Induction of Labor/IOL: your birth care provider may use a variety of methods to stimulate uterine contractions and induce labor for several reasons, including:
- labor contractions do not begin on their own within 1-2 weeks after your due date
- your water breaks and labor contractions do not begin on their own
- a complication puts you or your baby at risk (such as preeclampsia or infection)
- labor induction for non-medical reasons (convenience, scheduling) is controversial and not recommended because of the risks associated with IOL (see below)
According to statistics from the CDC (Centers for Disease Control), approximately 1 in 5 pregnant women has their labor induced (a 50% increase from 1990). Methods for induction of labor include:
- Stripping the membranes: your provider may strip your membranes by inserting a gloved finger into your vagina to separate the amniotic sac from the uterine wall. This causes the body to release a hormone (prostaglandins), which helps stimulate cervical change, leading to contractions. This can cause some cramping and spotting.
- Mechanically stimulating cervical change: your provider may insert a thin tube (catheter) with a small inflatable balloon at the tip. Once inserted, the balloon can be expanded with water in order to cause your cervix to expand. Another way to stimulate cervical change is with synthetic prostaglandins – by applying these synthetic prostaglandins (in gel or tablet form or via a mesh tampon-like object) to the cervix. Synthetic prostaglandins for labor induction are contraindicated for women with a history of C-Section.
- Breaking your water: described here and here, rupturing your membranes is sometimes used as a method of inducing or augmenting labor, although a cochrane review of the research shows that ROM for labor augmentation does not significantly reduce the length of labor.
- IV synthetic oxytocin: Pitocin (the synthetic version of oxytocin, a naturally occurring hormone) is administered via an IV to strengthen or induce labor contractions. Many women report that labor contractions with Pitocin are more painful than without, and depending on the rate at which the Pitocin is administered, there is some risk for uterine overstimulation. A Cochrane review of the research (discussed here) found that while Pitocin is effective at speeding up slow or stalled labors, it does not reduce or prevent C-Sections.
There are some at home labor induction techniques as well. Your provider may suggest that you have sexual intercourse, and there is some interesting science behind this recommendation. Men’s ejaculate contains prostaglandins, the same hormone that is used in a synthetic form to ripen the cervix!
More to come on induction of labor later this week!