Getting labor started
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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