Written by: Bentley Porterfield-Finn, Doula
Labor inductions, or interventions that artificially facilitate the initiation or completion of childbirth, have been on the rise recently [1]. In 2018, the CDC reported that 27% of pregnant people were induced [2]. However, this number is likely an underestimation, as induction of labor is underreported in federal statistics [3]. Some labor inductions occur for medical reasons, but some do not. As with other aspects of childbirth, being informed about induction is valuable in the preparation and decision-making process. In this article, I want to review the various medical labor induction methods and things pregnant people should consider when induction is presented as an option.
WHY HAVE A LABOR INDUCTION?
Some labor inductions are necessary when there are medical problems or pregnancy complications that indicate it is safest to deliver baby as soon as possible. Medical reasons for induction include post-term dates (~42 weeks gestation) if the mother’s water breaks before labor starts (premature rupture of membranes), fetal growth restrictions, or medical complications such as preeclampsia or gestational diabetes. Inductions that occur without medical necessity are frequently referred to as “elective” inductions. For example, many pregnant people induce for due-dates, meaning they are induced because they have reached their estimated “due date” at 40 weeks gestation.
USE THE BRAIN ACRONYM
If your care provider begins to mention induction at 39 or 40 weeks, I encourage you to ask your provider questions such as:
- Am I healthy and safe?
- Is my baby healthy and safe?
- What are the medical benefits of inducing?
- Are there any health risks associated with waiting for labor to start naturally?
And when assessing the answer to these questions, use the BRAIN acronym--consider the Benefits, Risks, Alternatives, your Intuition, and Nothing (what happens if you do nothing).
METHODS OF LABOR INDUCTION
There are various methods of medical labor induction. The method used will depend on factors such as the reason for induction and where your body is in the labor process.
Usually, before spontaneous labor officially begins, your cervix will ripen, efface, and dilate. If you are being induced before your cervix has begun to ripen and efface, an induction method that facilitates this process will be used first. Most of these methods use artificial prostaglandins. Natural prostaglandins are a hormone produced by your body to help kickstart labor. Cervical ripening on its own does not start labor--it’s the first step, so these cervical ripening methods are oftentimes followed up with artificial oxytocin. Natural oxytocin is the hormone your body produces that initiates and sustains labor progress. The most common cervical ripening agents are:
- Cervidil: A tampon-like object with gel on the end inserted into the vagina. The gel contains artificial prostaglandins, which help ripen the cervix (fun fact: sperm contains prostaglandins, which is why having sex is sometimes recommended as a form of natural labor induction). The Cervidil is usually left in the vagina for about 12 hours as it helps ripen the cervix, and it may cause uterine contractions.
- Cytotec (misoprostol): This also contains artificial prostaglandins but in pill form. The pill can be taken orally or inserted into the vagina.
- Cervical balloon catheter: Also called the Foley bulb, this is a small flexible catheter inserted into your cervix. This device uses a balloon to help dilate your cervix.
After a cervical ripening agent is used, artificial oxytocin is oftentimes the next step. If your cervix is already dilated or effaced, Pitocin might be the only induction method used.
- Pitocin: This is artificial oxytocin administered through an IV. Your medical team can control how much oxytocin is administered. Pitocin causes strong and intense uterine contractions.
Other common methods of labor induction include:
- Stripping the membranes: Your provider will insert a finger into the space between your amniotic sac and the wall of your uterus. They will then move their finger in a sweeping motion. This can stimulate contractions, but it can also cause intense cramping and light vaginal spotting.
- Amniotomy: Also known as artificial rupture of membranes (AROM), this is when your provider breaks your bag of waters in an effort to stimulate or progress labor. They insert what looks like a crochet hook into your vagina and use that to break your amniotic sac or your “waters.” When your water breaks, the production of prostaglandin often increases, speeding up contractions.
Each of these methods comes with specific risks, and I encourage you to do further research on the methods and discuss them with your care provider, especially if you are facing a potential induction. If induction is not medically necessary, it’s best to be patient, trust your body, and have faith that labor will start when baby is ready.
Citations:
[1] Little, S. E. (2017). Elective Induction of Labor: What is the Impact? Obstet Gynecol Clin N Am 44; 601–614.
[2] Martin, J. A., Hamilton, B. E., Osterman, M. H. S., et al. (2019). Births: Final Data for 2018. National Vital Statistics Reports. Vol. 68 No. 13.
[3] Declercq, E. R., Sakala, C., Corry, M. P., et al. (2013). Listening to MothersSM III: Pregnancy and Birth.New York: Childbirth Connection.
