How does a doctor induce labor?

Q: I'm a few days past my due date. What are some of the ways my doctor might induce labor?

A: If your doctor decides that inducing labor is in your and your baby's best interest, there are a few different ways to go about it. He or she may first try an in-office technique to help kick labor off on its own. Called stripping the membranes, it's basically a more intense version of a pelvic exam. It involves feeling around your cervix to separate the membranes that connect the amniotic sac to the wall of the uterus. This causes your body to release prostaglandins, the hormone-like substances that may help get labor started. However, not every physician opts to do this, since it doesn't always work and can be painful for you. Also, stripping the membranes doesn't mean labor will start right away; it may still take a few days for everything to really get going. If your doctor opts for a more immediate approach, you'll be admitted to the hospital and will have one or several of the following methods, depending on the condition of your cervix and what your doctor feels will be most effective.

If your cervix is not ripe (meaning it has not started dilating or becoming effaced), your doctor will likely try:

• Prostaglandin suppositories or pills: Small pills called Misoprostol are placed in the vagina every few hours; suppositories called Cervidil are inserted into the vagina every 12 hours. Both types of medication release prostaglandins to help get your cervix ready for labor. • Foley bulb: This is a small balloon that's inserted into your cervix and then inflated, forcing it to begin opening (similar to doing an angioplasty to clear clogged arteries).

If your cervix is dilated, but contractions just haven't begun, your doctor will likely try:

• Pitocin: This drug mimics the hormone oxytocin, which signals your uterus to begin contracting. It can be used to get labor started or rev up sluggish contractions.• Rupturing your membranes: Your doctor may intentionally break your water to get labor started. Sometimes this does the trick; other times it has to be done in conjunction with Pitocin.

Remember that going just a few days past your date doesn't necessarily mean you'll be induced. The waiting game can be frustrating, but try to relax and take advantage of the down time -- you'll certainly be busy enough after the baby arrives! And trust that you will not be pregnant forever. In fact, most doctors won't allow you to go more than two weeks past your due date, because the placenta can start to age and deteriorate, compromising baby's blood and oxygen supply.

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