Ways to induce labor: a practical guide to inducing labor
Why induce labor?
Induced labor means starting your labor artificially rather than waiting for nature to take its course. Your doctor or midwife might recommend inducing labor if you develop complications such as pre-eclampsia or diabetes, if your waters break and labor does not start naturally within 72 hours, or if your baby isn’t born two weeks after your due date.
But your due date is not an exact science - neither scans nor the calculation used to determine your baby’s due date are 100% accurate. Only 4 out of 100 babies are born on their due date, and it’s perfectly normal to have your baby between 38 and 42 weeks of pregnancy.
Medical ways to induce labor
> Cervical sweep
A cervical sweep (or membrane sweep) can be carried out at home, at your prenatal appointment, or in hospital. A midwife or doctor will insert a finger inside your cervix and attempt to ‘sweep’ the membranes away from the cervix in order to induce labor. You may experience some discomfort, cramps and / or bleeding.
During an internal examination, a gel or vaginal pessary containing a hormone, which can help to shorten and soften your cervix, is placed close to the neck of the womb. You’ll be monitored and may need further doses.
> Amniotomy (Breaking your waters)
This procedure can’t be carried out unless your cervix has started to dilate. It’s performed in hospital by a midwife or doctor during an internal examination, often following a prostaglandin induction.
Syntocinon is administered in hospital via drip. It’s a drug which helps stimulate stronger contractions. It may be recommended following an amniotomy if labor has not begun within two hours.
What are the risks of inducing labor?
Induced labor tends to be more painful than a labor that starts spontaneously, so do talk to your doctor or midwife about your options for pain relief if you decide to be induced.
Freelance midwifery adviser Sheena Byrom says: ‘In my experience, inducing labor often initiates a 'cascade of intervention' as labor doesn't naturally progress and is harsh and far more painful, so I wouldn't recommend it unless medically indicated.’
If you’re induced you’re more likely to need an epidural and assisted delivery, and your mobility may be restricted as you’ll need to be closely monitored. Other risks include hyperstimulation of the uterus, which can affect your baby’s heartbeat and cause distress.
The risks are greater for women who have had caesarean sections.
Can I have a home-birth if I am induced?
No. If you decide to be induced you won’t be able to give birth at home, in a midwife-led unit or birth center, or in a birthing pool.
Can I refuse to induce labor?
Yes. You have the right to decline an induction and wait for labor to start naturally.
The World Health Organization (WHO) have produced guidelines as to when it's appropriate to induce labor.
Though it's thought the placenta will start to decline in efficiency in a prolonged pregnancy (over 42 weeks), there isn't sufficient medical evidence to say whether or not a gestion period of over 42 weeks is harmful for you or the baby.
If you refuse an induction then you and your baby will be carefully monitored to make sure there's no signs of fetal distress or health concerns.
Are there any benefits to being induced?
Only if there are serious medical grounds for inducing labor.
How can I induce labor at home?
Here are some ways to induce labor naturally...
> Home methods of inducing labor include:
- Having sex (hugs before drugs)
- Having your nipples stimulated
- Drinking raspberry leaf tea
- Eating spicy food
- Going for long walks
> Other natural ways of inducing labor include:
Pros and cons of natural induction
There is no formal evidence that natural methods of inducing labor work but in view of the risks of medical induction, you might want to consider natural methods before you agree to induction.
Marie Mongan, M.Ed., M.Hy., of Concord, N.H, award-winning hypnotherapist and founder of HypnoBirthing (The Mongan Method) advises 'Hugs before drugs'.
Her program recommends that women do try sex, nipple stimulation and long walks to get labor started but insists that the baby knows when it wants to be born and that moms should wait for a natural start to labor so long as it's safe to do so.
HypnoBirthing advocates that a naturally started labor leads to an easier, less painful birth that is less stressful for the baby and mother.
Mom of four and homeopath Sarah Ockwell-Smith, 35, is a doula and parenting author from England, and director of BabyCalm. She advises caution when trying home methods of induction.
‘Lots of women try eating pineapple etc in the belief that it’s possible to induce labor naturally,’ she says. ‘But all those things are urban myths. Stimulating your nipples can ripen your cervix but that’s not the same as inducing labor, and there is evidence that drinking castor oil can induce labor - but it’s also likely to cause diarrhea, tummy pains, nausea and vomiting, so isn’t advisable.'
World Health Organization: General principles related to the practice of induction of labor
- Induction of labor should be performed only when there is a clear medical indication for it and the expected benefits outweigh its potential harms.
- In applying the recommendations, consideration must be given to the actual condition, wishes and preferences of each woman, with emphasis being placed on cervical status, the specific method of induction of labor and associated conditions such as parity and rupture of membranes.
- Induction of labor should be performed with caution since the procedure carries the risk of uterine hyperstimulation and rupture and fetal distress.
- Wherever induction of labor is carried out, facilities should be available for assessing maternal and fetal well-being.
- Women receiving oxytocin, misoprostol or other prostaglandins should never be left unattended.
- Failed induction of labor does not necessarily indicate caesarean section.
- [However] wherever possible, induction of labor should be carried out in facilities where caesarean section can be performed.
By Heidi Scrimgeour