Augmentation of labor

Overview

Labor augmentation can accelerate a prolonged or stalled active labor during childbirth. Techniques used to augment labor enhance the strength and frequency of uterine contractions, potentially enabling a vaginal delivery and reducing the likelihood of a cesarean section. 

This can involve medications and other techniques designed to make contractions more frequent, stronger, and closer together. If your contractions slow down or become too infrequent, labor augmentation might be necessary to ensure the safety of both you and your baby during delivery. Your healthcare provider may use various methods to assist in facilitating labor and ensuring a smoother delivery process.

Reasons for undergoing the procedure

If your childbirth is stalling or taking too long and you are in natural active labor (as opposed to induced labor), you could require labor augmentation.

Labor failure to progress could be caused by:

• The amniotic sac remains unruptured.
• Irregular or weak contractions.
• Completely stopped contractions

If you have these conditions, healthcare providers won’t augment your labor:

• Your infant is in breech position (butt or feet first), or transverse position (shoulder first).
• You have intrauterine scar tissue, or Asherman syndrome.
• There are scars on your uterus. These can have resulted from a previous C-section or another type of surgery.

Risks

On rare occasions, oxytocin can cause hyperstimulation, leading to overly strong uterine contractions. These intense contractions may cause fetal distress, meaning your baby might not be receiving enough blood or oxygen. This procedure is associated with an elevated risk of uterine rupture. To mitigate these risks, your healthcare provider can adjust the oxytocin dosage. Additionally, electronic fetal monitoring is used throughout labor and delivery to track the strength of your contractions and monitor your baby’s heart rate, helping to reduce potential complications.

Another procedure, an artificial rupture of the amniotic sac, carries a small risk of chorioamnionitis, a bacterial infection. Bacteria can enter the amniotic fluid surrounding your baby, increasing the risk of newborn sepsis. You may also face risks such as sepsis and blood clots. To address these conditions, you and your baby will be prescribed antibiotics after childbirth.

A further risk associated with amniotomy is umbilical cord prolapse. This occurs when the umbilical cord slips into the cervix and vagina ahead of the baby, potentially cutting off the baby’s oxygen supply. In such an emergency, a C-section will be necessary.

Before the procedure

Before delivery, you will have a discussion with your healthcare provider about pain relief options. One option you may consider is an epidural anesthesia. This involves an anesthesiologist inserting a catheter (a thin tube) into the epidural space, which is located between your spinal column and the outer membrane surrounding your spinal cord. The catheter is placed in your middle or lower back and remains in place during childbirth, allowing your anesthesiologist to administer pain relief as needed throughout the process.

During the procedure

Healthcare providers employ comparable techniques for both labor augmentation and induction. These methods promote cervical ripening, facilitating the cervix’s opening for childbirth. The specific approach is tailored to each individual’s unique labor circumstances.

Among the methods for labor augmentation are:

• Amniotomy: The amniotic sac that covers your baby is ruptured by your healthcare provider using a device inserted into your cervix. This can be known as breaking the water. When amniotic fluid is released, it allows your baby’s head to descend further and apply more direct pressure to the cervix. This increased pressure typically results in wider cervical dilation and may trigger more frequent and powerful contractions.
• Balloon catheter: Your healthcare provider introduces a specialized catheter into the cervix. This catheter has a small balloon at its end, which is then inflated. The balloon expands and spreads your cervix. The catheter and balloon come withdrawn when the cervix has sufficiently expanded.
• Medications: A synthetic hormone, typically oxytocin, is delivered through an intravenous line. This medication replicates the effects of prostaglandins in the body. Your cervix expands and contractions are triggered by this hormone-like substance.

Outcome

Augmentation of labor can facilitate vaginal delivery and save you from needing a C-section. The healthcare provider makes a surgical incision in your abdomen and uterus to deliver your baby during a C-section. The recuperation period following a cesarean section typically involves a longer duration and increased discomfort compared to vaginal delivery.

Several factors affect your recovery. The following conditions could cause you additional problem and take longer to heal:

• C-section birth.
• Episiotomy.
• Vaginal tear.

Seek medical attention with your healthcare provider if you experience any of the following:

• Infection.
• Foul-smelling vaginal discharge.
• Heavy vaginal bleeding.
• Chest pain.
• Shortness of breath (dyspnea).
• Dizziness
• Fainting or syncope.
• Nausea and vomiting.
• Severe pain.
• Swelling (edema) in your legs, arms or face.