When you’re pregnant, you find yourself in a whole new world of terminology, jargon and acronyms.
Trying to work out what it all means can be confusing and, sometimes, you can’t help but feel like a complete newbie.
Among all the incomprehensible doctor shorthand, you might notice the letters IOL on your medical records.
So what does IOL stand for in pregnancy?
If you see the letters IOL, they simply mean ‘induction of labour’.
Perhaps you’ve had an induction of labour (IOL) in a previous pregnancy or perhaps you’ve been scheduled for induction of labour in your current pregnancy.
Ways to induce labour
Your hospital might offer women several forms of induction of labour, including:
#1. Cervical ripening gels, pessaries and tablets
When induction of labour is recommended and a woman has an unfavourable cervix, the cervix can first be ripened with synthetic hormone (prostaglandin), to induce labour. An ‘unfavourable cervix’ means that, on internal examination the cervix is seen to be closed and not ready for labour.
Vaginal prostaglandins can be administered, via a vaginal examination, with a gel or pessary. Tablets for induction of labour can be taken orally.
Initially, just one dose is given to try to start labour. The dose may be repeated if nothing progresses after a number of hours.
This is a relatively common procedure. After the application of prostaglandins, some hospitals allow women to go home for the cervical ripening to happen and return later, when labour is established.
#2. Synthetic oxytocin
The most common method of induction is via an IV drip containing a synthetic version of the labour hormone, oxytocin. The drug is commonly known as Syntocinon in Australia and the UK, and Pitocin in the US.
To begin the induction, the pregnant woman is admitted to the hospital and then hooked up to the IV. She will then be monitored as the contractions begin, as her labour is now classed as high-risk. Unfortunately, the monitors can restrict movement and further interventions are common.
Read more about the increased risk of having your labour induced in BellyBelly’s article Induction of Labour – What Are The Risks of Being Induced?
#3. Artificial rupture of membranes (AROM)
If a woman’s cervix is partially open, her doctor can rupture the membranes. This is also called an amniotomy.
Using an amnihook (which looks like a long crochet hook) inside the vagina, the health professional will break the bag of water surrounding the baby, in the hope it will trigger labour.
#4. Foley catheter
The Foley single balloon catheters were originally designed to empty a patient’s bladder. In labour induction with a Foley catheter, the balloon catheter can be inflated slowly to dilate the cervix mechanically.
Inducing labour shouldn’t be taken lightly.
Research shows that uterine rupture is much more common when:
- Induction of labour occurs
- There is uterine hyperstimulation, usually caused by artificial oxytocin infusion
- There is a previous caesarean section scar.
Because the Foley balloon catheter doesn’t involve medication, it has fewer risks for both mothers and babies.
The Foley catheter is a safer, recommended option for women who’ve had a previous c-section and can also be used on anyone who has a partially open cervix.
Although induction of labour is a common procedure, there is an increased risk of complications, especially if medications are used. Some of these risks are serious, others not so much.
Many inductions, however, result in further interventions, including emergency c-sections. In Australia and the US, one in three babies is born by c-section, which is double the level recommended by the World Health Organization. Reducing the number of inductions of labour is likely to reduce the number of c-sections performed.
It’s important to make sure you’re aware of all the risks as well as the benefits, so you can make a decision that will offer the best outcome for you and your baby.
How is IOL done in pregnancy?
Going into labour spontaneously would be ideal for most pregnant women.
Although spontaneous labour would be preferred in most cases, induction might sometimes be necessary.
The pros and cons and the risks of induction of labour versus expectant management should always be considered and discussed with the pregnant woman.
In most places, induction of labour usually follows a very similar process:
Vaginal examination:
When induction of labour is being considered, a vaginal examination is necessary, to see the status of the cervix. Depending on the amount of cervical ripening, a decision will be made about the most convenient form of induction.
Bishop score:
The Bishop score measures the ripening of the cervix; a low score indicates an unfavourable cervix and a high score means the cervix is ready and a few contractions will cause the woman to go into labour.
Read more about this in Bishop’s Score During Pregnancy – What Is It And How Is It Used?
Vaginal prostaglandins
They are used when the Bishop score is very low and spontaneous labour seems far away. To be able to access it, the cervix needs to be ripe. This means that each cervical feature should be favourable. The cervix needs to soften, come forward and start to dilate.
Artificial prostaglandins are more commonly used in nulliparous women (women who are pregnant with their first baby) than in multiparous women because, once fully dilated, the cervix won’t close as tightly as it originally was before vaginal birth.
Foley catheter
As previously discussed, if the cervix is slightly open, a Foley catheter can help to open up the cervix mechanically without using any medication that could cause adverse outcomes. Uterine hyperstimulation should be avoided whenever possible, as it can originate fetal distress.
Artificial rupture of membranes (ARM)
When inducing labour, the cervix is ripened to give access to the amniotic sac.
Thanks to the chorionic membrane (the internal side of the amniotic sac), the amniotic fluid is full of natural prostaglandins, which, when it is in contact with the cervix, will help induce labour naturally.
Once the waters are in contact with the cervix, labour contractions are likely follow soon after.
Artificial rupture of membranes needs to be done in a hospital setting by a skilled professional, as there can be fetal compromise if the procedure is not done correctly.
An umbilical cord prolapse would be an undesired direct consequence of the artificial rupture of membranes.
Read more in BellyBelly’s article Umbilical Cord Prolapse | What Is It And How Can I Prevent It?
Once ARM has been performed, the pregnant woman is placed in continuous CTG monitoring, to keep up beat-to-beat fetal surveillance.
Once the artificial premature rupture of membranes has taken place, the obstetric team usually allows 2 to 4 hours for the woman to go into labour. If she does, then no more procedures should be necessary.
Oxytocin infusion
An artificial oxytocin infusion will most likely be used for induction of labour, to establish regular uterine contractions. The infusion is administered intravenously and the dose is continually increased until regular labouring contractions are achieved.
Reasons to induce labour
Although IOL shouldn’t be taken lightly and having these conditions doesn’t actually mean labour should be induced, here are some of the obstetric factors considered for induction of labour:
- Maternal conditions. High blood pressure, diabetes, pre-eclampsia and obstetric cholestasis are maternal conditions that might be resolved with induction
- Premature rupture of membranes. Some providers don’t like to wait for labour to happen spontaneously once the water breaks. In many units, once the membranes have broken they’ll allow 24-48 hours for labour to start spontaneouslyIf labour doesn’t commence after the given time from the last intact membranes, IOL will most likely be offered. You should know that you can wait to go into labour on your own. If this is the case, it’s important that no vaginal examination is performed when the amniotic sac is no longer protecting the baby from infection. If you suspect a water leakage make sure nothing is inserted in your vagina.
Read more about this in Pre-Labour Rupture Of Membranes – When Your Water Breaks.
- Fetal compromise. IOL will be offered when the baby’s health or growth inside the womb could be compromised. Make sure you discuss your options with your reproductive medicine team.
Non-legitimate causes to induce labour
Please remember that not all healthcare providers have your best interests at heart. Some obstetric teams might suggest induction of labour in circumstances that do not require IOL or where IOL could be detrimental to the health of mother and baby.
Some of these are:
- Prolonged pregnancy. This is when the gestational age goes over 42 weeks. In this case, it’s very likely that your healthcare providers will suggest the induction of labour. This doesn’t mean you can’t have an expectant management and wait until labour starts spontaneously.
Read more in Your Rights At 42 Weeks Of Pregnancy | Important Facts You Need To Know.
- Previous caesarean section. Having had a caesarean section in the past is no reason for you to be offered an induction. Research shows that induction of labour shouldn’t be offered to women with a previous C-section, whether it was a scheduled or an emergency caesarean section. Uterine rupture is much more common when synthetic oxytocin is used. In a previously scarred uterus, a uterine rupture will be more likely.
- Baby’s position. If your healthcare providers are not happy with where your baby’s head is, inducing labour won’t solve that. Expectant management is the wisest approach when the baby’s head isn’t in the pelvis. A good example is a baby breech presentation. When labour isn’t induced but allowed to happen normally, the baby has extra time to find the right way and get the head well engaged in the birth canal. Even if the baby hasn’t turned or moved from the original position when spontaneous labour begins, the baby has had extra time to mature. In this case, and especially when the baby’s head isn’t engaged in the pelvis, induction of labour will most likely fail. Adverse neonatal outcomes are more common when induction of labour occurs.
What is a scheduled IOL?
A scheduled IOL means that the day of your induction has been already scheduled. In many units around the world this happens when you reach 42 weeks of pregnancy. Be careful with healthcare professionals who give you an induction date when you reach term. Sometimes they set the date of your scheduled induction as early as 37-38 weeks of pregnancy.
Personally, I consider this to be a very shady clinical practice. It is unacceptable for individualised care not to be on the menu and for a pregnant woman to be treated as a number. When you’re given an induction date weeks ahead you can almost hear ‘Next!’ as you leave the room.
Take this approach as being a good opportunity to look for different providers in your area.
You need a provider who makes you feel confident and who believes your body is perfect and you will go into labour when the time is right.
What does failed IOL mean?
This is one of the ugliest sentences in obstetrics. A failed induction means that, after attempts to induce labour by different means, the induction hasn’t been successful and it failed to dilate the cervix.
The reason I don’t like this term is that although it is the induction that has failed, many women are left with the impression that their bodies have failed. It’s not that at all. There’s absolutely nothing wrong with that woman’s body. It just means the artificial efforts to make her go into labour have failed.
Many women, however, are left with the impression that their bodies have failed and they haven’t responded to the treatment, as expected.
An unsuccessful induction just means your body is working perfectly well and it’s doing what it needs to do to protect your baby from unknown harm.
A failed IOL usually means your baby isn’t yet ready to be born.
Once it’s considered that induction has failed, the baby will most likely be born by emergency caesarean section.
An emergency section means that the decision has been made in the moment. It doesn’t mean it’s life-threatening.
A failed induction can develop adverse clinical circumstances, such as postpartum haemorrhage and other complications derived from making the uterus do something it wasn’t prepared to do.
Recommended Reading
- Induction Of Labour – What Are The Risks Of Being Induced?
- Methods Of Induction Of Labour – 4 Different Methods (gives more detail than this article does)
- How To Bring On Labour Naturally – 11 Natural Methods.
