Labor Induction and Augmentation

Overview

If you pass your due date and your labor does not start on its own, your doctor may want to try to start (induce) labor. Your doctor may suggest doing this for other reasons. It may be a good idea to induce labor if you have another problem. For example, it may be done if you have high blood pressure. Or it may be a good idea if the placenta can no longer give enough support to the baby.

There are several ways to induce labor, such as using medicine or breaking the amniotic sac.

After you have your baby, you should not have any side effects from the medicine used to start labor.

Ways to induce labor

There are several ways to induce labor.

• Medicine may be used to make the cervix soft and help it thin.
• Medicine may be used to cause the uterus to contract.
• A balloon catheter may be used to help the cervix open.
• Your doctor may sweep the membranes or break the amniotic sac to start or increase labor. This may be done if your cervix is soft and slightly open.

Medicine to soften the cervix or contract the uterus

• Misoprostol (Cytotec) is a pill to soften and thin the cervix. It is taken by mouth or placed in the vagina.
• Oxytocin (Pitocin) can be given through a vein (intravenously), usually after the cervix softens. It causes the uterus to contract.
• Dinoprostone (such as Cervidil or Prepidil Gel) can be inserted as a suppository into your vagina or as a gel into the cervix. When the cervix is ripe, labor may start on its own.

Balloon catheter to help induce labor

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 of the membranes to help induce labor

Sweeping of the membranes separates the amniotic membrane from the uterus enough so that the uterus starts to make 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.

Artificial rupture of the membranes to induce labor

To help start or speed up labor, your doctor may rupture your amniotic sac. (This is called rupture of the membranes.) It should only be done after your cervix has started to open (dilate) and the baby's head is firmly descended (engaged) in your pelvis.

Augmentation

If active labor has started on its own but contractions have slowed down or completely stopped, steps may need to be taken to help labor progress. This is called augmentation. It may be done when:

• Active labor has started, but your contractions are weak or irregular or have stopped entirely.
• You have gone into active labor, but the amniotic sac has not ruptured on its own. In this case, your doctor or nurse midwife may rupture the amniotic sac (amniotomy) to augment labor. If labor still does not progress, oxytocin (Pitocin) may be given to make the uterus contract.
• Active labor has started and the amniotic sac has ruptured on its own, but labor still is not progressing. Oxytocin (Pitocin) may be given to make the uterus contract.