Common Labor Induction Methods
& What to Ask Your Doctor
(I’m not a medical doctor. The info I share here is just personal opinion and experience. Please, always consult your doctor.)
I always dreamed of labor being like it is in the movies. My water would break with a sudden gush and then I would yell, “It’s time,” to hubby. Yea — it never once went like that. I’ve had seven births and five, yes, five of them have been inductions! Even my two spontaneous births didn’t quite go like that, though, either.
Last year I shared that there are times when it is time to induce labor. I left off without sharing the common induction methods that are used in most hospitals. I know how scary it can be to face an induction. Especially if this is your first birth – or first induction. You need to arm yourself with knowledge, prepare yourself, and ask questions.
Even though, there are no easy answers and there are no guarantees, if you arm yourself with information you might just succeed in getting that birth you’ve been hoping for.
Having an induction doesn’t mean a horrible and overly painful experience. Know what your options are.
First and foremost learn what your Bishop Score is. A Bishop Score is an assessment of how easy it will be to send your body into labor.
It takes into account your cervical dilation, effacement, and what station your baby is positioned in and some doctors used a modified version which adds points for how many previous children you’ve had vaginally. Here is an easy calculator to use when trying to figure this out for yourself: click here.
If you don’t know what your dilation, effacement, station, position and the other info – please don’t be afraid to ask your doctor or midwife.
Once you know that, you will know whether or not your cervix is favorable for an induction. With an unfavorable cervix, your induction is not likely to take without some sort of ripening agent.
As far as cervical ripening, there are a few different choices in this category. Each of these has some risk to both the mother and baby. I have not gone in to or listed all of the risks here. There are numerous articles in which to find this information.
I’m only going into what it will be like during the labor and a few of the more major risks for each item. Please remember to consult with your own doctor because I am not a doctor. This is just my personal opinion and information that I’ve obtained from reading and from my own births.
Common Labor Induction Methods
1. My favorite that I’ve used is a cervical prostaglandin gel. Prostaglandins are what your body makes by itself to send you into labor.
This method seems quite easy to me. The doctor or midwife inserts the gel into your cervical area. You rest in the hospital bed for a certain length of time while being monitored (usually 30 minutes) and then you are free to move around.
I’ve used this method twice. I was able to use the birthing ball, to walk the halls, to use the shower or tub and to move around freely without the use of IVs and cords hooked up to me. They periodically monitored the baby’s heart rate and the contractions.
With my first gel induction, labor was a total of 9 hours from start to finish. My second gel induction was a total of 3.5 hours from 1cm to baby. They were beautiful and easy births and I love that there was not continuous monitoring or dealing with cords and IVs.
2. Cervidil – This is a small tab that it is inserted vaginally and it has a small cord attached. The tab can be removed at anytime. You must lie down for 2 hours and be monitored continuously while on this medication. It can be removed at anytime and left in for up to 12 hours.
Many times this is used prior to the pitocin starting. When I had my 3rd child I was given Cervidil at night and left to be monitored all night. I went from 1cm to 2cm over night and then the tab was removed and pitocin drip was started. It was a much slower process than the gel was for me but I do not know if others have the same results.
When I was pregnant last year I found out that Cervidil doesn’t appear to be a choice to women who have had 6 or more previous full term pregnancies. Last time, that was me. I was having baby #7. Thankfully, I didn’t need that drug at all so it was a non-issue. Please check with your doctor.
3. Cytotec is a small pill that is broken up and used vaginally. I didn’t realize that it was being used for induction purposes before a few months ago when my local hospital informed me of this. Cytotec is not approved by the FDA to be used in pregnant women. It can cause uterine rupture in women with a history of a previous C-Section. You must be monitored for 3 hours continuously after it is inserted. There is a huge controversy surrounding this drug, but I was informed by my midwife and other nurses at the hospital that this drug is safe in small doses and with monitoring of the mother and baby. I have never used it and I was quite nervous at the thought of it. There is an interesting article devoted to information surrounding this controversy here.
4. Mechanical Dilation This is also known as a Foley Bulb Catheter. According to emedicinehealth “A balloon catheter, such as a Foley catheter, is a narrow tube with a small balloon on the end. The doctor inserts it into the cervix and inflates the balloon. This helps the cervix open (dilate). The catheter is left in place until the cervix has opened enough for the balloon to fall out (about 3 cm).”
I did not find this to be painful but a slightly uncomfortable experience. It was no worse than a membrane sweeping (probably less painful, actually). It was slightly strange to walk around with this foley bulb there – especially the tubing, but I was able to walk around with it and not have any issues sitting on the birthing ball or walking around the halls of the hospital. The midwife told me it might stay in for up to 12 hours.
For me, it took about 4-5 hours to fall out on its own. However, when it came out it was not 3 cm as we all expected – I was a full 6 cm dilated. I would say this did a lot to get me ready for pitocin, but it did not send me into labor on my own.
5. Membrane Sweep or Stripping the Membranes is usually done in the office. It can be done during a cervix check during your weekly checkup. This can start up labor or cause some dilation and effacement.
Sometimes this needs to be repeated. “The health care provider puts her or his finger into the cervix — the mouth of the uterus — and uses the finger to gently separate the bag of water from the side of the uterus near the cervix.”source This can be slightly painful but it can be helpful in getting your cervix ripened without the use of these other agents.
6. AROM or Breaking of the Waters is a way to either speed up labor or get it started in some cases. According to americanpregnancy.org “When the bag of water (amniotic sac) breaks or ruptures, production of the hormone prostaglandin increases, speeding up contractions.”
This is easily done if your cervix is dilated and effaced enough for the doctor to place a thin, sterile hook past your cervix to poke a small tear in the bag of waters. This will result in fluid gushing out. However, this doesn’t really hurt. It may be slightly uncomfortable.
After this happens, you will be placed “on the clock” with delivery needing to happen within 24 hours. The positive to having your water broken is the doctor or midwife can then check for meconium staining in the fluid. The negative is it might make contractions slightly harder and more uncomfortable.
7. Pitocin – This is was most people think of when they think induction. This is also what can be very painful. “Oxytocin is the preferred pharmacologic agent for inducing labor when the cervix is favorable or ripe. Numerous randomized, placebo-controlled studies have focused on the use of oxytocin in labor induction. It has been found that low-dose (physiologic) and high-dose (pharmacologic) oxytocin regimens are equally effective in establishing adequate labor patterns.” (source)
With this method you will be tied to cords and iv tubing. You must be monitored continuously the entire time and be on IV fluids as well as the pit drip. There are risks of hyper-stimulation of the uterus and of causing fetal distress with the use of pitocin, thus the constant monitoring.
With a good doctor or a midwife, they may let you sit on a birthing ball or rocking chair so you do not have to stay in one position during the entire labor. This can make it much more bearable to be able to go without pain meds. I found that if the dose is kept on a slower/lower drip the pain is no worse than labor without the use of induction meds.
In my last birth, this past December, I had a pitocin induction after AROM. It was no more painful than my births with no pitocin. The nurse allowed me to tell them when to up the dose of pit. I was able to stand, sit on a birthing ball, the edge of the bed and they were about to pull out a squatting bar for me. I was able to go pain-med free. The worse part was having IVs placed so I had to walk slowly to the bathroom – and no tub time!
I hope this helps you in making decisions when you are faced with a possible induction. Always remember to discuss your options with your doctor and midwife.
Find out what labor induction methods are available in the hospital that you will be delivery in.
Weigh the risks and rewards for each of these decisions. Remember to do what you feel is best for you and your baby.