If your labor hasn't started on its own, your practitioner can use certain techniques to bring on (or "induce") contractions. She can use some of the same procedures to augment, or speed up, your labor if you stop progressing for some reason. According to the U.S. Centers for Disease Control, about one in five births in the United States is induced.
Why would my labor be induced?
Your labor might need to be induced if the risks of prolonging your pregnancy are higher than the risks of delivering your baby right away. The most common reasons for this include:
• Your water breaks and your labor doesn't start on its own within a reasonable amount of time. (Exactly how long that is will depend on your healthcare practitioner and your particular situation.)
• You're still pregnant one to two weeks past your due date. Most practitioners won't let you wait longer than that to give birth because it puts you and your baby at greater risk for a host of problems. For example, it's more likely you'll develop an infection in your uterus that could be dangerous for your baby, or that your placenta will stop functioning properly, which could lead to a stillbirth or a baby born with serious problems. What's more, your labor is more likely to be prolonged or stalled, both you and your baby have an increased risk of injury during a vaginal delivery, and your chances of needing a c-section are higher.
• Tests show that, for whatever reason, your placenta isn't functioning properly, you have too little amniotic fluid, or your baby isn't thriving or growing as he should.
• You develop preeclampsia, a serious condition that can endanger your health and restrict the flow of blood to your baby.
• You have a chronic or acute illness — such as high blood pressure, diabetes, or kidney disease — that threatens your health or the health of your baby.
• You've previously had a full-term stillbirth.
What are some of the techniques used to induce labor?
The methods your practitioner would use to induce labor depend on the condition of your cervix at the time. If your cervix hasn't started to soften, efface (thin out), or dilate (open up), it's considered "unripe," or not yet ready for labor. In that case, your practitioner would use either hormones or "mechanical" methods to ripen your cervix before the induction. Sometimes these procedures end up jump-starting your labor as well.
Some of the methods used to ripen the cervix and induce labor are:
• Stripping or sweeping the membranes. If your cervix is already somewhat dilated, your practitioner can insert her finger through it and manually separate your bag of waters from the lower part of your uterus. This causes the release of hormones called prostaglandins, which may help further ripen your cervix and possibly get contractions going. In most cases, this procedure is done during an office visit. You're then sent home to wait for labor to start, usually within the next few days. Many moms-to-be find this procedure uncomfortable or even painful, though the discomfort is short-lived.
• Using prostaglandin medications. Your practitioner may try to ripen your cervix by inserting medication that contains prostaglandins into your vagina. This medication may also stimulate contractions — sometimes enough to jump-start your labor.
• Using a Foley catheter. Your practitioner may insert a catheter with a very small uninflated balloon at the end of it into your cervix. When the balloon is inflated with water, it puts pressure on your cervix, stimulating the release of prostaglandins, which cause the cervix to open and soften. When your cervix begins to dilate, the balloon falls out and the catheter is removed.
• Rupturing the membranes. If your cervix is at least a few centimeters dilated, your practitioner can insert a small, plastic hooked instrument into it and break your bag of waters. This procedure causes no more discomfort than a vaginal exam. If your cervix is very ripe and ready for labor, there's a small chance that this alone might be enough to get your contractions going. If that doesn't happen, your practitioner will give you the drug oxytocin (Pitocin) through an IV. Once your water has broken, most practitioners will want you to deliver within the next 12 to 24 hours because the risk of infection for you and your baby increases over time.
• Using Pitocin. Pitocin is a synthetic form of the hormone oxytocin, which your body naturally produces during labor. Your practitioner may give you this drug through an IV pump to start or augment your contractions. She can adjust the amount you need according to how your labor progresses.
What risks are associated with inducing labor?
The primary risk you face if you're induced is that the induction won't work and you'll need a cesarean. The process of ripening the cervix and then inducing labor with oxytocin can take a long time. If you still haven't gone into labor after 24 to 48 hours, your practitioner may consider it a failed attempt and you'll have to deliver by c-section. This process can be very hard psychologically on you and your partner. What's more, having a c-section after a failed induction is associated with higher rates of complications, especially infection, and longer hospital stays.
In addition, certain techniques, including using Pitocin, prostaglandins, or nipple stimulation, occasionally hyperstimulate the uterus (meaning you have contractions that come too often or are abnormally long and strong), which in turn can stress your baby. In rare cases, prostaglandins or Pitocin also cause placental abruption or even uterine rupture, though ruptures are extremely rare in women who've never had a c-section or other uterine surgery. (Prostaglandins are associated with a relatively high rate of rupture in women attempting a vaginal birth after a cesarean (VBAC), so they should never be used if that's the case. And some experts don't think women attempting VBAC should be induced with Pitocin, either.)
To assess both the frequency and length of your contractions as well as your baby's heart rate, you'll need to have continuous electronic monitoring during an induced labor. In most cases you have to lie or sit while being monitored, but some hospitals offer telemetry, which lets you walk around during the process.
Remember that your practitioner will recommend inducing your labor only when she believes that the risks to you and your baby of waiting for labor to begin on its own are higher than the risks of intervening.
Are there any circumstances in which my labor shouldn't be induced?
Yes. You'll need to have a c-section rather than a labor induction whenever it would be unsafe to labor and deliver vaginally, including the following situations:
• Tests indicate that your baby needs to be delivered immediately or can't tolerate contractions.
• You have a placenta previa; you have a vasa previa (when blood vessels from the umbilical cord are embedded in the amniotic membranes and at risk for rupture during labor); or the cord is lying in front of your baby's head and could be compressed as his head enters the birth canal or prolapse through your cervix when your water breaks.
• Your baby is in a breech or transverse position, meaning that he's not coming head-first.
• You've had more than one c-section. (Some practitioners believe that women with even one previous c-section shouldn't be induced.)
• You had a previous c-section with a "classical" (vertical) uterine incision or other uterine surgery, such as a myomectomy (surgery to remove fibroids).
• You're having twins and the first baby is breech, or you're having triplets or more.
• You have an active genital herpes infection.
Are there any techniques I can try myself at home to get my labor going?
No do-it-yourself methods have been proven consistently to be both safe and effective. Here's the scoop on some of the techniques you may have heard about:
• Nipple stimulation: Twisting or pinching your nipples releases your own natural oxytocin. A few studies have found it to be effective in getting labor going within 72 hours if your cervix is already ripe, but the method has not been well studied. And don't try it at home: Nipple stimulation requires monitoring because it can sometimes cause prolonged contractions that could stress your baby and depress his heart rate.
• Sexual intercourse: Having sex won't induce labor, but it can't hurt to try! Semen contains some prostaglandin, and having an orgasm may stimulate a few contractions.
• Castor oil: Castor oil is a strong laxative, and stimulating your bowels may cause some contractions, but no good studies have proven it consistently effective, and you're likely to find the effect on your gut very unpleasant.
• Herbal remedies. A variety of herbs are touted as useful for labor induction. Some are risky because they can hyperstimulate your uterus (and may be unsafe for your baby for other reasons as well), and the safety and effectiveness of others remains unproven.