Augmentation of Labor

What is augmentation of labor?

Augmentation of labor speeds a slow or stalled spontaneous active childbirth. Healthcare providers use medications and other methods to help move the process along. These methods stimulate more uterine contractions and make them stronger and closer together. You may need labor augmentation if there’s too much time between contractions or your contractions stop. A slow or stalled labor and delivery can be dangerous.

What is the definition of augmentation of labor?

In medical terms, augmentation means adding (augmenting) a medication or other treatment to improve outcomes. With augmentation of labor, your healthcare provider uses medications or other methods to aid your labor and delivery.

What is the difference between augmentation of labor and induction?

Labor induction starts the labor process. A healthcare provider (typically an Ob-Gyn) uses artificial means to open your cervix and start contractions.

Providers use augmentation of labor only when you experience prolonged labor. You’re in prolonged labor if you’re still in active childbirth 18 to 24 hours after your contractions start. Healthcare providers also call this failure to progress.

Who needs augmentation of labor?

You may need labor augmentation if you’re in natural active labor (not induced labor) and the childbirth process stalls or takes too long.

Failure of labor to progress may be due to:

• Unruptured amniotic sac.
• Weak or irregular contractions.
• Contractions that stop altogether.

Who should not get augmentation of labor?

Healthcare providers won’t augment your labor if these conditions exist:

• The fetus is in a complex position that isn’t head first. They may be breech (butt or feet first) or transverse lie (shoulder first).
• You have Asherman syndrome (intrauterine scar tissue).
• You have uterine scars. These may have come from an earlier cesarean birth (C-section) or a different surgery.

What happens before augmentation of labor?

Before you deliver, you and your healthcare provider will discuss pain relief options during delivery. You may choose to get a type of anesthesia called an epidural. A provider called an anesthesiologist inserts a catheter (thin tube) into the epidural space. This is between your spinal column and the outer membrane of your spinal cord. The catheter goes into your middle or lower back. It stays in place throughout childbirth. It allows your anesthesiologist to offer you pain relief as needed.

What happens during augmentation of labor?

Healthcare providers use similar assisted delivery methods to augment labor, as well as induce labor. These methods aid cervical ripening (opening the cervix for childbirth). The treatment depends on your specific childbirth situation.

Labor augmentation methods include:

• Amniotomy: Your provider inserts a device into your cervix to rupture the sac of amniotic fluid that surrounds the fetus. You may know this as breaking the water. This release of amniotic fluid can allow your baby’s head to put more direct pressure on your cervix. This causes it to open wider. You may also have more frequent, stronger contractions.
• Medications: You receive an IV of a lab-made drug like oxytocin (Pitocin®) that mimics prostaglandins. This hormone-like chemical opens your cervix and brings on contractions.
• Balloon catheter: Your provider inserts a catheter with a balloon on the tip into your cervix and inflates it. The inflated balloon widens your cervix. After the cervix expands enough, the balloon and catheter fall out.

What are the benefits of labor augmentation?

Labor augmentation can aid vaginal childbirth, helping you avoid a C-section. During a C-section, your healthcare provider delivers your baby through a surgical incision in your abdomen and uterus. Recovery from a C-section is often longer and more painful.

What are the risks of labor augmentation?

In rare instances, oxytocin can cause strong uterine contractions (hyperstimulation). These strong pushes may trigger fetal distress. Fetal distress means your baby isn’t getting enough blood and oxygen. You also have a higher risk of uterine rupture. Your healthcare provider can adjust the amounts of oxytocin to prevent this problem. To further lower these risks, your provider will use electronic fetal monitoring. This checks the strength of your contractions and the fetal heart rate throughout labor and delivery.

Although it’s uncommon, artificially breaking open the amniotic sac has the potential to cause a bacterial infection called chorioamnionitis. Bacteria can contaminate the amniotic fluid surrounding the fetus. This increases the risk of newborn sepsis. You’re also at risk for blood clots and infections like sepsis. After childbirth, you and your baby will receive antibiotics.

An amniotomy also increases the risk of umbilical cord prolapse. The umbilical cord slips into the cervix and vagina ahead of them, which can cut off their oxygen. You’ll need an emergency C-section.

What is recovery like after labor augmentation?

Your recovery depends on many factors. You may have more discomfort and need more time to heal if you have:

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

When should I call the doctor?

You should call your healthcare provider if you experience:

• Chest pain.
• Dizziness or fainting (syncope).
• Extreme pain.
• Excessive, foul-smelling vaginal discharge.
• Heavy vaginal bleeding.
• Nausea and vomiting.
• Shortness of breath (dyspnea).
• Signs of infection like fever and chills.
• Swelling (edema) in your legs, arms or face.

A note from Cleveland Clinic

Healthcare providers use augmented labor techniques only when medically necessary to aid a stalled childbirth. Medications and procedures can open your cervix and stimulate contractions. You may need to augment labor to keep you and the fetus healthy. Augmented labor may also help you avoid a C-section, which has a longer, more painful recovery. If you experience a prolonged labor, your provider will discuss childbirth options with you.