Evidence suggests that compared with spontaneous labour, induction or augmentation of labour after a previous Caesarean delivery increases the risk of uterine rupture by 2 to 3 times, and increases the risk of Caesarean birth by 1.5 times. However, because the absolute risk of uterine rupture is low, induction and augmentation of labour can be offered when the indication is appropriate and after counselling on potential benefits and harms. Physicians and midwives should talk with their patient or client about the decision to induce or augment labour, the proposed method to be used, time intervals for serial vaginal examination, and criteria for labour progress that would lead to discontinuing labour and proceeding to a Caesarean birth.
If oxytocin augmentation is used, clinicians should pay very close attention to labour progress and uterine activity. The use of oxytocin requires one-to-one nursing or midwifery care and continuous electronic fetal monitoring during active labour.
In people who have had a previous Caesarean birth, pregnancy that continues beyond 40 weeks is not a contraindication for labour. Induction of labour should be considered only after 41 weeks, unless there are other medical indications for it. Mechanical methods of induction such as amniotomy or Foley catheter cervical ripening are preferred, because they are associated with a smaller increased risk of uterine rupture. Misoprostol or prostaglandins should not be used during labour after Caesarean birth because of their association with a high risk of uterine rupture.