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As the end of pregnancy nears, the
cervix normally becomes soft (ripe) and begins to open
(dilate) and thin (efface), preparing for labor and delivery. When labor does
not naturally start on its own and vaginal delivery needs to happen soon, labor
may be started artificially (induced).
Even though inducing labor is a fairly common practice, childbirth
educators encourage women to learn about it and about the medicine for
stimulating a stalled labor (augmentation) so that the women can help decide
what is right for them.
When labor is induced for medical reasons, it is usually because it's safer for you to have the baby now rather than risk further problems from staying pregnant.
Your labor may be induced for one of the
Some women ask to have their labor induced when there isn't a medical reason for it (elective induction). And sometimes doctors will induce labor for nonmedical reasons, such as if you live far away from the hospital and may not make it to the hospital if you go into labor.
In these situations, your doctor will wait until you are at least 39 weeks, because this is safest for your baby.
When labor does not happen as expected or as needed, inducing
labor is preferred over delivering by
cesarean section. If labor induction isn't successful,
another attempt may be possible. In some cases, a cesarean delivery is best for
the mother and baby, depending on their conditions.
There are several ways to induce labor contractions.
The cervix is thought to be ripe and ready for active labor when it is
soft, well dilated, and effaced, and when the cervix and baby are positioned
low in the pelvis. If the cervix is not ripe enough, medicines may be continued
until it is.
A balloon catheter, such as a Foley catheter, is a narrow tube with a small balloon on the end. The doctor inserts it into the cervix and inflates the balloon. This helps the cervix open (dilate). The catheter is left in place until the cervix has opened enough for the balloon to fall out (about 3 cm).
Sweeping, or stripping, of the amniotic membranes is a simple first
step used to try to start labor. Sweeping of the membranes separates the
amniotic membrane from the uterus enough so that the uterus starts making
prostaglandins. This type of chemical helps trigger
contractions and labor. After the cervix is open a little, this step can easily
be done in your doctor's or nurse-midwife's office.
Sweeping the membranes works in 1 out of 8 women. This means that
it starts labor without needing to use oxytocin or artificially rupture the
membranes.2 To sweep the membranes, your doctor or
nurse-midwife reaches a gloved finger through the cervix. He or she then
"sweeps" the finger around the inside edge of the opening.
Sweeping the membranes is low-risk. It does not raise your risk of
infection. You may start to feel uncomfortable afterward, with irregular
contractions and some bleeding.2
To help start or speed up labor, your doctor may
rupture your amniotic sac (rupture of the membranes). This should only be done
after your cervix has started to open (dilate) and the baby's head is firmly
descended (engaged) in your pelvis. If the membranes are ruptured too early,
there is a risk of the umbilical cord slipping down around or below the baby's
head (cord prolapse). If the cord gets squeezed between the baby's head and the
pelvis bones, the blood supply to the baby may be reduced or stopped.
To rupture your amniotic sac (amniotomy), your doctor
inserts a sterile plastic device into your
vagina. This device may look like a long crochet hook
or may be a smaller hook attached to the finger of a sterile glove. The hook is
used to pull gently on the amniotic sac until the sac breaks. This procedure is
usually not painful. A large gush of fluid usually follows the rupture of the
amniotic sac. The uterus continues to produce amniotic fluid until the baby's
birth. So you may continue to feel some leaking, especially right after a hard
If active labor has started on its own but contractions have slowed
down or completely stopped, steps need to be taken to help labor progress
(augmentation). Augmentation will be done when:
If labor fails to progress in spite of membrane sweeping, an
amniotomy, oxytocin, or a combination of these measures, delivery by cesarean
section may be considered.
American College of Obstetricians and Gynecologists
(2009, reaffirmed 2013). Induction of labor. ACOG Practice Bulletin No. 107. Obstetrics and Gynecology, 114(5, Part 1): 386–397.
Boulvain M, et al. (2005). Membrane sweeping for
induction of labour. Cochrane Database of Systematic Reviews (1).
November 13, 2013
Kathleen Romito, MD - Family Medicine & Kirtly Jones, MD - Obstetrics and Gynecology
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