‘my sincere thought is that if my doctor had given more time I may just have been able to achieve my desire for a vaginal delivery’.

Question: I had a caesarean section for a failed induction but my sincere thought is that if my doctor had given more time I may just have been able to achieve my desire for a vaginal delivery. What is your opinion?

Answer: Induction of labour is the planned initiation of labour prior to its spontaneous onset. The commonest reason for induction of labour is prolonged pregnancy as there is evidence that pregnancies extending beyond 42 weeks gestation are associated with a higher risk of stillbirth, foetal compromise in labour, meconium aspiration and mechanical problems at delivery.

Other reasons for induction of labour are foetal growth restriction, pre-eclampsia and other maternal hypertensive disorders, deteriorating maternal illnesses, prelabour rupture of membranes, unexplained antepartum haemorrhage, diabetes mellitus, twin pregnancy continuing beyong 38 weeks, intrahepatic cholestasis of pregnancy, maternal iso-immunization against red cell antigens and ‘social’ reasons.

Broadly speaking, induction of labour is performed when the risks to the foetus and/or the mother of the pregnancy continuing outweigh those of bringing the pregnancy to an end. It should only be performed if there is a reasonable chance of success and if the risks of the process to the mother and/or foetus are acceptable.

Induction of labour may fail and this is said to have occurred if an artificial rupture of membrane is till impossible after the maximum number of doses of prostaglandin have been given, or if the cervix remains uneffaced and less than 3cm dilated after an ARM has been performd and oxytocin has been running for 6-8 hours with regular contractions. When an induction fails, the options include attempting induction again at some point in the future, or performing a caesarean section. Delaying delivery further is only acceptable if there is no major threat to foetal or maternal condition. This may be the case with a failed social induction, for example. Failed induction in the setting of pre-eclampsia or foetal growth restriction will usually necessitate a caesarean delivery.

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