Labor Induction Procedures

There are several different ways to induce labor. The methods your doctor or midwife uses will ultimately depend on the condition of your cervix. Your doctor or midwife will check to see if your cervix is getting soft, thinning out and opening up (effacing and dilating). If your cervix hasn’t yet, then it’s considered “unripe” and not ready for labor. In that case, your doctor or midwife may insert medicine containing the hormone prostaglandin close to your cervix to help it along before the induction. Quite often, your doctor or midwife may break your water soon afterwards to jump-start labor. Many times oxytocin will be given through an IV to start contractions and help them to get stronger and regular. Hospitalization and close fetal monitoring are mandatory during a labor induction. Inductions are often done overnight for women whose cervix isn’t ready to go into natural labor, while other times when a woman’s body is ready to go into labor, induction may not take long at all.

Stripping (or “sweeping”) the membranes is one induction procedure that is often done in your doctor’s office and then you are sent home. This is basically an aggressive pelvic exam where your doctor or midwife manually separates your amniotic sac from the lowest part of your uterus (or cervix), by inserting a gloved finger and “sweeping” it in a circular motion around the inside of your cervix. Stripping the membranes is supposed to stimulate the release of prostaglandin hormones to bring on contractions. It is believed that labor starts as a result of this procedure typically within a few days, although it may need to be repeated before labor develops and no one knows if this is just coincidence or the result of the stripping. Many times this procedure is uncomfortable and sometimes brings on cramping and spotting.

Many times during an induction, your doctor or midwife may help your cervix to become soft and pliable to move things along. This is often done by having a prostaglandin medication (gel or suppository) placed in or near your cervix, often more than once. Dinoprostone (Cervidil or Prepidil ) is a common prostaglandin gel used to soften the cervix. Cervidil is typically given in the form of a removable vaginal insert, with a retrieval cord and resembles a tampon. Prepidil is typically given in the form of a gel, sometimes smeared on the cervix. Some doctors use Misoprostol (Cytotec) to induce labor, however it’s a controversial method and is more riskier than Prepidil and Cervidil, due to the increased possibility of uterine hyper-stimulation and uterine rupture, as well as fetal distress. So far the FDA has not approved Cytotec for use to induce labor, only for treatment of ulcers. Cytotec is typically given in the form of a tablet inserted vaginally near the cervix or a pill ingested orally.

Another common technique for labor induction is rupturing the amniotic sac or “breaking your water” (amniotomy). If your cervix is very ripe and ready for labor, this alone might get your contractions going. Your doctor or midwife uses a small hook instrument (that resembles a crochet hook) to make a hole in the amniotic sac, during a pelvic exam and it’s not generally uncomfortable. This causes the amniotic fluid to begin leaking out, which usually brings on contractions within hours. Once your water has broken, most doctors and midwives will want you to deliver within the next 12 to 24 hours because the risk of infection for you and your baby increases over time. Breaking your water should only be done if your cervix is starting to dilate and your baby’s head is firmly engaged in your pelvis, which reduces the risk of cord compression or cord prolapse, leading to decreased or stopped blood flow to your baby.

If prostaglandin medication and/or having your water broke doesn’t get labor well on it’s way, your doctor or midwife may decide to give you oxytocin (Pitocin) intravenously (through an IV) to produce uterine contractions. Pitocin is a synthetic form of oxytocin, which is a hormone that your body produces naturally during labor to make your uterus contract. The amount of Pitocin used depends on how your body accepts it and the levels are generally slowly increased until the contractions reach the desired strength and frequency, about every 15-30 minutes. A low-dose that allows at least 30-45 minutes between dose increases is best. If you start contracting well enough on your own, the medication may be decreased or shut off, which is less painful for you and easier on your baby. Many women (80% who’ve had Pitocin) say that it causes more intense, more painful contractions that last longer and many times have double peaks.

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