Most inductions use a combination of methods. Some of the most common are:
- Cervical ripening. If your cervix has not begun to soften or dilate (open), most doctors will apply a prostaglandin, a hormone-like "ripening" agent. Prepidil comes in a gel that is applied directly to your cervix; Cervidil is delivered via a tampon-like device. Misoprostol (Cytotec) is another prostaglandin drug that can be placed near the cervix or taken orally. (Cytotec is primarily an anti-ulcer drug and has not been approved by the FDA for labor induction, although doctors can prescribe it "off-label." It can cause serious side effects, such as severe bleeding and uterine rupture. Fetal and maternal deaths have also been reported.)
Be aware that cervical ripening can take days. Also, prostaglandins -- especially Cytotec -- should not be used on anyone who has had a previous c-section because of the increased risk of uterine rupture. If needed, doctors can manually stretch the cervix using balloon-like devices.
- Pitocin. Given through an IV, Pitocin (a synthetic form of the contraction-inducing hormone oxytocin) stimulates labor. The dose is slowly increased until a satisfactory labor pattern occurs.
- Breaking your water. Your care provider can manually break your bag of water with a small hook. This may start labor or jump-start a stalled labor. However, it increases the possibility of infection and, in rare cases, can lead to a prolapsed cord (a condition in which the cord is compressed with each contraction, cutting off oxygen to the baby). Because your uterus is now open to infection, it also puts a time limit on your labor (usually 24 hours).
- Nondrug techniques. They include stripping your membranes -- your caregiver uses a gloved finger to separate the bag of water from your cervix, causing your body to release natural prostaglandins.
Jennifer L.W. Fink is a writer in Mayville, Wisconsin, and a mother of three.
Originally published in American Baby magazine, August 2004.