burden of staying in the hospital for more than the necessary amount can be another reason to elect to induce labor.

=== Concerns===
Induced labor may be more painful for the woman.<ref>National Institute for Health and Clinical Excellence, "CG70 Induction of labour: NICE guideline", [http://publications.nice.org.uk/induction-of-labour-cg70/introduction] July 2008, retrieved 2012-04-10</ref> This can lead to the increased use of [[analgesic]]s and other pain-relieving pharmaceuticals.<ref>[[David Vernon (writer)|Vernon, David]], ''[[Having a Great Birth in Australia]],'' [[Australian College of Midwives]], 2005, {{ISBN|0-9751674-3-X}}</ref> [[Epidural analgesia]] is used most commonly for pain management. 
The most recent reviews on the subject of induction and its effect on Cesaerean section indicate that there is no increase with induction and in fact there can be a reduction.<ref name="cmaj.ca"/><ref>{{cite journal|last=Caughey A.|date=8 May 2013|title=Induction of labour: does it increase the risk of cesarean delivery?|journal=BJOG|volume=121|issue=6|pages=658–661|doi=10.1111/1471-0528.12329|accessdate=11 June 2014}}</ref>

== Non-medical interventions==

Some women choose not to induce without medical indicators and resort to more natural remedies to increase the progression of labor. Such approaches are supported by limited research and are not guaranteed. 

* Breast stimulation has been proven to induce labor due to the natural release of [[oxytocin]]. <ref name=Breast>{{cite journal|last1=Jhirad|first1=A|last2=Vago|first2=T|title=Induction of Labor by Breast Stimulation|journal=Obstetrics and Gynecology|date=1973|volume=41|issue=3|pages=347-350}}</ref> 
* [[Acupuncture ]] is believed to direct energy and blood flow towards the bottom half of the mother's body. Based on a comprehensive literature review, there is a low risk incidence of side effects after several sessions of acupuncture. <ref name=Acupuncture>{{cite journal|last1=Lim|first1=Chi Eung|last2=Wilkinson|first2=Jenny|last3=Wong|first3=Wu Shun|last4=Cheng|first4=Lisa|title=Effect of Acupuncture on Induction of Labor|journal=The Journal of Alternative and Complementary Medicine|date=2009|volume=15|issue=11|pages=1209-1214|doi=10.1089=acm.2009.0100}}</ref> 
* [[Castor oil]], a bowel stimulant, is theorized to promote uterine contractions. Even though, a clinical trial found no adverse maternal or neonatal outcomes to using castor oil in inducing labor, there is no evidence that castor oil is effective in inducing labor. <ref name=CastorOil>{{cite journal|last1=Boel|first1=Machteld Elisabeth|last2=Lee|first2=Sue Jean|last3=Rijken|first3=Marcus|last4=Paw|first4=Moo Koo|title=Castor Oil for Induction of Labor: Not Harmful, Not Helpful|journal=Obstetrical & Gynecological Survey|date=2010|volume=65|issue=2|pages=77-78|doi=10.1097/01.ogx.0000368137.31846.18}}</ref>

==See also==
*[[Tocolytic]]s, labor repressants

==References==
{{Reflist|2}}

== External links ==
* Harman & Kim. "[http://www.aafp.org/afp/990800ap/477.html Current Trends in Cervical Ripening and Labor Induction]" American Family Physician 1999; 60:477–84.
* [http://www.webmd.com/a-to-z-guides/inducing-labor-naturally-can-it-be-done Inducing Labor – WebMD.com]
* [http://www.nice.org.uk/guidelineD Induction of labour]. Clinical guideline, UK National Institute for Health and Clinical Excellence, June 2001.
* Josie L. Tenore: [http://www.aafp.org/afp/20030515/2123.html Methods for cervical ripening and induction of labor]. American Family Physician, 15 May 2003.
*"Catecholamines – blood ." National Library of Medicine . N.p., n.d. Web. 28 Mar. 2011. <http://www.nlm.nih.gov/medlineplus>.

{{Obstetrical procedures}}
{{Uterotonic}}

{{DEFAULTSORT:Labor Induction}}
[[:Category:Childbirth]]
[[:Category:Obstetrical procedures]]