A closer look at labour induction
Julia had carried her pregnancy for 42 weeks and talk had started from peers, friends and in laws that she had carried the pregnancy for too long.
The reasons for this were varying from person to person. Some said the gods were not happy with her pregnancy, some said she was bewitched, while others said she was cursed.
All this got Julia anxious, so much that she went to her gynaecologist to seek his opinion. On arrival, discussion and counselling by the obstetrician was done to allay’ Julia’s anxiety.
The doctor advised her that induction was the ideal intervention to initiate labour. She was asked to bring her bag of utilities and as early as 6am Julia was induced by a progesterone tablet being inserted in her private parts.
On asking why he was doing the procedure so early, the doctor explained that it is a standard to induce during the day for close monitoring of the foetal heartbeat and the contractions to avoid risks which can happen at night. Julia later gave birth to a normal and healthy baby.
At 36 weeks, Connie was tired of her pregnancy. “I am a businesswoman and I need to be on the move,” she says. She asked for induction but her obstetrician refused, saying at 37 weeks, there was no indication for induction. “I felt disgusted,” she recounts.
However, she adds that the doctor explained two issues: the first being that induction is not done simply because one is tired of the pregnancy. Connie explained that the doctor fully understood her autonomy but he also respected the conflicting ontology of common good. “These two terms were quite contradicting,” she adds.
In his explanation, the doctor said he had to respect Connie’s rights but according to entology, he could not perform the induction because it was not right according to the set guidelines for induction. Both baby and mother were well. Despite being tired and desiring induction, Connie was counselled and reassured by the doctor and later gave birth to a bouncing baby boy at 40 weeks.
“Amina’s Obstetrician assessed her and both agreed on the plan of delivery. The date was set for induction and she had been reassured of a smooth sailing. Induction was done using a tablet, very early in the morning. After four hours, she started getting some mild contractions.
The doctor did a vaginal examination and found out that Amina’s cervix had opened up to 2-3 cm. “After 30 minutes, the ‘waters broke’ and the cord came out,” Amina’s narrates. The doctor had to stop the procedure and she was taken to theatre for caesarean birth. “It was such a huge disappointment,” she recalls. Despite that, Amina gave birth to a healthy child.
Sophie was induced and labour progressed on very well. Upon vaginal examination, she was found to have dilated up to 6cm. “At that time, I was experiencing strong contractions. I am thankful for the supportive team that was beside me,” she says.
To make matters worse, the foetal heartbeat was 180b/m yet antenatal classes had indicated that normal foetal heartbeat range from 120 – 160 b/m. The obstetrician indicated that it was a sign of foetal distress thus the induction could not continue.
“I was taken for a caesarean birth and the baby was delivered with a low score thus taken to the nursery,” she shares. Thankfully, the baby recovered after two days and is healthy. She observed that induction should only be done in hospitals with theatre facilities to handle emergencies.
Caution
Mercy had two previous uterine scars but some of her friends told her it was possible to have a spontaneous vaginal birth. She carried a normal pregnancy up to 38 weeks. The doctor and I set a date for caesarean section which I shared with my friends. My friend scorned me and said I was not a woman by culture.
“I was advised to buy Misoprostol tablets from a drug shop to initiate labour,” she narrates. She bought three and inserted them all into her private parts. After two hours, she got very strong contractions and was rushed to a public facility, in a very bad state.
“Thankfully, I was attended to fast but even then, I had a raptured uterus and the baby was dead,” she says adding that unfortunately, her uterus was removed.
Definition
Inducing labour is when your health care provider gives you medicines or uses other methods to start labour for various reasons.
Post maturity of pregnancy: According to Dr Stephen Kyakonye Kaddu, a gynaecologist at UMC Victoria Hospital, this is after 40 weeks of gestation. This is not good for both mother and baby and the aim is to deliver the baby prior to foetal compromise.
Gross foetal deformity: Sister Victoria Elizabeth, a midwife with Paragon Hospital, says such deformities include a child with hydrocephalus and it is advisable that the mother be induced so that the baby can get help early.
Oligohydromnious (reduced water in the womb): Dr Kaddu explains that this condition puts the baby at risk thus the need to deliver the baby to avert it.
Maternal health conditions: These include preeclampsia (severe high blood pressure), severe malaria and obstetric cholestasis are some of the conditions. Sister Elizabeth says the decision to induce will depend on the health of the mother and the foetus.
Intrauterine foetal death: In cases where the baby dies while in the womb, induction of labour should be offered if the mother is physically well with intact membranes. However, Sister Victoria asserts that physicians should decide whether labour induction is warranted on a case-by-case basis, after consideration of maternal and infant conditions, cervical status, gestational age, and other factors.
Complications
Dr Kaddu points out that complications include failure of induction, where the medical personnel may give the mother another cycle of prostaglandins, or opt for caesarean section. Another is uterine hyper-stimulation, which is evidenced when contractions last too long or are too frequent which leads to foetal distress. Others are cord prolapse, infection and uterine rupture, among others. That said, it is advisable that induction be done in a medical facility by a professional to avert any complications.
