When will the wait be over?
The more advanced the pregnancy, the more difficult it becomes for the mother: bending over is an acrobatic maneuver, restful sleep is almost unthinkable, and you, your family and friends become increasingly nervous. If the expected date of birth has also passed, there may be additional concerns. However, worries are generally unnecessary. Very few children are born exactly on the calculated date.
Nevertheless, if the due date is exceeded, the gynecologist treating the pregnant woman will examine her carefully and monitor her closely. For example, they will recalculate the due date. If this does not deviate from the original date, the doctor will check the baby’s movements and heartbeat every two to three days and determine the amount of amniotic fluid. In certain cases, the doctor will then decide to induce labor.
Induce birth if the due date is exceeded
Doctors currently make the following recommendations for induction of labor, depending on the week of pregnancy and possible risks:
37th to end of 39th week of pregnancy
40th to end of 40th week of pregnancy
If there are no complications for mother and child, you can wait to induce labor. A study on maternal morbidity showed that the caesarean section rate increased significantly from 40+ weeks’ gestation. The cases of vaginal-operative deliveries, maternal soft tissue injuries, infections and delayed labor also increased significantly.
41st to end of 41st week of pregnancy
In order to reduce possible consequential damage (such as excessive birth weight, increased probability of caesarean section, meconium aspiration, infant death), pregnant women can be advised to have the birth induced. This applies in particular if pregnant women are very old (over 40), overweight (BMI 30 and over) or smokers.
From the 42nd week of pregnancy
From the 42nd week of pregnancy, induction of labor or a caesarean section is advisable even if there are no signs of possible complications, as the risks of maternal and fetal complications now increase significantly.
Other reasons for induction of labor
A missed due date is a possible reason for the doctor to induce labor. In addition, some women wish to have a planned birth, a so-called elective induction, for purely pragmatic reasons. From a medical point of view, there seems to be nothing to be said against this. However, elective induction should not take place before the 39th to 40th week of pregnancy.
High-risk pregnancy
Childhood causes of a high-risk pregnancy:
- premature rupture of membranes
- too little amniotic fluid (oligohydramnios)
- Growth retardation (growth retardation)
- Risk of fetal death in the womb
- Decreasing fetal movements
- Disproportionately large child (fetal macrosomia)
Maternal causes of a high-risk pregnancy:
- Type I, type II or gestational diabetes
- Advanced maternal age (from 40 years)
- Liver dysfunction (intrahepatic pregnancy cholestasis)
- “Pregnancy poisoning” (pre-eclampsia)
Methods of induction of labor
Medical induction of labor accelerates the birth before it actually begins. Nevertheless, it can take several days. The pregnant woman is admitted as an inpatient for the induction of labor.
Doctors differentiate between medical and mechanical induction methods. These methods have improved significantly over the years and the risks (such as caesarean section after a failed induction) have decreased.
Which method of induction of labor the doctor chooses in each individual case depends, among other things, on previous caesarean births, the state of health and possible risks as well as the condition of the cervix. Doctors also take the pregnant woman’s wishes into account.
Inducing birth with medication
- Oxytocin: Hormone that increases the calcium content of the uterine wall and thus leads to contractions. It also promotes the production of prostaglandins, which in turn soften the cervix. Oxytocin is administered by infusion (“contraceptive drip”). It is mainly used when the cervix is already soft and mature.
- Prostaglandins, especially prostaglandin E1 (misoprostol) and E2 (dinoprostone): They cause the immature cervix to soften, loosen and open. Prostaglandins are administered either in the form of tablets or as vaginal suppositories.
Inducing birth mechanically
The balloon catheter is the mechanical alternative to prostaglandins. By inserting the catheter and then filling it with saline, the balloon exerts pressure and causes a slight mechanical dilation of the inner cervix. The female body reacts by releasing prostaglandins, which causes the cervix to dilate. During treatment, the pregnant woman can also be administered oxytocin. However, this does not appear to be absolutely necessary.
There is a second mechanical way to induce birth: by opening the amniotic sac (amniotomy). However, this is only done if the cervix is mature and the baby’s head is in a good position.
Do not worry
Even if you are a so-called high-risk pregnant woman, the chances of having a healthy baby are good. This is because the doctor will initiate the birth at the right time and avoid possible risks as far as possible, or at least keep them as low as possible.
