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When is augmenting necessary?

When is augmenting necessary?


Augmentation may be suggested by your caregiver if:

The labour has started, then stopped or slowed

The waters have broken, but labour will not establish

The cervix is not opening, even with strong contractions

The labour is slow because the baby is in an awkward position

The caregiver feels the labour should be progressing more quickly

The labour has started then stopped or slowed

Sometimes the contractions are strong and regular, but then weaken (or become short and infrequent). In this case the cervix may be opening slowly, or perhaps not at all. The medical term for this is 'hypotonic' (or low tone) contractions, or inefficient uterine action. This means the contractions are happening, but are not strong enough to dilate the cervix.

This can occur for a number of reasons including:

The woman is not in established labour yet.

Prelabour can be frustrating and prolonged for some women. It can also be quite painful (and if you have never had a baby before, it can be hard to know if it is the 'real thing'). Sometimes the only way to find out if the contractions are 'labour' or 'prelabour' is for the woman to have a vaginal examination (to see if the cervix is dilating).

You may be able to go into the hospital (or see your caregiver for a visit) to check the dilation, and then go back home again if the cervix is less then 3 cms dilated. Being checked should not, in itself, be a reason for augmentation. (The reasoning being "You are here now, let's get things going.") However, after discussions with your caregiver, you may both agree that augmentation is the most appropriate option.

Being exhausted and / or dehydrated.

The contractions can slow (or stop) if the woman becomes dehydrated. This can be experienced if the prelabour has been prolonged, prior to the established labour starting, or the labour itself has been prolonged. Some women (and / or caregivers) will opt for augmentation during the prelabour phase to 'get the show on the road', the reason being to 'do something' before the woman becomes too tired and / or dehydrated. Of course this is always possible, but is not inevitable. If you are inclined to wait, then this is a valid choice.

Some caregivers will simply suggest re-hydrating the woman with a drip, to encourage the contractions to return. If the waters have not broken then augmentation with an ARM may be reasonable. Some women will use natural therapies for augmentation, as well as drinking plenty of fluids to prevent (or reverse) dehydration. An oxytocin drip may be necessary, which also entails continuous monitoring of the baby's heart rate in the delivery suite.

The woman has had pain relief.

Certain pain relieving interventions can slow (or stop) the labour. This will depend on the type of pain relief, the stage of the labour and / or the woman's individual response to it. Narcotic injections, epidurals and using the bath before reaching the active phase of 1st stage (more than 3- 4 cms dilated) all have the potential to slow, or weaken the contractions.

A narcotic injection will wear off in about 3 to 4 hours. An epidural takes about 2 hours. Getting out of the bath and walking around will often be enough to strengthen the contractions again. The usual approach by caregivers to augment the labour after medical pain relief is to break the waters and / or start an oxytocin drip.

Being moved in labour.

Being disturbed (or moved) can slow, or stop, the labour. This is the case for many mammals when trying to give birth. When the woman moves from her home to her birthplace, or transfers from a planned birth centre or home birth to the delivery suite, it is a natural phenomenon to observe her temporarily slow (or stop) labouring. Generally labour will start up again, once the woman has settled into her new environment (after an hour or so). If you move during the prelabour phase, then the contractions may not return so readily. It is an option to go back home until the contractions strengthen again.

Feeling apprehensive or concerned.

The woman's psyche can play a major role in the functioning of her body. Being fearful, or anxious, can slow, or halt, the progress of her labour (as it can with animals in nature). A woman's fears can be internally generated from personal concerns, or created from external influences or 'threats'.

Internal concerns

will normally manifest themselves as the woman being unable to move into the 'next phase' of her labour.

For example:

  • A fear of the pain ahead, could hinder her body from moving from the prelabour / early phases of labour to the active phase of 1st stage.
  • Concerns about 'losing it' could inhibit her from moving into the transitional phase.
  • Concerns about parenting, the baby being OK, or wanting a particular sex of her baby, could slow (or stop) the contractions just before it is time to push, or prolong the pushing phase.
  • A fear of tearing may prevent the woman from wanting to push, or allowing the baby's head from being born in the final stages.

External concerns

can also play a role in slowing the labour's progress.

For example:

  • Complications are unfolding, threatening the health of the woman and her baby.
  • The caregiver may suggest unanticipated medical interventions.
  • The woman may not feel at ease, or is not relating well to her allocated caregiver (or having conflict with her partner and / or support people).
  • There are too many people in the room, coming and going, disturbing her rhythm, invading or threatening her privacy.

Last revised: Tuesday, 27 November 2012

This article contains general information only and is not intended to replace advice from a qualified health professional.

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