What is Augmentation of Labour? Understanding Methods and When They Are Used

Labour is an intense and unpredictable process that can progress at varying speeds for different women. In some cases, labour may slow down or stall, requiring medical intervention to help it continue effectively. This is where augmentation of labour comes into play. Augmentation of labour refers to medical techniques used to speed up or strengthen labour when it is not progressing as expected. It is an essential tool in modern obstetrics, helping ensure a safe and timely delivery for both mother and baby.

This article will explore what augmentation of labour entails, when it is recommended, and the methods used to augment labour. We will also look at why antenatal care and preparation are key to understanding how labour progresses and when intervention might be needed.

What is Augmentation of Labour?

Augmentation of labour involves the use of medical interventions to help labour progress more effectively. It is different from induction of labour, which starts labour artificially before it begins on its own. Instead, augmentation is used when a woman is already in labour, but the process is not moving forward as expected, often due to contractions that are too weak or infrequent.

The goal of augmentation is to stimulate or strengthen contractions to encourage cervical dilation and the baby’s descent through the birth canal. This reduces the risk of complications associated with prolonged labour, such as foetal distress or maternal exhaustion.

When is Augmentation of Labour Needed?

Augmentation of labour is typically recommended when:

Labour is slow or has stalled: In some cases, contractions may become too weak or spaced too far apart to effectively dilate the cervix. This is known as labour dystocia or “failure to progress.”

The mother’s or baby’s health is at risk: If prolonged labour is putting the baby at risk of distress or if the mother is becoming too exhausted, augmentation can help move the process along.

Contractions are irregular: If contractions are irregular or inefficient, augmentation may be used to help coordinate uterine contractions more effectively.

It is essential to monitor the labour process closely during your antenatal appointments and during the early stages of labour. Understanding how your body is progressing and being aware of your options in case of slow labour will empower you to make informed decisions.

Methods of Augmentation

There are several methods that healthcare professionals can use to augment labour, depending on the circumstances. Some methods are mechanical, while others involve medication. The most common methods include:

1. Artificial Rupture of Membranes (ARM)

One method used to augment labour is artificial rupture of membranes (also called amniotomy), where the healthcare provider breaks the waters (amniotic sac) around the baby. This is done using a sterile tool and can help speed up labour by increasing pressure on the cervix, promoting stronger contractions.

ARM is usually done if the cervix is partially dilated, and the baby is in a favourable position. While it can stimulate contractions, it also increases the risk of infection, so it is only used when medically indicated.

2. Oxytocin (Syntocinon) Infusion

The most common method of augmenting labour is the use of synthetic oxytocin (Syntocinon in the UK). Oxytocin is a hormone that naturally causes contractions in the uterus. When labour is slow, synthetic oxytocin is administered via an IV drip to help strengthen and regulate contractions.

Oxytocin infusion is carefully monitored to avoid overstimulating the uterus, which can lead to complications such as excessive contractions or foetal distress. Your healthcare provider will adjust the dose to ensure contractions are strong enough to promote cervical dilation without causing unnecessary stress to you or the baby.

Read more about oxytocin use in labour on the NHS website.

3. Changing Positions and Movement

In some cases, simply encouraging the mother to change positions or move around can help stimulate labour. Walking, using a birthing ball, or adopting different labour positions can help the baby move into a better position for delivery, which can stimulate stronger contractions.

If you are working with a midwife or doula during labour, they may suggest various positions to encourage labour progression before resorting to medical interventions. Prenatal exercises and antenatal yoga can also help you prepare for active labour, giving you the tools to stay mobile during contractions.

4. Nipple Stimulation

Nipple stimulation is a natural way to encourage the release of oxytocin and increase the strength of contractions. It is sometimes recommended as a non-medical way to augment labour, particularly in the early stages. However, it should only be used under the guidance of your healthcare provider to ensure safety for both you and the baby.

Risks and Benefits of Augmentation

As with any medical intervention, there are risks and benefits associated with augmenting labour. It’s important to understand these before deciding whether augmentation is the best option for you.

Benefits of Augmentation

Reduced risk of complications: Prolonged labour can lead to complications such as infection, foetal distress, or maternal exhaustion. Augmentation can help prevent these complications by ensuring labour progresses at a steady pace.

Timely delivery: In cases where the baby or mother’s health is at risk, augmentation can help ensure a quicker delivery, reducing the need for emergency interventions like a caesarean section.

Stronger contractions: Augmentation helps regulate and strengthen contractions, which can help the cervix dilate more effectively, leading to a smoother delivery.

Risks of Augmentation

Overstimulation of the uterus: If oxytocin is administered too quickly or in too high a dose, it can cause excessively strong contractions, leading to foetal distress or other complications. Careful monitoring is essential to avoid this risk.

Increased pain: Augmented contractions can be more intense than natural contractions, leading to increased discomfort. Pain relief options, such as epidurals, may be considered in these cases.

Infection: Breaking the waters (ARM) can increase the risk of infection, as the protective barrier between the baby and the outside environment is removed. This is why ARM is only performed when necessary.

Increased likelihood of further interventions: In some cases, augmentation of labour may increase the likelihood of needing further interventions, such as assisted delivery with forceps or ventouse (vacuum extraction).

The Royal College of Obstetricians and Gynaecologists provides more information on managing slow labour and the use of oxytocin.

How Can You Prepare for Augmentation?

While augmentation of labour is not always planned, understanding the process and your options is an important part of your antenatal care. Discussing your birth plan with your midwife or obstetrician during your antenatal appointments can help you prepare for the possibility of labour augmentation.

Additionally, taking antenatal classes near me can help you and your birth partner learn more about the labour process and the potential need for medical interventions. These classes also cover relaxation techniques, pain relief options, and ways to stay active during labour, which may reduce the need for augmentation.

If you are practising antenatal yoga or other forms of prenatal fitness, you may be more comfortable using natural techniques, such as movement or position changes, to encourage labour progression.

Conclusion: Understanding Augmentation of Labour

Augmentation of labour is a valuable tool in modern obstetric care, helping ensure that labour progresses safely and effectively when it slows down or stalls. While the process can be intimidating, understanding the methods used and the reasons behind them can help you feel more prepared and in control during labour.

During your antenatal care journey, discussing the possibility of augmentation with your healthcare team can help you make informed decisions if the need arises. Whether through medical intervention or natural methods, the goal is to ensure a safe and healthy delivery for both you and your baby.

For more information on labour interventions, pain relief options, and antenatal preparation, visit the NHS Pregnancy and Baby Guide.