Failed Induction of Labour – Why Doesn’t Induction Work?

Induction of labour is a widely used induction praction and might seem quite simple to hear: going to the hospital, getting a ‘drip’ fixed, undergoing induced contractions and having a baby. However, many women end up having failed inductions. Now that labour has been induced artificially, the contractions start, but your body just isn’t in sync with the contractions. The mom takes the brunt of the painful contractions, which usually result in an epidural and an emergency c-section. All this pain and stress can be reduced if we understand why sometimes induction does not work in labour. Simply put, why does this happen? Let’s delve a little deeper into this issue and understand why exactly an induction fails.

What Is Induction of Labour?

According to the Mayo Clinic, labour induction is a process which causes labour to start artificially before it naturally begins on its own (1). Natural labour begins when your baby’s lungs secrete a hormone which tells your body that he is ready to enter the world. This kickstarts your labour and causes your uterine muscles to contract, which opens the cervix. Every method of induction follows the same pattern – tricking your body into believing that it is ready to give birth. The motto of labour induction is to have a normal vaginal delivery with significantly less chances of maternal or neonatal morbidity (2) (3).

Do Inductions Work Every Time?

Many times, women get induced with medications to undergo false labour, but the process ends up failing, and this could end up causing foetal distress. Even after the induction, pregnant women remain in the latent phase for a prolonged time. As a result, these women have to have an emergency C-section then and there. When a c-section is provided in the latent phase even after induction, it is often termed as “failed induction. (4)” Rouse et al., in order to define failed induction, concluded that the latent phase could be allowed as long as 12 hours without excess obstetric morbidity, with initiation of oxytocin, rupturing of membranes, and dilation of 4-5 cm to include it in failed labour induction (5). Other experts at the American Journal of Obstetrics & Gynecology highlight the failed labour induction criteria as a minimum of 12 to 18 hours of oxytocin administration after the rupture of the membrane before deciding that labour induction has failed due to nonprogression to the active phase (2).

This happens quite a number of times. Some are even told that it was a great thing that they were in the hospital so that their baby could be saved. People mistakenly think that labour will automatically kick in once induction starts, but the answer is no. Liken the process to a flower bud whose petals are tightly furled. If you forcibly try to pry the petals apart to get to the flower bud inside, you will destroy both the flower bud and the petals surrounding it. But if the bud has opened a bit, then you might be lucky enough to encourage the petals to open. Same with induction, if both your body and the baby are not ready, your labour will be that much harder to proceed to a successful finish.

Failed labour induction is associated with a higher fetal and maternal morbidity as it increases the likelihood of emergency cesarean delivery and increased risk of perinatal and maternal outcomes, including nonreassuring fetal heart rate tracing, severe birth asphyxia, uterine rupture, stillbirth, and postpartum haemorrhage (6).

Why Do Inductions Fail?

Let’s talk about what causes induction to fail.

The unborn baby in your tummy is still developing his lungs, brain and heart. Your body is wrapped tightly around him so that he goes through this development in a safe environment. During your third trimester, your body will start increasing its number of oxytocin receptors. When your baby is ready to be born, oxytocin will be released into your bloodstream and trigger these oxytocin receptors, ‘unlocking’ them. These receptors then signal your uterine muscles to start contractions and dilate the cervix. Your contractions will increase with time and become more intense as oxytocin releases in waves into your blood.

A cycle will establish itself naturally, with more oxytocin being released in response to stimulation by your baby, resulting in birth. Now, when does a failed induction of labour occur? If your labour is being induced artificially, you will need a large amount of oxytocin to stimulate oxytocin receptors. If oxytocin is being flooded into your system from external sources, the oxytocin receptors in your body will get overwhelmed and fail to respond to the normal feedback your body would usually have. If your body does not respond, the oxytocin drips will be increased, and this will result in painful contractions.

Babies will face trouble due to this greater pressure, and mothers might ask for an epidural to help them bear the pain. There might also be foetal distress, resulting in an emergency C-section.

Did Your Body Fail? – Myth Busted

If induction fails, many women end up thinking that their bodies don’t respond the way it was supposed to. They will start thinking that the same thing will happen the next time, and the only option for childbirth for them is a C-section. This will lead to constant worry, anxiety and insecurity in their minds. But this is a myth. The reality is that women’s bodies are biologically designed to protect their babies inside until they are born.

When the baby is ready to be born, there will be a signal that your baby is ready, and your body will respond by going into labour. When an induction fails, the main reason is that your baby wasn’t ready to come out of your womb and did not send a signal your body was expecting to get. Since induction is artificial and not biological, it interferes with the normal cycle of things in your body and ends up either not responding well or refusing to comply.

FAQs

1. What is the established criteria to conclude a failed labour induction?

According to the ACOG, failed induction of labour is applied when a patient undergoing labour induction fails to progress to the active phase of labour (2). On the other hand, Rouse et al devised a protocol which mandated, if the condition of the mother and the unborn baby permits, at least 12 to 18 hours of oxytocin administration after the membrane rupture with a lack of progression from the latent to the active phase of labour (5).

The critical thing to remember if you have had a failed induction is that it is absolutely not your body’s fault. Do not blame yourself or feel guilty about a failed induction; it is not your fault. As induction is an artificial process, it is natural that it has a considerable chance of failing. Your body is not broken, and neither was your baby too big. Your body just functioned exactly as it was supposed to, to protect the baby inside. The heartwarming thing is that your baby is safe, and his birth was still an amazing experience, whatever the case. So rest, heal and enjoy the journey of motherhood!

References/Resources:

1. Labor induction; Mayo Clinic; https://www.mayoclinic.org/tests-procedures/labor-induction/about/pac-20385141

2. Ayala. N. K, Rouse. D. J; Failed induction of labor; American Journal of Obstetrics & Gynecology; https://www.ajog.org/article/S0002-9378(22)00043-6/fulltext; March 2024

3. Tadesse. T, et al.; Failed induction of labor and associated factors among women undergoing induction at University of Gondar Specialized Hospital, Northwest Ethiopia; BMC Pregnancy and Childbirth; https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-022-04476-7; March 2022

4. Grobman. W, et al.; Defining failed induction of labor; American Journal of Obstetrics & Gynecology; PubMed Central; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5819749/; January 2018

5. Rouse. D. J, et al.; Criteria for failed labor induction: prospective evaluation of a standardized protocol. Obstet Gynecol.; PubMed; https://pubmed.ncbi.nlm.nih.gov/11042299/; November 2000

6. Demssie. E. A, et al.; Failed induction of labor and associated factors in Adama Hospital Medical College, Oromia Regional State, Ethiopia. SAGE Open Med.; PubMed Central; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9133872/; March 2022

Also Read:

Natural Ways to Induce Labour
How to Use Nipple Stimulation to Induce Labour
Using a Foley Balloon Catheter for Labour Induction
Effective Exercise for Easier Labour and Normal Delivery

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