Labor augmentation

Labor augmentation

What is labor augmentation?

If your labor isn't progressing very well, your healthcare practitioner may try to help it along (or "augment" it) by doing something to stimulate your contractions. She may decide to do this if your contractions aren't coming frequently or forcefully enough to dilate your cervix or help move your baby down the birth canal.

How is it done?

Before augmenting your labor, your practitioner will carefully assess your contraction pattern and examine you to find out how much your cervix has effaced (thinned out) and dilated, as well as how far your baby has descended. She'll also pay close attention to your baby's heart rate in response to the contractions you're having, to make sure your baby will be able to tolerate stronger contractions.

Then, if she determines that it's appropriate to augment your labor, you'll be given a drug called oxytocin. This drug (often referred to by the brand name Pitocin) is a synthetic form of the hormone that your body naturally produces during spontaneous labor. You'll receive it through an IV line that's connected to a pump so your practitioner can control the amount of medication you get. (If you're at a birth center and your practitioner decides that you need oxytocin, you'll be transferred to a hospital.)

Your practitioner will start you off with a small dose and gradually increase it until your uterus responds appropriately. How much you'll need depends on the quality of your contractions so far, how sensitive your uterus is to the drug, how much your cervix is dilated, and how far along you are in your pregnancy. As a rule, you're shooting for three to five contractions every ten minutes.

The goal is to give you just enough oxytocin to bring on contractions that dilate your cervix in a timely way and help your baby descend – but not so much that your contractions become too frequent or abnormally long and strong, which could stress your baby. Having more than five contractions in ten minutes (averaged over 30 minutes), single contractions that last longer than two minutes, or contractions that occur within a minute of each other would be considered too much.

While your labor is being augmented, your practitioner will use continuous electronic fetal monitoring to keep tabs on your contractions and your baby's well being.

Are any risks associated with using oxytocin?

The most common problem associated with oxytocin is overstimulation of the uterus. This can happen if the dose is too high, and it may in turn cause various problems with the baby's heart rate. But because oxytocin wears off pretty quickly, your practitioner can solve that problem by lowering the dose or temporarily stopping the infusion altogether. She can also give you other drugs to relax your uterus more rapidly, if necessary. Then she can start the oxytocin again at a lower dose.

Sometimes a baby can't tolerate the stress of any effective contractions. (This can happen with spontaneous contractions as well as contractions stimulated by oxytocin.) In this case, your practitioner would turn off the oxytocin, and you would deliver your baby by cesarean section.

Are there other ways to augment labor?

You may have heard that walking around will help move your labor along. The results of a 2009 review of research on the subject of birthing positions suggests that among women without epidurals, remaining mostly upright (whether walking, sitting, standing, or kneeling) during the first stage of labor shortened that stage by about an hour. And there was no downside, so as long as you're comfortable walking or otherwise remaining upright, it's worth a try.

Your practitioner can also try to get your labor going more quickly by rupturing the membranes (the "bag of waters") that surround your baby, if your water hasn't already broken on its own. She can do this by inserting a slim, plastic hooked instrument through your vagina and dilated cervix to rupture your amniotic sac. This should cause no more discomfort than a regular vaginal exam.

While this procedure, known as amniotomy, has been used for a long time to augment labor, experts continue to debate its risks and benefits. Having an amniotomy may mean a somewhat shorter labor and less chance that you'll need oxytocin. On the other hand, keeping your amniotic sac intact until it breaks on its own offers greater protection against infection and umbilical cord compression during contractions.

Your practitioner will consider whether amniotomy is a good choice for you based on factors such as how far your cervix is dilated, how low the baby is in your pelvis, whether you need internal fetal monitoring, and your risk of infection.

Watch the video: #2 Augmentation Of Labor In Real Situation (December 2021).