Different methods of medical induction of childbirth


After nine long and tiring months, you are more than ready for your package of joy to make its way into the world. You have been looking forward to the moment when your water breaks, and you have to rush to the hospital. You even dreamed of keeping your little one for the first time.

But before you can look for your partner’s eyes and smile on your baby’s precious face, you must first go through the birth. As with anything during pregnancy, there is always room for unpredictability. You may need to induce a medical birth with the help of your provider.

When will a doctor or midwife recommend induction?

There are some conditions when a doctor or midwife recommends medical induction. First, they will evaluate the health of you and your baby. They will take into account your baby’s gestational age, your baby’s weight and size, your baby’s position, and the condition of your cervix. After weighing the benefits and risks, you and your caregiver will determine if medical induction is the next best step. According to the Mayo Clinic, these are the medical reasons you may be induced:

  • Pregnancy after term – After approaching two weeks after the due date and the birth did not start naturally.
  • Rupture of membranes before birth – Your water is broken, but you have no contractions.
  • Chorioamnionitis – Your uterus has an infection. (That’s why your medical team will check your temperature regularly to make sure it’s not elevated, which may be a sign of an infection.)
  • Restriction of fetal growth – This is also known as intrauterine growth retardation (IUGR). This is when the baby does not grow at the expected rate during the mother’s pregnancy and your baby’s expected weight is less than the 10th percentile for gestational age.
  • Oligohydramnios – When there is a small amount of amniotic fluid around the baby.
  • Gestational diabetes – When you develop diabetes during pregnancy.
  • Disorders of high blood pressure during pregnancy
    • Preeclampsia – A complication of pregnancy characterized by high blood pressure and signs of damage to another organ system, usually the liver and kidneys. It usually starts after 20 weeks of pregnancy in women whose blood pressure has been normal.
    • Chronic high blood pressure – High blood pressure that was before pregnancy or occurred 20 weeks before pregnancy.
    • Gestational hypertension – High blood pressure that develops after 20 weeks of pregnancy.
  • Detachment of the placenta – When the placenta separates from the inner wall of the uterus before birth – partially or completely.
  • Certain medical conditions – Other medical conditions such as kidney disease.

Different methods for medical induction of labor

Here’s what you need to know about the options available and it may be recommended to bring your body into labor mode.

Amniotomy

What is?

Also called artificial membrane rupture (AROM) or the most popular “water breaking”. An amniotomy is a quick procedure in which your doctor will intentionally rupture the amniotic sac.

How is it applied?

The process is complete while you are in bed in the delivery room. Your provider will use a small surgical hook called an amnihook, which is inserted into the vagina and cervix to pierce the membranes in the amniotic sac. This will release amniotic fluid as well as natural hormones that can stimulate contractions. There are no nerve endings in the amniotic sac, so this is a painless procedure. It feels like an examination of the cervix and then a discharge of warm fluid. Once the procedure is complete, expectant mothers usually give birth within a few hours. However, this is not guaranteed.

Cervidil (dinoprostone)

cervidil

What is?

For pregnant mothers who are either near or near the end of their pregnancy, Cervidil is an option that doctors may recommend to help with maturation (also known as softening) and cervical dilation. The vaginal insert is infused with a synthetic version of prostaglandin – a hormone-like substance found naturally in the body and responsible for the cramps you feel during menstruation. By using prostaglandins, the muscles of the cervix relax and labor can begin.

How is it applied?

Similar in shape and size to a tampon, Cervidil is inserted into the vagina by your healthcare provider. It will stay in place until you no longer need it or after 12-24 hours. You will notice a long strip that is attached to the insert. But it is important not to pull or remove it, as it is necessary when your doctor needs to remove it. (Here’s a video to see how it’s administered.)

Cytotec

What is?

Cytotec is used in pregnant women whose cervix is ‚Äč‚Äčlong, closed or immature. It helps to soften the cervix so that it can properly expand and cause uterine contractions.

How is it applied?

Cytotec is available as pills and is taken orally with water. Another option is to place the pill at the end of your vaginal canal (called a vaginal Cytotec). The pill dissolves quickly and lasts longer than the oral form.

Foley balloon

What is?

A foil balloon (or foil bulb) is a small balloon-like instrument attached to the end of a catheter and used to open the cervix and help it reach abrasion (stretch and become thinner).

How is it applied?

The uninflated balloon is inserted into the cervix through the catheter and filled with saline to inflate the device. The foil bulb will put pressure on the cervix to expand it. Once the cervix expands (usually about 4-5 inches), the foil bubble will fall off.

Membrane Removal / Erasure

What is?

Membrane removal or membrane cleansing is a procedure that ends when you are either full-term (39 to 41 weeks of gestation) or partially enlarged to help induce labor.

How is it applied?

Membrane throwing can be completed during your regular doctor’s visits when you are close to or the due date has expired. Your doctor will insert a finger into the vagina and up through the cervix to move it by hand and separate the thin membranes connected to the amniotic sac. When the membranes are removed, the body can release prostaglandins to help produce contractions and prepare the cervix for childbirth.

Pitocin

A young pregnant woman in the hospital ward is medically induced and ready to give birth to a baby.

What is?

To help start the contractions, your doctor may recommend the use of Pitocin. This is one of the most common methods of medical induction of labor. The drug, a commonly used drug at birth, is an artificial variation of oxytocin – a natural hormone produced to help the uterus contract and is also released when a woman’s body is ready for childbirth.

How is it applied?

Pitocin is given intravenously in your hand while you are in the delivery room. Your nurse will slowly increase the dose to start your contractions. It is removed when you experience contractions with an interval of two to three minutes.

Whether your body can cause a natural birth or you have to cause a medical birth, all that matters is that you can hold your new baby in your arms. But knowing your options before you begin the process will help you and your provider make the best choice when and if needed.



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