When labor needs to start, there are multiple ways to approach it. Many people are surprised to find that there are many different types of induction. No single method will work for every pregnancy.
Breaking the Bag of Water
Using an item called an amnihook, your practitioner will make a tiny tear in the bag of water. This will cause the water to begin leaking out. Since the bag does not have nerves, this should be no more painful than your average vaginal exam. The thought is that once the bag is ruptured contractions will usually begin. Benefits: No chemicals may be needed, you maintain more mobility than if you were required to have an IV. Disadvantages: Contractions may not start and then this leads you to other interventions such as the use of Pitocin. It may additionally create an infection of the sac, the cushion for the baby is now removed, and rarely, but possibly, the prolapse of a cord, necessitating an immediate cesarean. Breaking the amniotic sack also requires that you have a baby within a certain amount of time, depending on the circumstances and your practitioner’s beliefs. It is better to use amniotomy with other methods of induction.
Pitocin
This is an artificial version of the body’s hormone oxytocin. It is given by way of an IV line and is used to cause contractions. The amount of Pitocin used will depend on how your body accepts it. Generally, the amount is increased every 10-30 minutes until a good contraction pattern is achieved. Sometimes this is done in combination with breaking the bag of water. Benefits: A bit easier to control than say breaking the water, because the drug can be stopped by closing off the IV line. This does not commit you to have the baby. It can be turned off or stopped to allow mom to rest or even go home. Disadvantages: Can cause fetal distress. May not cause contractions. May cause too many contractions or contractions that last too long. Because of the potential risks, the FDA came out and declared that this drug was not to be used for inductions for convenience or scheduling reasons.
Prostaglandin Gels/Suppositories
These are used more frequently when the cervix is not favorable, meaning that it is dilated less than 3 centimeters, hard, posterior, not effaced, barely effaced, or any combination of the above. By using Bishop’s Score your practitioner will decide if this is the best place to start. This can be used alone, or more often will be done 12 or more hours prior to the use of Pitocin. Frequently it will be given more than once over the course of an evening/night. A suppository or tampon-like substance will be placed in or near your cervix during a vaginal exam. Benefits: The more favorable your cervix, the less likely the induction is to “fail.” Sometimes this is all that is needed, other times Pitocin is also used. It can be done as an outpatient procedure. It does not commit you to having the baby. Disadvantages: Takes longer to get into active labor, can be nerve-wracking if your institution’s policy is that you have to stay at the hospital during the waiting period. Sometimes mom becomes nauseated or has headaches. This cannot be quite as controlled as Pitocin but tends to be milder. Some forms of the prostaglandins now have strings attached making them removable if dangerous contractions occur.
Misoprostol (Cytotec)
This is a pill that can either be ingested orally or placed near the cervix. It is used more often when the cervix is not very favorable. Benefits: No tethering of the IV line. It can be used alone. The more favorable your cervix, the less likely the induction is to “fail.” Not as messy as the suppositories potentially can be. Does not commit you to having the baby. Disadvantages: May require the use of Pitocin or other means in addition. It can cause a very rapid labor. The recent thought is that this is not a valid option for mothers who are attempting VBAC; discuss this with your practitioner.
Home Induction
There are a number of ways to induce labor at home. They vary from nipple stimulation and intercourse to ingesting herbs and substances like castor oil. Many women will swear by one or all of these, however, not all women will go in to labor with any method of induction.
WalkingSexual intercourseOrgasm with or without a partnerNipple stimulationCertain foods (i.e. spicy foods, oily salads)Bumpy car ridesStrenuous activityVisualizationCastor oilCertain herbs and homeopathics (black and blue cohosh, Caulophyllum, etc.)
Benefits: Typically less intervention and less likely to lead to a cesarean. Generally if your body and baby are not ready these will not work but it varies by method. These are easier to do and less worrisome for most moms. Disadvantages: There can be serious consequences, particularly if you are not a term and your baby is not ready to be born. Many of the old wives’ tales, like castor oil, do not generally work and can have potential complications including things like meconium staining, fetal distress, etc. Always check with your practitioner before using any of these methods.
Factors Affecting Labor Induction
Many times inductions are done for the reason of being past your due date. There has been some research recently that shows that due dates actually need to be longer than 40 weeks. Often there are unnecessary inductions. Sometimes they are done because a woman is attempting vaginal birth after cesarean (VBAC) or has suspected large baby. Many studies have shown that these are not necessarily good reasons for induction, particularly if the cervix is not ripe. Some women are fearful of induction for a variety of reasons, including the increased chances of a c-section, the increased need for pain medications, or the fear of the reason for induction, particularly if there is a question about the baby’s health.
A Word From Verywell
If induction is suggested, gather facts and information, and ask questions. Why is it being suggested? How would it be attempted? What happens if it doesn’t work? What happens if you do nothing? There isn’t a consensus on the use of induction, though it has its time and place, as any intervention does for medical reasons, though even the experts can’t agree on all of the times an induction would be the best choice.
