Induction is the artificial start or continuation of labor. An induction may be recommended by your provider for a variety of health reasons concerning you or your baby. Inductions may be mechanical or medicinal. This list is not all-inclusive but represents the most common forms of induction.
Medicines used in Induction
Prostaglandins – are lipids that induce labor and ripen the cervix, which means they soften, thin, and shorten the cervix. Cervidil (Dinoprostone) is the only FDA-approved prostaglandin for cervical ripening and labor induction. Misoprostol, brand name Cytotec, is used off-label.
Oxytocin – is a hormone that causes uterine contractions in labor. Pitocin is synthetic Oxytocin. Pitocin is given IV.
Mechanical Inductions
Balloon Catheter – a tube with one or two balloons at the end. One balloon can be inserted into the opening of the cervix and expanded to help dilation. Or, one balloon is inserted past the cervix inside the uterus and one outside the cervix in the vagina.
Laminaria – rods of water-absorbent seaweed, which are inserted into the opening of the cervix to help it dilate.
Sweeping of the Membranes – is a procedure in which your maternity provider sweeps a finger between your uterus and amniotic sac. This is thought to increase prostaglandins.
Artificial Rupture of Membranes – is a procedure in which a crochet hook-like tool is used to puncture the amniotic sac. This is an attempt to increase contractions or make them stronger.
Bishop Score
Inductions are not guaranteed.
If the amniotic sac ruptures in an induction, the birthing person must stay in the hospital; and if the induction then is unsuccessful, there will be a C-Section.
So, the Bishop Score is used by maternity providers to measure the cervix’s readiness for labor. The higher the score, the more ready the cervix. Different providers take the Bishop score to mean different things. Some use it to decide whether an induction is necessary to start labor. Others use it to decide what type of induction to start; cervical ripening or uterine contractions. And still, some may say the score is high enough to wait for labor to start naturally. Pregnancies can go into 42 weeks safely. Most first time mothers give birth in their 41st week.
In most cases, it is not recommended to have an induction prior to 39 weeks because an induction prior to 39 weeks could lead to a premature newborn.
Medical inductions have risen in the United States from 9.6% in 1990 to 31.4% in 2020. Providers are recommending inductions at 39 weeks pregnancy because observational research has shown lower cesarean rates and better delivery outcomes with induction at 39 to 40 weeks compared to waiting. But medical inductions can lead to a “cascade of interventions” that bring on medical complications in labor and delivery. Birthing parents may want to try spontaneously starting labor at home.
Alternatives to Medical Induction
Nipple Stimulation and Sexual intercourse – oxytocin, ‘the love hormone’ is released with nipple stimulation. It may be performed during low-risk labor for at least 30 minutes on each nipple or until a contraction has been achieved. Sex also releases oxytocin, and prostaglandin is found in semen.
Castor Oil – is proven to cause cervical ripening and to bring on labor. Ask your provider about appropriateness.
Red Raspberry Leaves – are a common herbal tea used in labor. It is thought to promote regular contractions. The evidence is small.
Acupuncture – Check out my post on Chiropractors and Acupuncturists for information on acupuncture in labor.
Only try these alternatives after speaking with your maternity provider.
References
- https://www.acog.org/womens-health/faqs/labor-induction
- https://www.ajog.org/article/S0002-9378(23)00081-9/fulltext
- https://my.clevelandclinic.org/health/articles/24411-prostaglandins
- https://www.babycenter.com/pregnancy/your-body/what-is-a-bishop-score-and-what-does-it-mean-for-your-labor_41002530
- https://www.mdcalc.com/calc/3320/bishop-score-vaginal-delivery-induction-labor
- How Long After Induction Parents Can Expect To Give Birth
- Can Sexual Intercourse Help Stimulate Labor? (youtube.com)
- https://www.ajog.org/article/S0002-9378(12)01059-9/abstract
- https://www.ajog.org/article/S0002-9378(19)30425-9/abstract
- https://pmc.ncbi.nlm.nih.gov/articles/PMC4235054/
- https://www.ajogmfm.org/article/S2589-9333(23)00414-7/fulltext
- https://pmc.ncbi.nlm.nih.gov/articles/PMC6953318/
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