Ways to Induce Labor

Laboring Woman in Bed with Monitor
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You may hear a lot about the induction of labor being done when it is not needed for medical reasons. The truth is, sometimes having labor happen sooner is best for mother and/or baby for health reasons. With this in mind, there are still many ways to start labor before nature is ready.

  • Prostaglandins (PGE2): There are many different formulations of these medications (gels, tablets, pessaries). Current research does not show large difference between each of them. Using them to ripen the cervix can increase the chance of having a vaginal birth within 24 hours. Some studies show that it may lower the risk of cesarean section, while others show no effect. One risk is that they can increase the risk of your baby having heart rate changes with uterine hyperstimulation. Oral
  • Misoprostol (Cytotek): This is a medication commonly used for gastrointestinal issues. It was found to help induce labor. It can be given orally or as a vaginal insertion of the tablet. Oral administration has been shown to be as effective as the vaginal insertion. It has been found to be more effective than a placebo. Using oral misoprostol (usually given between 20 and 25 mcg) requires adequate staff for appropriate monitoring.
  • Breaking Your Water (Amniotomy): It is sometimes used alone when a mother has other contraindications for medications in labor, but according to the Cochrane Reviews, it is not best done alone. The risks of amniotomy include discomfort, infection, and potentially a cord prolapse. These risks need to be weighed in to any decisions made about using it alone or with other methods of induction.
  • Pitocin: This is given via IV in the hospital. It is one of the most common methods of induction. It can be used alone, or it can be used in conjunction with PGE2 or amniotomy, etc. When they looked at a group of moms who needed to induce labor because of their water being broken, the Pitocin group had lower infection rates in their babies. There is an increase in epidural usage associated with the use of Pitocin.
  • Catheters: There are special catheters that can be placed inside the cervix to help it dilate. This can be used when other medicinal methods are not preferred, for example, in a mother who is attempting a vaginal birth after cesarean (VBAC).

Which method is best for you will depends on a couple of factors, from how ready your body is for labor, and how quickly your baby needs to be born.

Talk to your practitioner about whether or not your cervix is favorable and if it is not, ask how they intend to factor this into the method of induction chosen. Just because you did not necessarily plan on having an induction, does not mean that all of your plans need to be thrown out the window. You still have a voice and options, even within an induction.

Sources:

Alfirevic Z, Aflaifel N, Weeks A. Oral misoprostol for induction of labour. Cochrane Database of Systematic Reviews 2014, Issue 6. Art. No.: CD001338. DOI: 10.1002/14651858.CD001338.pub3

Alfirevic Z, Kelly AJ, Dowswell T. Intravenous oxytocin alone for cervical ripening and induction of labour. Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD003246. DOI: 10.1002/14651858.CD003246.pub2.

Bricker L, Luckas M. Amniotomy alone for induction of labour. Cochrane Database of Systematic Reviews 2000, Issue 4. Art. No.: CD002862. DOI: 10.1002/14651858.CD002862.

Hofmeyr GJ, G├╝lmezoglu AM, Pileggi C. Vaginal misoprostol for cervical ripening and induction of labour. Cochrane Database of Systematic Reviews 2010, Issue 10. Art. No.: CD000941. DOI: 10.1002/14651858.CD000941.pub2.

Howarth G, Botha DJ. Amniotomy plus intravenous oxytocin for induction of labour. Cochrane Database of Systematic Reviews 2001, Issue 3. Art. No.: CD003250. DOI: 10.1002/14651858.CD003250.

Thomas J, Fairclough A, Kavanagh J, Kelly AJ. Vaginal prostaglandin (PGE2 and PGF2a) for induction of labour at term. Cochrane Database of Systematic Reviews 2014, Issue 6. Art. No.: CD003101. DOI: 10.1002/14651858.CD003101.pub3

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