Your pregnancy is considered full term at 39 weeks, about one week before and after your due date. At this time, your body will naturally and spontaneously go into labor. Some labors are longer than others, especially for first-time mothers, and augmentation is not needed; yet if labor begins but is prolonged or does not progress, augmentation of labor may be recommended by your doctor. 

Stages of Labor

Human labor is divided into 3 stages^1:

• Stage 1: Labor begins with gradual dilation and effacement of the cervix
• Stage 2: Begins when the cervix is fully dilated (10 cm) and effaced (100%) and ends once the baby is delivered
• Stage 3: Happens from the moment baby is delivered and ends once the placenta is expelled

Factors of a normal vaginal delivery include the baby’s characteristics, uterine contractions and maternal energy, and the anatomy of the pelvis. These three factors are known as the passenger, power, and passage. Healthcare providers monitor these factors as your labor progresses to identify any additional interventions needed to move the process along. 

What is Labor Augmentation?²

This means increasing how long your contractions last  and how often they happen for faster labor progression after spontaneous labor has already started. Methods to speed up labor can be medicated or non-medicated. Each has pros and cons that should be discussed with your doctor to find the appropriate approach to deliver your baby safely. 

Non-Medicated Augmentation

• Movement is an effective and natural way to augment labor. If you are in labor but not progressing, try walking or swaying in place.³ Connect with a doula or childbirth professional before your delivery to learn positioning techniques to boost contraction efficiency and help encourage your baby into the correct position in the birth canal. 
• Nipple stimulation can be a safe, proven, and effective technique to stimulate uterine contractions and progress labor. Massaging the nipples by hand expression or breast pump has been scientifically studied to stimulate a more efficient contraction pattern.⁴ Talk to your healthcare provider about whether nipple stimulation is a safe option for you or not. 
• “Breaking your water” or amniotomy, ruptures the sack of fluid that protects your baby throughout pregnancy. When the sack is ruptured, the fluid drains out and your baby’s head begins pushing down on the cervix and encourages dilation. There should be no pain when your water breaks. Some women feel a “pop” and gush, while others just feel damp and slow leaking of the fluid. Often the amniotic sac breaks on its own. Still, if labor is not moving as quickly as your doctor or midwife anticipated, they may puncture the amniotic sac to speed up labor and create more frequent contractions. The breaking of your water anticipates the delivery of your baby within 24 hours.⁵

Medicated Augmentation

• Pitocin, the synthetic version of the hormone oxytocin, is the most common form of progressing labor in hospital settings. Pitocin is administered intravenously and is started with a low dose and is increased slowly over time so that your care team can monitor how your baby’s heart rate responds.⁶ The goal is to create an efficient contraction pattern that dilates the cervix, but does not cause overstimulation of your uterus muscles. 

Sometimes these interventions can cause stronger contractions that what your body would do on its own, naturally. If your baby does not tolerate the stronger labor contractions well it could lead to the necessity of a cesarean delivery. Once augmentation has started, you may begin to feel your baby lower into your pelvis, and/or the frequency or contractions will be closer together and feel more intense. Other times, mothers may feel no changes at all. 

Questions to Ask Your Doctor Before Augmentation of Labor

1. Are there any other interventions I will need with an augmentation? 
2. What are the benefits of augmenting my labor? 
3. What are my alternatives?
4. Will I be allowed to move freely? 
5. What are the risks based on my health and pregnancy history? 
6. Is augmenting my labor medically necessary?
7. Do I have to make this decision now?

Risks & Complications with Labor Augmentation⁷

Labor Augmentation and the Risk of Cesarean⁸

If your labor is still not progressing after trialing augmentation, your doctor may recommend a cesarean birth for your and your baby’s safety. A cesarean birth is major surgery and there are substantial risks that should be discussed with your doctor or midwife.

Labor Augmentation and Breastfeeding

Overall, infants exposed to birth interventions can have a more difficult time getting the best start with breastfeeding. Labor augmentation can increase your chance of needing pain medications or additional birth interventions that are known to impact breastfeeding success. Studies show that infants exposed to synthetic oxytocin had lower breastfeeding assessment scores and a higher risk of early breastfeeding cessation.⁹

Supplementation may be needed if your baby is not breastfeeding well. This can be your own expressed milk, donor milk (if your birth place offers this option) or formula.¹⁰ If your breasts are not stimulated early and often, this can lead to low milk supply. Hand expressing and using alternative feeding methods other than bottles to provide breast milk for your baby is the best option in these situations.

If your doctor is recommending labor augmentation, ask questions, be informed, and seek the advice of an International Board Certified Lactation Consultant (IBCLC) to ensure you are well prepared for breastfeeding. With support and education, you can overcome any challenges and go on to breastfeed your new baby successfully.

What If I Have Questions?

If you are interested in learning more, these Aeroflow classes expand on some of the topics discussed above:

• Birth and Breastfeeding
• Ultimate Breastfeeding Prep
• Lactation Q&A

Want More Info?

For a directory of Aeroflow’s other Care Guides offering information on pregnancy, baby care, and more, browse our comprehensive list of titles:

References