Ways to induce labour

If you are overdue for more than 42 weeks and nothing is happening naturally, a decision to induce is taken. In some cases, induced labour may be an alternative even before the estimated delivery date. This can be the case if the mother has a health issue, such as diabetes or other illness, preeclampsia, problematic pregnancy pains, severe fears of delivery or if the water has broken but no contractions have started. Induced labour may also be necessary if the baby doesn’t grow normally or if it is unwell.

How long an inducement takes, as well as the choice of method, depends on the status of the mucus plug, other present circumstances and how the mother is anticipated to react to various methods. If ripening has occurred, the mucus plug is soft, forward-tilted, short and the cervix has started to dilate, while the mucus plug is long, closed, firm and backward tilted before ripening. If ripening has not occurred, it may still be 2-3 days until labour starts.

Four methods of induced labour:

Prostaglandin medication: Medication containing prostaglandin can be administered if the mucus plug does not come away naturally. Prostaglandin causes the mucus plug to soften and the cervix to dilate. Medication can be applied as a gel or be placed in the vagina, or as a tablet dissolved in water and taken orally. A tablet is normally taken every other hour until the mucus plug comes away. Prostaglandin is normally the first step of induced labour and can be followed by other methods.

Another method is the Foley Bulb method using a BARD catheter, a so-called balloon catheter. This is a plastic tube with a small balloon at the end which is placed into the vagina and inflated with a saline solution. The mother’s cervix must be at least one centimetre dilated and it is common to start the procedure by giving prostaglandin hormone. Thereafter the catheter is put in place and the tube is taped onto the woman’s leg. The tube is stretched gradually, approximately once every half hour, to mechanically push the balloon through the vagina. The catheter falls out once the cervix dilates to 3-4 centimetres, although this may take several hours. The catheter can sometimes cause severe persistent “period pain” and the woman may need pain relief, e.g. Alvedon (paracetamol).

Artificial rupture of membranes (amniotomy) is a method whereby the midwife pierces the bag of water surrounding the baby. A rupture of membranes can only be done if the cervix has opened three to four centimetres and is performed using a long, slim tool that looks similar to a long crochet hook. Rupturing of membranes is not painful in itself, but the contractions can become very strong.

A drip that stimulates contractions is often given once the cervix canal is sufficiently softened, or after the rupture of membranes. This method is called synthetic oxytocin drip and is administered via an intravenous (IV) line in the arm. The drip bag hangs on a mobile IV stand, allowing the woman to move around freely. The midwife can regulate the contractions by turning the drip up or down. Many women experience intense contractions when having oxytocin drip, hence epidural anaesthesia is often given as well. Oxytocin drip can also be administered in cases where normal labour stops.