In cases in which you are definitely 41 weeks or further along and it seems your child is perfectly content to spend his infancy in your womb, your practitioner may recommend induction. Inducing labor involves both helping the cervix ripen for baby's passage and stimulating uterine contractions; both are important for a successful labor and delivery. If the cervix is not adequately effaced and dilated, the chance of interventions (for example, C-section or use of forceps) goes up. If you are a first-time mom, you are at increased risk of having a cesarean section as a result of a “failed induction.”
Cervical ripening decreases the chance of failed induction. Your provider may use one of several methods to facilitate cervical ripening, including membrane stripping and amniotomy (manual breaking of the membranes or bag of waters). Stripping (or sweeping) of the membranes is simply the separation of the amniotic membrane from the wall of the cervix. Your provider will insert her finger in the cervix and gently sweep it between the amniotic membrane and the uterine wall.
If she opts for amniotomy, she'll use an instrument with a small blunt hook on the end (an amnihook) to break through the amniotic sac. With the latter method, if labor does not start on its own within twenty-four hours, scheduled induction may be necessary because of the risk of infection for the baby.
Amniotic fluid that is greenish or brown in color may contain meconium, your baby's first bowel movement. The presence of meconium can indicate fetal distress. If you are leaking amniotic fluid and there are signs of meconium, the situation should be evaluated by your provider immediately.
Because a scheduled induction is more successful when the cervix is prepared for the experience, your practitioner may recommend an application of prostaglandin to your cervix the day prior or in the hospital. The prostaglandin helps to ripen the cervix for labor and delivery. In some cases it can be used alone as an inducing agent. The prostaglandin can take the form of a gel or tablet and can be inserted into the vagina. On some occasions the tablet is given orally. The baby's heart rate is assessed with a fetal monitor after the prostaglandin is given and during labor. More than one application may be ordered.
Manual dilators and Foley catheters can also be used for cervical ripening, as an alternative to the use of drugs. The type of cervical ripening method used depends on your personal preference, your medical history, and the cervical exam. Prostaglandins are not used in induction in women with a previous cesarean section since they can increase the risk of uterine rupture.
Pitocin, a synthetic formulation of the hormone oxytocin that stimulates uterine contractions, may be prescribed as an inducing agent. The hormone is given intravenously, and you will be hooked up to a fetal monitor to monitor your baby's progress.
According to the CDC, more than one in five births were induced in 2005. Researchers attribute the increase to earlier prenatal care, wider availability of induction agents, and nonmedical reasons such as convenience for the patient or doctor. Because induction can cause intense contractions and result in a longer labor, its use should always be carefully considered.