If uterine contractions, i.e. labour pains are targetedly induced, mostly through administration of drugs, this is referred to as induction of labour. If an induction of labour is suggested or planned, this often brings up a number of questions, especially in the pregnant woman and the father-to-be. Therefore, insecurity and concerns about the interventional measure are absolutely understandable and quite normal.   

The birth of a child is the process at the end of a pregnancy during which the child leaves the uterus. In general contraction of the uterus, and consequently labour, starts naturally between the 39th and 41st week of pregnancy.  
The process of birth is divided into three main stages - stage of dilatation or first stage followed by the transitional stage (which is a sub-stage), the stage of expulsion or second stage and the postnatal or third stage.  

Natural birth starts with the stage of dilatation during which labour pains occur irregularly with a frequency of 2 to 3 pain periods within 30 minutes. The purpose of this first phase is the shortening of the cervix and the mouth of the uterus. Over the course of the dilatation stage the frequency of labour pains is increased to 2 to 3 within 10 minutes, also the intervals become more regular.  

During the transitional phase the frequency of labour pains becomes faster, the uterus contracts more and more and the pain grows stronger. The head of the child is successfully engaged in the pelvis of the mother.  

The third stage of birth, the stage of expulsion begins as soon as the mouth of the uterus is nearly fully dilated (8 to 10 cm). Now, labour pains occur with a frequency of 6 to 7 pain periods within 15 minutes. As the child’s head is appropriately positioned in the birth canal the bearing-down reflex is induced birth-giving woman leading to expulsion of the foetus from the womb.  

The postnatal stage also referred to as placental stage is the last phase of birth. Depending on the intensity and duration of postnatal labour pains it will last between 10 and 30 minutes. Birth ends with expulsion of the placenta (afterbirth). The placenta is then examined for completeness by the attending physician or the midwife. In some cases scraping out of the uterus may be required in order to prevent possible complications. Administration of hormones may also be required in order to encourage freeing and expelling the placenta. 

Although it is always desirable to let nature take its course, it may be reasonable or necessary for the mother and child to induce the birth process. Situations that may require the induction of labour may include fore sample postmaturity of the child of more than 10 to 12 days past the expected date of delivery, unusual cardiotocogram (CTG, monitoring of foetal heart frequency), premature rupture of the foetal membrane, amniorrhexis (rupture of the foetal membrane) without subsequent labour or diseases of the mother, such as toxaemia (blood poisoning) of pregnancy or diabetes.   

For choosing the appropriate method for induction of labour a differentiation must be made whether the mouth of the uterus is already open or if it is not yet mature.
If the mouth of the uterus is mature, the sensitivity for labour-inducing drugs is fairly high.  
A drug that is often used for induction of labour is the hormone Oxytocin that is administered as an infusion directly to the vein of the birth-giving mother. Dosage is increased every 30 minutes under defined conditions until contraction of the uterus takes place successfully and labour begins.  

Another option for induction of labour with a similar effect as the above-described therapy is administration of so-named prostaglandins. These drugs are not administered as infusion but positioned locally near the mouth of the uterus as gel or tablets.  
The effect of prostaglandins is to induce labour after approx 2 to 3 hours after administration.  
The process of birth is monitored by means of CTG in any case of induced labour.  

If the mouth of the uterus is not yet mature, best success is achieved with the use of prostaglandin as a gel being positioned in the cervix. The purpose is to reduce the resistance of the mouth of the uterus and encourage maturation. If the mouth of the uterus is appropriately opened birth may subsequently be induced by triggering contraction and labour pains through administration of Oxytocin. 

As an induction of labour is generally planned, it is important for the birth-giving mother to get information and support from the attending gynaecologist or the midwife. A joint decision should be taken on what method is appropriate for each individual woman and her personal situation. In addition, it is helpful to consider available and possible methods for alleviation of pain during birth beforehand.  

Every birth and, of course, every intervention in the natural process of birth may involve risks. Speaking with the attending gynaecologist and the midwife will help understand the processes before making decisions about further steps.