Inducing labor means using medication or specialized instruments to artificially prompt contractions to deliver a baby vaginally.
What are some reasons why labor may be induced?
Your doctor may induce labor if:
- Your baby is long overdue (about 41 ½ weeks)
- You develop a serious illness, such as preeclampsia or gestational diabetes
- Your baby’s health is at risk inside the womb
- It would be difficult for you to get medical help once the contractions begin naturally (i.e., you live far away from the hospital)
You can also choose to induce labor, called elective induction. Women may choose to induce to fit the birth into their families’ or their doctors’ busy schedules. In the U.S., about one out of every four inductions falls into this category. Elective induction of labor is a controversial issue, but ultimately the choice to induce labor is yours to make in consultation with your doctor. Most doctors do not recommend inducing labor for non-medical reasons before 39 weeks.
How will my doctor determine if I am ready for labor?
Your health care team will use a measurement called the Bishop score to determine whether your body is prepared for a vaginal delivery. The Bishop score can help your doctor decide whether labor should be induced. A low score (0-5) is usually interpreted to mean that your body is not ready to deliver. Your doctor may have to “ripen” the cervix before attempting to induce labor. A higher score (8-13) typically means that your body is ready to deliver very soon, and labor may begin on its own in the near future. Inducing labor will likely result in a successful vaginal birth.
What does it mean to “ripen the cervix”?
The cervix is the small, doughnut-shaped organ that forms the bottom of the uterus. In order to have a vaginal birth, the cervix must dilate (widen) to allow the baby to be pushed through. It might seem weird to talk about the cervix as though it were a piece of fruit, but the word “ripen” just means that we use medications or instruments to help the cervix prepare for a labor-induced vaginal birth.
What medications are used to ripen the cervix?
In labor induction, doctors can ripen the cervix with drugs called prostaglandins. These are similar to hormones that you produce naturally when you are about to go into labor. Prostaglandins soften and thin out the cervix, allowing it to dilate. They can be administered orally or vaginally.
Some women may not be able to tolerate taking prostaglandins, particularly women who have had a prior C-section delivery. In these cases, doctors may use other methods.
What are some other methods for ripening the cervix?
There are several techniques that healthcare providers can try to ripen the cervix.
- Laminaria. Your doctor may layer a type of seaweed called laminaria in the cervical neck. Laminaria expands when it comes into contact with moisture, which then helps the cervix to dilate.
- Cervical balloon. The cervix can also be ripened by inflating a small balloon inserted into the cervical neck via a catheter.
- Stripping the membranes. In this technique, your doctor will gently sweep the membranes that attach the amniotic sac to your uterus with a gloved finger. This can stimulate the production of prostaglandins, which can naturally ripen the cervix.
- Amniotomy. In some cases, your doctor will rupture the amniotic sac with a special perforating instrument. When the amniotic sac ruptures naturally, this is known as your “water breaking,” and it is usually followed by the start of labor. An amniotomy can be performed to start labor or to intensify contractions. However, if labor does not start within a few hours of an amniotomy, your baby may be at risk of infection.
- Oxytocin. This is a naturally-produced hormone that directly causes uterine contractions. Oxytocin can also be administered by a healthcare provider to induce labor or speed along its progression. After administering oxytocin, you can expect contractions to begin in about a half hour.
What about natural methods?
Although non-pharmacological methods of inducing labor haven’t been widely researched, you may find them helpful. Some popular tips for helping labor along include:
- Walking or changing positions. Motion and gravity may work together to kickstart the process.
- Having sex. Semen actually contains trace amounts of prostaglandins which may soften the cervix.
- Stimulating your nipples. This can release oxytocin, the chemical which causes contractions.