A Brief Introduction to Induction Methods

In many cases, labor and birth don’t need anything to get started. However, inducing labor — getting it started using medications or devices — is sometimes safer if labor hasn’t begun on its own. Different induction methods can be used to bring on labor. If labor doesn’t start and your or your baby’s health could be at risk, a cesarean delivery (aka C-section) may be recommended.

You can often have a voice in deciding how you want to try to induce labor if it becomes necessary. There are several methods to choose from:

• Cervical ripening agents: A cervical ripening agent is a medication that softens, opens, and thins out the cervix. The cervix is the small organ between the vagina and the uterus. Opening up the cervix makes vaginal birth possible. The most common cervical ripening agents are prostaglandins. These are synthetic hormones taken by mouth or inserted in the vagina to open the cervix.
• Balloon catheter: A thin tube connected to one or more balloons can be inserted into the cervix to stretch the cervix and cause contractions in the uterus. Balloon catheters may be paired with cervical ripening agents.
• Oxytocin/Pitocin: Oxytocin and Pitocin are a hormone and synthetic hormone that cause contractions.
• Artificial rupture of membranes (AROM): With the ****artificial rupture of membranes (AROM), a small plastic hook is used to break your water. Breaking your water can lead to the baby moving into position for birth and the cervix opening up. It releases hormones that tell the body it’s time for birth.

When may labor induction be medically recommended?

Labor induction may be recommended when continuing the pregnancy is riskier than inducing delivery. These situations can include:

• Hypertension (high blood pressure)
• Protein in the urine
• Preeclampsia
• Pre-pregnancy diabetes
• Gestational diabetes
• Liver problems in pregnancy (choleostasis)
• HIV infection (depending on viral load)
• The baby isn’t growing
• Too little amniotic fluid
• Too much amniotic fluid
• The baby has an immune response to your blood (alloimmunization)
• Pregnancy with multiples (e.g., twins, triplets, etc.)
• History of stillbirth
• Pregnant for longer than 41 weeks

Are induction methods painful?

Anything that opens up the cervix can be painful. As the cervix opens, you may feel pressure and cramping. In some cases, you’ll be sent home with dilators in your cervix or a balloon catheter inserted. Whether you’re at your birthing location or at your home, you can work with your prenatal care provider to make sure you’re able to manage the pain.

Of the most common induction types, AROM comes with the least associated pain. If you’re concerned about feeling too much pain, that could be a good option for you.

Are some induction methods more effective than others?

Research points to trying prostaglandins or balloon catheters before moving on to oxytocin/pitocin or AROM. For people who are giving birth for the first time, using a combination of methods to open up the cervix is the safest way to decrease labor time. Finally, for most people, pitocin (the synthetic version of oxytocin) is recommended after the cervix has been opened and before active labor.

Talk to your prenatal care provider about what induction methods feel comfortable for you. You can come up with a few options to try before moving on to a C-section. Remember that your plans may change if issues come up. Your provider’s top priority is keeping you and your baby safe.

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Sources:

• https://www.aafp.org/pubs/afp/issues/2022/0200/p177.pdf
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8363560/