If you're in labor and your contractions become irregular, infrequent or stop altogether, or if your cervix isn't dilating any further, your doctor might suggest augmentation of labor to get things back on track.
Here’s what you need to know about labor augmentation, including when it might be useful and when it’s not recommended.
What is augmentation of labor?
Labor augmentation is the process of helping along a slow or stalled labor that has already begun. It means giving labor that has already started a boost.
What is the difference between augmentation of labor and inducing labor?
Augmentation of labor is helping kick-start a slowed or stalled labor that has already begun. Inducing labor means getting labor going from the very beginning, before it's in progress at all (i.e. starting labor from scratch).
When is augmentation of labor done?
There are a few instances when your labor might stall and need some extra nudging along:
- Your cervix stops dilating.
- An epidural weakens your contractions. (Keep in mind that it’s usually normal for the first and second stages of labor to progress more slowly with an epidural than without.)
- Your contractions slow, stop or otherwise become irregular.
- Pushing isn’t moving your baby along.
How is augmentation of labor done?
If your cervix isn’t dilating and effacing in early labor, your practitioner may suggest either walking or resting (sleeping or using relaxation techniques). This may also help rule out false labor.
If labor has begun and labor augmentation is ultimately best for you and your baby, these techniques may be used alone or in combination. Your practitioner may attempt to:
- Administer oxytocin. If you’re not dilating and effacing as quickly as expected and/or your contractions have slowed, stopped or become erratic, your practitioner may give you a dose of Pitocin (a synthetic form of the hormone oxytocin that causes your uterus to contract) through an IV. The amount will be carefully monitored — and you'll only get enough to jump-start contractions.
- Stimulate your nipples. You or your partner might be advised to rub or twist your nipples to stimulate the production of your body's own natural oxytocin.
- Rupture your membranes. If your amniotic sac is still intact and you’re already in the active phase of labor but your cervix is dilating slowly, or if your baby is moving slowly down the birth canal, your practitioner may rupture your membranes. This can help give your labor a boost, though ACOG recommends waiting a bit before trying this unless it’s required to facilitate internal monitoring.
When is augmentation of labor not recommended?
The most recent guidelines from the American College of Obstetricians and Gynecologists (ACOG) recommend delaying certain labor intervention and augmentation methods when possible — and in some instances avoiding them altogether — in low-risk pregnancies if Mom and baby are doing well.
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Instead, the group recommends attempting more natural methods of labor augmentation. Augmentation of labor also might not be an option if:
- You’ve had a prior C-section, other major uterine surgery or uterine scarring for another reason.
- Your baby is breech.
Natural ways to augment labor and manage pain
When appropriate, ACOG recommends attempting more natural ways of moving labor along and managing pain. These include:
- Emptying your bladder or bowels (if they’re full, they can impede baby’s descent)
- Squatting, standing, walking or otherwise changing positions
- Trying massage or other relaxation techniques
- Spending early labor in water, if the hospital or birthing center is equipped with birthing tubs
Risks of augmentation of labor
The augmentation of labor can come with a few risks or downsides, including:
- Slowed fetal heart rate. Synthetic oxytocin or prostaglandin can lead to excessive or irregular contractions that may slow your baby’s heart rate and reduce his oxygen supply.
- Infection. In very rare cases, rupturing your membranes too early can result in infection in you or your baby.
- Umbilical cord prolapse. This is when the umbilical cord drops through the open cervix ahead of the baby. An emergency C-section may be needed if the umbilical cord gets trapped and compressed by your baby’s body as labor progresses.
What if augmenting labor doesn't work?
Usually these methods of augmenting labor will work well enough to get things back on track.
If you’re a first-time mom you’ll probably be allowed to push for up to three hours if you don’t have an epidural and four if you do (or two to three hours if you’ve given birth before).
If it takes longer, your practitioner will assess how you’re feeling and may attempt delivery with vacuum extraction or forceps, or decide to do a cesarean delivery.
If you’ve been in active labor for more than 24 hours (sometimes less) and haven’t made sufficient progress, or if your baby shows signs of stress like slowed heart rate, most practitioners will turn to a C-section delivery. Some may wait longer, assuming Mom and baby are both doing well.
No matter how your baby comes into the world, your practitioner will do what's best to ensure a safe and healthy delivery.
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