4. Induction Series: Part 2 - Methods of Induction of Labor

In 2020, more than 30% of births in the United States were inductions. One out of every 3 babies came out before they were ready. That’s up from 9% in 1990. In my previous blog post, I discussed many of the reasons why an OB might suggest an induction of labor. This time we’re going to dive into the different methods that the OB can use to get your labor going, all of which have risks. Even the simplest induction methods can lead to emergency c-sections, maternal death or fetal demise, but we’re going to get more into that in the next blog post. Some of these methods that I mention will be the first steps that your OB will try to get your labor going. 

Whenever you go into the OB’s office, you need to know your rights. Know that you don’t have to schedule this induction appointment or even go when the time comes and if an induction attempt fails, you can go home! You can tell your OB that you think your body needs more time and you can leave. The first induction method is the first step that can lead to the cascade of intervention, which is an easy way to end up with a traumatic birth experience if it’s medically unnecessary or done too early. If an induction attempt fails, maybe that’s a sign that baby isn’t as ready as your OB thinks. 

The next few induction methods that I’m doing to go over are all applied or performed at the cervix in an attempt to ripen or dilate.

To start out, we’ll go with one of the earliest induction methods, the membrane sweep. If your OB is wanting to get things started, this is one of the first options that can be attempted by your doctor and will sometimes be performed as early as 38 weeks. The doctor or midwife will insert their finger inside the cervix and sweeps around the inside, separating the amniotic sac from the cervix. This can do nothing or it could cause a premature rupture of membranes. 

An amniotomy, or artificial rupture of membranes, or breaking the bag of water is something the OB or midwife can do that might get labor going. The cervix has to be at least 3 cm dilated for the OB or midwife to successfully break the bag. This is sometimes used to start labor or to augment it once labor has already started. As mundane as this procedure seems, rupturing the membranes can cause cord prolapse which is life-threatening to the fetus. The cord slips down through the cervix in front of the baby’s head which cuts off the blood supply from the placenta to the baby. 

Cytotec or misoprostol, which is also the “abortion pill,” can be taken orally or placed on the cervix to induce cramping. This synthetic prostaglandin is actually indicated as a stomach ulcer medication, but a side effect of this drug is uterine contractions. Cytotec is not FDA approved (not that that approval means much these days) for use during pregnancy or labor. 

Cervidil is another prostaglandin drug that is applied directly to the cervix. If successful, it can ripen the cervix and help it dilate more easily. 

Laminaria, which is dehydrated kelp - yes, the plant that grows underwater - that is rolled into a rod and inserted in the cervix. It absorbs the moisture from the surrounding tissues and swells to its original size. This swelling stretches the cervix and causes a release of prostaglandins that can ripen the cervix for further dilation.

A foley balloon is a medical device that is inserted into the cervix and then inflated -like a balloon- with a saline solution to manually open the cervix, similar to the laminaria. It is left in until the cervix has opened enough for it to fall out. 

Pitocin, a synthetic oxytocin, is used to get uterine contractions going before your body is ready. They create much stronger and longer contractions than your natural oxytocin which is why many women complain that these contractions hurt much worse than natural contractions. Due to the greater strength and length, they can very easily lead to fetal distress. Doctors will usually try another method before or alongside Pitocin to help get labor going faster. Many OBs like to use the words oxytocin and Pitocin interchangeably, but they are different. Pitocin does not cross the blood brain barrier and interrupts the body’s natural feedback loop and interferes with bonding for the mother and baby because neither are receiving the benefits of the body’s natural oxytocin hormone, but we’ll dive more into that in the next blog posts regarding risks. 

All of the methods mentioned above are considered medical induction methods, but now I’d like to look at natural induction methods that you can do at home if your OB is urging you book a medical induction appointment with him. 

The first method, and maybe the best is sex. Remember those prostaglandin hormones that ripen the cervix and prepare it for dilation? Well, it turns out that sperm have very high amounts of prostaglandins, so when you get it on with your partner, not only will you be increasing your oxytocin levels, you’ll be introducing prostaglandins to your cervix. How’s that for an induction method? 😉

Nipple stimulation is another easy way that may get your body in gear to get labor to start. You can do this, your partner can do this, and if you are at full term, you can even use a breast pump. Hot tip on the breast pump, if you are able to harvest any colostrum, the sticky yellow/orange milk your body produces as your first sources of food for your baby, save that just in case baby needs a little pick me up after labor and doesn’t latch right away. You can buy small syringes to keep the milk in until baby comes. Just remember to keep it in the fridge.

Walking may be able to help the baby engage in your pelvis and apply pressure to your cervix which increases oxytocin which can help get contractions going or help them stay regular. If you are in established labor, I’d be careful with this one. You don’t want to walk 5 miles, tire yourself out, and be too exhausted to get through labor, but a quick 10-20 minute walk a day to try to get labor going or keep it going is okay, but always listen to your intuition. Curb walking can also help create more space in the mid pelvis which can help a baby with a funky lie get into a better birthing position. To do this, you just walk along side a curb, with one leg on the curb and the other on the ground. Yeah, it feels silly, but it works!

On the topic of castor oil, it can be a very effective tool of inducing labor if you’re already close to going into labor naturally, but there are also some pretty gnarly side effects, as well. So, I wouldn’t use this unless you were really trying to avoid a medical induction, and definitely as a last resort. Castor oil is a stimulant for your bowels, which in turn can irritate your uterine muscles, inducing contractions. It tends to work better on multiparous women, meaning those that have had at least one birth before. 

As for spicy foods, like castor oil they can irritate the gut, but there’s no evidence backing them up as a legitimate method for induction, but if you feel like having some Mexican food for dinner, you go right ahead!🌶️

As discussed in my previous post, there ARE medically indicated reasons for an induction of labor, so you as a mother need to listen to your intuition, do a little bit of research and do what feels right to you because we are past the age of listening and following people blindly just because of the letters after their name. See: the year 2020. 

Having an induction of labor comes with risks, which we’ll discuss next week. If you have a medical condition, NOT being induced comes with risks as well. Everything depends on your specific personal situation and you should be treated that way. Not like a number.