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Inducing Labor

If you've reached this point in your pregnancy without going into labor, then you may be champing at the bit and ready to leap at any suggestion to speed things up. By 42 weeks, your practitioner may suggest inducing labor artificially. Many providers will consider this even earlier, at 41-42 weeks, especially if your cervix is open already.

About 15 percent of all labors are artificially induced in the United States, and there are certainly many situations where inducing labor seems like the best choice for both mom and her baby.

If you're overdue, your practitioner may want to induce labor before your placenta ages too much--an aging placenta can deprive your baby of essential nutrients and oxygen. One of the first signs that the placenta is not working well is a decrease in the amount of amniotic fluid. You may notice that the baby is less active. At that point, the baby may be better off out than in. Induction jump-starts a labor that may not have naturally begun until several days in the future; it also increases the risk of ending up with a cesarean delivery. However, babies who are not thriving anymore in utero may be much happier in your arms, even if the induction fails and the baby is delivered by cesarean.

After 42 weeks, there's a greater risk of your baby inhaling meconium--his first bowel movement--or suffering from dysmaturity syndrome. Hallmarks of dysmaturity syndrome include a thin face, overly long limbs, prominent eyes, and skin as thin as parchment paper. Babies with dysmaturity syndrome are less likely to tolerate the stress of labor. It's also possible that incubating your baby too long will result in a baby too large to fit through your pelvis--that's another situation where the risk of cesarean delivery is possibly higher.

There are many other circumstances that would prompt your provider to offer you induction. If you are full-term, for example, and have been struggling with mild preeclampsia, you may be induced to cure your preeclampsia. You also may be induced if your baby seems very small and you are full-term.

If your provider suggests inducing labor, gather all of the information you can in the time allowed. An induced labor is generally longer than a natural labor. The contractions are as strong as those you'd experience in natural labor, but there may be no gradual increase in their intensity. If prolonging your pregnancy carries a significant health risk for you or your baby, however, an induced vaginal delivery is generally considered better for both you and the baby than a cesarean delivery.

Doctors have several methods of inducing labor. The one your practitioner uses will depend on a number of factors, such as the readiness of your cervix and your baby's health.

Membrane stripping. Your health care provider will do a cervical exam, and with her finger, she will separate the amniotic sac from the wall of the uterus. Many women have cramping and spotting after this is done. When the membrane is separated, prostaglandins are released, and these ripen the cervix by causing contractions. Membrane stripping can be done only if your cervix is dilated.

Ripening the cervix. Before inducing labor, your practitioner may use a point system called a "Bishop Score" to determine whether your cervix is ready for labor. She will examine your cervix to see how effaced and dilated it is and will check to see if your baby has descended into your pelvis. Studies show that induced labors are most effective in women whose cervices are ready for labor, so if yours isn't, your health care practitioner may help things along by using one of several ripening agents. These include prostaglandin E suppositories, a prostaglandin-laced gel, prostaglandin on a vaginal device, or a prostaglandin tablet. Some women who go this route go into labor within 24 hours without needing to have any other intervention.

Other tricks used to open your cervix include laminaria (seaweed sticks, which absorb water from the cervix and slowly open it) or a urine catheter bulb (which gets blown up in the cervix and gradually opens it). Rupturing the membranes. Your practitioner may insert an obstetric tool that looks a little like a crochet hook through your cervix to tear a small hole in your amniotic sac. (This technique is also called an "amniotomy.") It mimics what sometimes happens in nature when your water breaks before labor begins. This procedure can be uncomfortable if you're less than a centimeter dilated, but otherwise it doesn't hurt at all. If labor doesn't begin within 24 hours after your water is broken, your practitioner may then induce you with Pitocin or another method to decrease the risk of infection.

Pitocin drip. Pitocin is a synthetic form of oxytocin, which is your body's contraction-inducing hormone. It's one of the most commonly used drugs in the United States. For most pregnant women, labor begins in part as a result of higher levels of oxytocin in the blood; your practitioner is aiming to mimic this natural process by administering Pitocin. If your labor is induced with Pitocin, you will be admitted to the hospital where you will have an IV needle inserted into your arm. It usually takes at least 30 minutes for the Pitocin to kick in, and your practitioner will probably start slowly and monitor your reactions and your baby's response to the drug as it builds in your system. There is no guarantee of rapid labor with Pitocin; still the uterine contractions may be strong, and each contraction may last 1 minute or more. Many women find that the breathing exercises they've practiced for labor help them a good deal during an induced labor as well.

Labor induction is a process, and if this is your first baby, you may have one or more interventions. For example, cervical ripening followed by Pitocin is an everyday occurrence. Ask your provider for an overview of what you can expect and then sit back and be patient.

Originally published in You & Your Baby: Pregnancy.

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