initiate birth

Dr. rer. nat. Daniela Oesterle is a molecular biologist, human geneticist and trained medical editor. As a freelance journalist, she writes texts on health topics for experts and laypeople and edits specialist scientific articles by doctors in German and English. She is responsible for the publication of certified advanced training courses for medical professionals for a renowned publishing house.

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If the due date is exceeded, the gynecologist will not automatically initiate a birth. Because only a few women give birth to their child on the calculated due date. Induction of labor can only be considered after careful clarification and in certain cases such as premature rupture of the bladder or maternal diabetes. Read more about why doctors induce childbirth and how.

When is the wait over?

The more advanced the pregnancy, the more difficult it becomes for the mother: Bending over is an acrobatic maneuver, restful sleep is almost impossible to think of, and you, your family and friends become increasingly nervous. If the calculated due date is exceeded, there may still be concerns. But as a rule worries are unnecessary. Very few children are born exactly on the calculated date.

Nevertheless, the attending gynecologist will carefully examine and closely monitor the pregnant woman if the appointment is missed. For example, he will calculate the due date again. If this does not differ from the original, he will check the child's movements and heartbeat every two to three days and determine the amount of amniotic fluid. In certain cases, the doctor then decides to initiate it.

Initiate birth if the deadline is missed

The following recommendations currently apply to physicians for induction of labor, depending on the week of pregnancy (SSW) and possible risks:

37th to the end of the 39th week of pregnancy

If the pregnancy is without complications, the doctor will usually not initiate the birth. However, if the mother is old (over 40 years), labor can be induced. In more recent studies, it has also been shown that the morbidity of newborns increases from gestational weeks 38 + 0 and the birth weight can rise to over 4000 grams (which means higher risks for a perineal tear of a greater degree, secondary bleeding and a delayed birth process).

40th to the end of the 40th week of pregnancy

If there are no complications for mother and child, it is still possible to wait to initiate the birth. A study on maternal morbidity showed that the rate of caesarean sections increased significantly from 40+ weeks of gestation. The cases of vaginal-operative deliveries, maternal soft tissue injuries, infections and delayed labor also increased significantly.

41st to the end of the 41st week of pregnancy

In order to reduce possible consequential damage (such as too high birth weight, increased likelihood of caesarean section, meconium aspiration, infant death), pregnant women can be recommended to induce childbirth. This is especially true if pregnant women are old (over 40 years), are overweight (BMI 30 and over) or smoke.

From the 42nd week of pregnancy

From the 42nd week of pregnancy onwards, induction of labor or a caesarean section makes sense even without any signs of possible complications, as the risks for consequential damage to the mother and child now increase significantly.

Further reasons for induction of labor

Missing an appointment is a possible reason if the doctor wants to initiate a birth. In addition, some women want the planned birth, a so-called request initiation, for purely pragmatic reasons. From a medical point of view, nothing seems to speak against it. However, the initiation should not take place before the 39th to 40th week of pregnancy.

High risk pregnancy

There are also high-risk pregnancies in which the birth has to be initiated before the actual due date. A high-risk pregnancy can have various causes, which lie with the mother and / or the child.

Childhood causes of high-risk pregnancy:

• premature rupture of the bladder
• too little amniotic fluid (oligohydramnios)
• Growth retardation
• Risk of infant death while still in the womb
• decreasing child movements
• disproportionately large child (fetal macrosomia)

Maternal Causes of Risk Pregnancy:

• Type I, Type II, or gestational diabetes
• old maternal age (from 40 years)
• Liver dysfunction (intrahepatic pregnancy cholestasis)
• "Pregnancy poisoning" (preeclampsia)

Methods of Induction of Labor

Medical induction accelerates the birth before the actual start of the birth. Nevertheless, it can take several days to complete. The pregnant woman is admitted to the hospital to initiate the birth.

Doctors differentiate drug and mechanical induction methods. These procedures have improved significantly over the years, and the risks (such as a caesarean section after a failed induction) have decreased.

Which method to initiate childbirth the doctor decides in each individual case depends, among other things, on previous caesarean sections, the state of health and possible risks as well as the condition of the cervix. Doctors also take the wishes of the pregnant woman into account.

Induce childbirth with medication

When doctors use drugs to induce labor, they give either oxytocin or prostaglandin to encourage labor:

• Oxytocin: hormone that increases the calcium content of the uterine wall, causing contractions. It also promotes the production of prostaglandins, which in turn soften the cervix. Oxytocin is given by infusion ("contraction 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 given either in the form of tablets or as vaginal suppositories.

Induce 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 stretching of the internal cervix. The female body reacts by releasing prostaglandins, which causes the cervix to mature. Oxytocin can also be given to the pregnant woman during treatment. However, this does not seem to be absolutely necessary.

There is a second mechanical way to induce childbirth: by opening the amniotic sac (amniotomy). This is only done when the cervix is ​​mature and the child's head is in a good position.

Do not worry

If the child is a long time coming, you don't have to worry. You are under regular medical observation and care - also by your midwife. What to do if the deadline is missed will be discussed in detail with you and the child's father. You will also be informed about possible risk situations.

Even if you are a pregnant woman at risk, the chances of having a healthy baby are good. 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.

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