Spontaneous, Induced, Augmented

There are words that are often used when it comes to labour and birth, some of them are easily understood, some not so much, and some are used one way by health-care providers and another way by mothers and fathers-to-be.   Three of these worlds relate to labour or the period before the baby is born vaginally.  They are ‘spontaneous‘, ‘induced‘ or ‘augmented‘.

Spontaneous labour, as it implies, is when a mother’s body (who has reached full term) spontaneously responds to the baby’s signal that he/she is ready to be born.   Yes, that’s right, in a healthy-full term pregnancy, it’s the baby that signals he/she is ready, not the other way around.   Once that trigger or signal is sent, how labour commences, even when spontaneous, varies from woman-to-woman.  For most, labour starts with regular (i.e. with a pattern) pressure waves or regular cramping (a.k.a. contractions) and in a small percentage of women (fewer than 2 in 10), it starts with Spontaneous Rupture of Membranes (SROM) (water breaks), followed by regular contractions (either immediately or up to 24+ hours later).

A lot of women experience “Braxton Hicks” or practice contractions, in the weeks and months prior to a baby’s birth, but “Braxton Hicks” are usually felt higher up and are irregular (no pattern).   Other “spontaneous” things that occur at the end of pregnancy include changes in the cervix (and therefore changes to vaginal secretions), changes in baby’s position (baby engages into the pelvis or drops), loosening of stools, etc.

Induced labour or an “induction of labour” is a managed labour & birth, meaning the mother’s labour has not yet started (with neither rupture of membranes, nor contractions), and instead it is “brought on” artificially.   There are several ways to ‘induce’ labour and each OB/GYN has his/her favourite method.  In Switzerland, in most cases, it starts with the insertion of a prostaglandin pessary or application of a prostaglandin gel (there are two types E1 & E2).  This is often done in the late evening and left in overnight, meaning the mother is admitted to the hospital/clinic and after insertion/application, the father/partner must go home.  Recent research shows that daytime insertion has similar outcomes, so this is also an option.    In the morning or at least six hours later, a hospital-based midwife or OB/GYN will assess the cervix.    After assessment, there is another insertion/application or a transfer to the birthing suite for an IV drip of artificial oxytocin (syntocinon, a.k.a. pitocin).   If the cervix is already partially dilated, some health care providers will also request to “break your waters”.    This is considered an Artificial Rupture of Membranes (AROM).

Finally,  augmented labour or an “augmentation of labour” is when labour is deemed to have started, but the health care provider decides that things are not progressing as fast as he/she would like.   In these cases, the cervix has usually already started to change, so prostaglandins are not used.  Instead, the HCP is trying to affect the contractions.   Like with an induced labour, it is often an IV drip with syntocinon that is used.   It is also possible to augment labour through AROM.

You will often read birth stories where the writers say “after a few hours” or “because my waters broke”…. they “induced my labour”.   In these cases, syntocinon was used to “induce” contractions, but if labour had already commenced, it is officially considered an “augmentation of labour”.

So there you have it, the the main words used to discuss labour or what is often termed the “birthing time”.    In French the equivalent terms would be

  • Spontaneous = spontanée
  • Induction of labour = déclenchement du travail / travail provoqué
  • Augmentation = stimulation du travail
  • Artificial Rupture of Membranes = rupture artificielle des membranes (amniotomie)
  • Waters = poche des eaux
  • Oxytocin = ocytocine
  • Prostaglandins = prostaglandine
  • Pessary = ovule

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