More ‘natural’ method of inducing labour proves safe

Women who need help starting labour could now be routinely offered a more natural option that allows them to go home before giving birth, new research suggests.

Around one in four pregnant women in New Zealand, around 15,000 annually, are induced, usually by using prostaglandins, a synthetic form of the hormone that starts labour.

In a new study, researchers at Waipapa Taumata Rau, University of Auckland looked at more than 1,000 women across ten hospitals, comparing the current method with a ‘balloon catheter’. See American Journal of Obstetrics and Gynecology.

The small flexible balloon is inserted through the vagina and up to the top of the cervix (neck of womb), gently promoting production of the body’s own prostaglandins to get labour started.

It remains in place for around 18 to 24 hours. This means the mother can go home and rest, plus spend time with whanau, before labour.

“We hypothesised that offering the balloon catheter would lead to more vaginal births,” said study lead Associate Professor Michelle Wise, Deputy Head of the University’s Department of Obstetrics and Gynaecology.

They did not find that was the case, but rather the rate of caesareans remained the same.

However, a common problem with administering synthetic prostaglandins is they can work too well and causes ‘hyperstimulation’, or too many contractions, which can distress the baby and lead to emergency caesarean birth.

In the study, the balloon catheters were not associated with any cases of hyperstimulation at all.

Importantly, says Dr Wise, there were no adverse events when people were at home with the balloon catheter in place. In fact, there were no more adverse events for women allocated balloon catheters at home, or for their babies.

Dr Wise believes there are a number of advantages with use of the balloon catheters that mean they should be routinely offered.

“The advantages are people get to spend some time out of the hospital,” she says. “Women tend to get more sleep, feel less anxious and more rested, and can spend time with whanau. That's all good for well-being during your induction.

“It's a more natural way of starting an induction, so you're avoiding the synthetic prostaglandin hormones.

“I would recommend that the maternity hospitals modify their processes and protocols to offer women the opportunity to use a balloon catheter for their induction and to enable them to go home for part of their induction, if it's safe to do so,” Dr Wise says.

“Then there is the time saved in the hospital and that is good for the hospital and means the midwives can then attend to more acute emergencies and assessments, offering care for women who really need that care.”

Dr Wise hopes women and clinicians will discuss this option and that it will be increasingly offered in New Zealand hospitals.