Each baby arrives in their own way - some requiring induction to emerge into the world. Labor induction is a treatment that stimulates delivery. This can be accomplished through pharmaceutical or non-pharmaceutical methods. In the Western world, it is estimated that 1/4th of pregnant women have their labor medically induced.
Reasons for Induction
Labor needs to be induced for a variety of reasons. Some of the most common causes are being past your estimated due date, water breaking without contractions, high blood pressure, pre-eclampsia, concerns around placental function, gestational diabetes, low or high amniotic fluid levels, or other medical issues.
Induction procedures vary depending on the birthing person’s body, age, and health history. Scheduled inductions typically take place in the evening, to allow you to prepare for the birthing process. Having a good meal and a shower beforehand is ideal. Some inductions may be more urgent than others, so make sure to speak with your provider about the best plan for you.
Once at the hospital, your vitals will be taken, your cervix checked, and an IV port will be placed. A heart rate monitor and contraction monitor will also be wrapped around your belly to check the baby. They will monitor your baby’s heart rate for at least 20 continuous minutes. You may also have a finger pulse oximeter or a cuff to measure your blood pressure. Depending on your wellbeing, these measurements may be taken more often during your labor and delivery.
1. Membrane Sweep
This is the least invasive “induction” method. In fact, it is less of an “induction” and more of a trigger that can cause labor to begin. Your provider places a finger into your cervix and swirls the finger around to separate the amniotic sac from the neck of the cervix. This procedure can be pretty uncomfortable. If the procedure is successful, contractions will begin within the next couple of hours. Often, the provider will perform the sweep, instruct the mom to walk around, then return for another exam to see if things have progressed. If the sweep isn’t successful, you may have to proceed with one of the most invasive procedures listed below.
There are three primary medications used to begin induction and make cervical changes. Cervidil (prostaglandin gel), Pitocin (synthetic oxytocin), and Cytotec (misoprostol).
- Cervidil: softens the cervix but does not cause contractions. The gel is inserted high into the vagina next to the cervix. Typically 1-2 doses are administered before any cervical changes occur. For your baby to exit, the cervix must be 100% softened (effaced) and 10cm open (dilated). This medication should not cause any discomfort after insertion.
- Pitocin: is used to stimulate contractions. It is administered through an IV at a low dose, then increased in even intervals until contractions are consistent, about 3-4 minutes apart. Contractions caused by Pitocin can be more intense than ones without medication. Because of this, you may want to ask about pain management options such as an epidural or nitrous oxide.
Some providers may prefer Pitocin or Cytotec, and both may not be at every hospital. Cytotec is more widely available because it is less expensive. Some people may be concerned about using Cytotec for induction because the drug’s intended use is to treat stomach ulcers. However, it was discovered to cause uterine contractions and is commonly used. Cytotec is a small pill that is administered orally or vaginally. You may receive multiple doses of Cytotec depending on your body's response.
3. Foley Balloon:
With the Foley Balloon, a small catheter is inserted into the vagina and placed against the cervix. By filling it with saline water, gentle pressure is applied to the cervix, encouraging effacement and dilation. While some may find the insertion mildly uncomfortable, others experience stronger sensations. Opting for upright positions and utilizing gravity, such as sitting, rocking, or bouncing on a birth ball, can aid in cervical changes and provide comfort.
4. Water Breaking:
If the cervix is already effaced and dilated, a provider may perform an artificial rupture of membranes (AROM), also known as water breaking. This procedure involves creating a small puncture in the amniotic sac using a specialized hook. The aim is to lower the baby's head in the pelvis, exerting pressure on the cervix. While you may experience a warm gush of fluid, this procedure is generally not uncomfortable.
As a natural induction method, engaging in sexual activity can be an enjoyable and natural way to encourage labor progression. Sexual stimulation and orgasm release oxytocin, a hormone that stimulates contractions. Moreover, semen from a male partner contains prostaglandins, which have similar effects to medications like Cervidil in softening the cervix.
In most cases, except for the initial administration of certain medications, you are encouraged to move around during labor. Utilizing gravity and staying active can aid in the birthing process. Whether you have a doula or nurse, they can guide you in using your hospital space effectively. Trust your intuition and listen to your body's needs, as it instinctively knows how to find comfort. Additionally, online resources and childbirth education classes offer positions and techniques to support labor progression and enhance comfort.
Castor Oil Is Not Recommended:
Castor oil is not recommended to induce labor due to its potential risks and limited effectiveness. Using castor oil for labor induction can lead to unpredictable and uncomfortable results. Castor oil stimulates the bowels, which can cause cramping and diarrhea. However, this intestinal stimulation does not always translate into effective contractions.
Moreover, the intense cramping and discomfort associated with castor oil can be distressing and exhausting for a pregnant person. Additionally, there is a risk of dehydration and electrolyte imbalances because of excessive bowel movements caused by castor oil.
Monitoring and Considerations:
Continuous monitoring of your baby's heart rate is crucial for ensuring their health and wellbeing during any induction. In some cases, babies may not tolerate induction medications well and display signs of distress.
If fetal distress persists, your provider may recommend a cesarean birth instead of continuing with induction and vaginal delivery.
Inductions can vary in duration, often taking longer than non-induced labor. Being patient and prepared for a labor process that may last from hours to days is important. If induction methods do not lead to the desired progress or expediting the birth is necessary, a c-section delivery might be the best option.
Remember, each birth journey is unique, and staying educated and empowered will enable you to actively participate in your birthing experience.