A medical induction is the artificial starting of labor. One of the most difficult things about birth is the unknown. When and how it will start is a top question that families often think about, especially as they near the end of pregnancy. Let’s discuss what the options are if an induction needs to be part of your journey.
A medical induction may be needed for many reasons. Some of those reasons could be approaching 42 weeks pregnant, pregnancy complications, or premature rupturing of the membranes (PROM). While the indications of each of these situations depends on multiple factors, these are the most common and more often have a medical necessity. I’m not here to say when a medical induction is truly needed (that’s a whole other blog) but if you do decide to move forward with an induction, you should be aware of the options available to you. If you are looking for more natural ways to nudge labor along, you can read Get This Baby Out!
Non-drug medical inductions:
Castor Oil
In simple terms, you would drink a specific amount of castor oil in a specific time frame given by your care provider. Your body doesn’t like the castor oil, so you reject it, typically with diarrhea and vomiting. The stomach and intestine contractions created by this expelling may cause the uterus to begin contracting, thus starting labor. Evidence is limited, but a castor oil induction does seem to appear effective at starting labor within 24 hours around 50-60% of the time. You want to make sure to stay hydrated since you’ve now gone into labor empty on all accounts. In addition to nausea, vomiting, and diarrhea, a castor oil induction may increase the risk of stressing baby and can lead to meconium in the bag of water.
Membrane Sweep
A membrane sweep is a procedure where a care provider uses their gloved fingers to separate the amniotic sac from the uterine wall. This can be done at any time, and may be suggested to start around 39 weeks. In order for the provider to preform the sweep, the cervix does have to be open (dilated enough) to about 1cm. The sweep releases a hormone, called prostaglandins, which may help start labor. (Fun fact-sperm is super high in prostaglandins!) Membrane sweeps are typically uncomfortable and can cause cramping and bleeding. Membrane sweeps do help encourage labor to start, within 48 hours, about 50% of the time. In personal experience, a first time mom will need more than one sweep in order for it to start labor.
Foley Balloon
A foley balloon is inserted into the cervix and artificially inflated with saline to open the cervix manually. It will fall out when the cervix has reached about 4cm dilated and hopefully labor will kick start on its own after. The balloon usually irritates the cervix and causes contractions that are intense and close together even in early labor. When a mom has those intense contractions that are prolonged, it can lead to other interventions, a longer labor, and an earlier epidural. In most cases, a foley balloon is the first step to a longer induction with multiple methods.
Breaking the Water
Artificially rupturing the membranes, or breaking the bag of waters may be part of a medical induction. Most often, breaking the bag of waters is used to accelerate an already moving labor, not necessarily start one. This is done with a little hook, during a vaginal exam, to put a small rip into the bag which lets out the amniotic fluid. It’s not painful at all, although most moms will feel the fluid come out. There is very mixed evidence on whether this actually speeds up labor, but the idea is that the baby’s head will be more firmly applied to the cervix which may provide faster dilation. Contractions are typically stronger after the bag has broken. Baby must be engaged in the pelvis, nice and low in order to do this. If the baby is too high, the risk of cord prolapse is present. The risk of infection is higher once the bag has been opened, although it’s still very low.
Drugs for medical inductions:
Cervical Ripening
In a lot of situations, the methods used will be determined by what is currently happening with your cervix. Your induction will be more favorable if your cervix has already begun to soften and thin. If your cervix is still hard, a cervical ripening drug will most likely be the first step. Some common drugs used are Misoprostol and Dinoprostone. Some are pills you swallow and others are a vaginal suppository. Every care provider will approach this method differently, but the medication is given every few hours, depending on dosage and how you respond to it. These medications help soften your cervix by inducing contractions. The intensity and frequency of the contractions vary greatly with the medications. The risk factors for these medications also vary, but can include cramping, nausea, vomiting, diarrhea, vaginal bleeding, fetal distress, and infection. Cervical ripening drugs are often part of a longer medical induction plan, but do have success at starting labor.
Pitocin
Pitocin is the synthetic form of our love hormone, oxytocin. It’s given continuously through an IV to start or speed up labor. Pitocin is started very slowly and at a low dosage and will be increased every 30-60 minutes to increase contractions until their frequency reaches 2-3 minutes. The medication is very effective, but it does come with risk factors. Contractions from Pitocin ramp up quickly, and your body often doesn’t have time to produce the necessary endorphins to help you manage them. As a result, pain management is usually needed once Pitocin has started. Pitocin can increase your risk of uterine rupture by producing too many or contractions that are too intense. It can also affect your baby’s heart rate, often leading to other interventions. There are some studies that show the use of Pitocin for long periods in labor can lead to a decreased ability for baby to latch and a decreased ability in milk production for mom.
Hope for medical inductions:
Birth can be unpredictable. No matter how much you plan and prepare, sometimes an induction is necessary. Even if you need an induction, remember that you still have options and that you can decline anything. Your voice, your values, and your wishes should still be respected and honored. All of the other parts of your birth plan can still be upheld. You can absolutely have a positive birth with an induction!
Happy birthing mama! You’ve got this!
