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Labor Induction and Augmentation - Topic Overview

Labor induction

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 following reasons:

  • Your pregnancy has gone 1 to 2 weeks past the estimated due date.
  • You have a condition (such as high blood pressure, placenta abruptio, infection, lung disease, preeclampsia, or diabetes) that may threaten your health or the health of your baby if the pregnancy continues.1
  • Your water (amniotic sac) has broken but active labor contractions have not started.
  • Your baby has a condition that needs treatment, and the risks of vaginal delivery are low. Induction and vaginal delivery are not attempted if the baby may be harmed or is in immediate danger. In such cases, a cesarean delivery (C-section) is usually done.

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.

Ways to induce labor

There are several ways to induce labor contractions.

  • Medicine may be used to soften the cervix and help it thin (efface).
  • Medicine may be used to cause the uterus to contract.
  • A balloon catheter (such as a Foley catheter) may be used to help the cervix open.
  • If your cervix is soft and slightly open, sweeping the membranes or rupturing the amniotic sac (amniotomy) may start or increase contractions.
  • If labor does not progress after an amniotomy, medicine such as oxytocin (Pitocin) can be used to stimulate contractions.

Medicine to ripen the cervix and induce labor

  • Misoprostol (Cytotec) is a pill taken by mouth or placed in the vagina (using a smaller dose). It is a medicine currently approved for treating ulcers. Using it for cervical ripening is a widely accepted but unlabeled use of this medicine.
  • Oxytocin (Pitocin) can be given through a vein (intravenously) in small amounts to ripen the cervix. But it usually is given after the cervix softens, to cause the uterus to contract. Labor that is induced by oxytocin usually starts off harder and progresses faster than labor that starts on its own, especially in first-time mothers. If oxytocin does not induce labor or if the baby's heart rate indicates distress, a cesarean delivery (C-section) may be needed.
  • Dinoprostone (such as Cervidil or Prepidil Gel) can be inserted as a suppository into your vagina (intravaginally). It can also be given as a gel that is gently squirted into the opening of the cervix (intracervically). When the cervix is ripe, labor may start on its own.
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