There are many ways to have a labor induction, which leaves many people confused about how their induction will go. Inductions are typically done in the final weeks of pregnancy for medical reasons or just because someone wants one.
Inductions are usually done using a variety of medications or other procedures to encourage a vaginal delivery. The method of induction your health care provider uses often depends on your Bishop Score.
Note: the contents of this website are not medical advice. Please ask your health care provider any questions or concerns you have regarding your health. This does not replace a physician-patient relationship. Please read my disclaimers for more information.
What is a Bishop score?
Set forth by Edward Bishop in 1964, the Bishop score uses a point scoring system to help predict how successful an induction will be. This can help guide the conversation around elective inductions and can also help predict the likelihood of a vaginal birth after inducing labor.
To calculate a Bishop score, your provider will need to do a manual cervical exam. This involves placing a gloved finger inside of the birth canal to assess the dilation of the cervix, how thin the cervix is (effacement), where the baby’s head is in the cervix (fetal station), the position of the cervix, and the consistency of the cervix (from soft to firm).
Dilation, effacement and station are rated from 0-3 points, while cervical consistency and position are rated 0-2 points. There is a minimum of 0 points and a maximum of 13 points. A score of 8 or higher is considered “favorable” for induction.
Note: a low Bishop score does not mean induction is not possible or recommended. There are many situations where induction is recommended despite low Bishop score.
Drugs used to induce labor
There are a few different drugs used to induce labor. Some of these medications are for cervical ripening, which is essentially increasing the Bishop score. With some, the goal is uterine contractions or dilation.
Medications used for cervical ripening
Most inductions start with cervical ripening using prostaglandins.
Prostaglandins are meant to thin and soften the cervix to get it ready for labor. This part of induction often takes a long time, but does not usually start active labor.
There are a few different ways that prostaglandins can be administered:
- A gel that is placed on the cervix by a physician (such as dinoprostol, or Prepidil)
- A pill you take by mouth (such as misoprostol, or brand name Cytotec)
- Vaginal insert (such as misoprostol, or Cytotec)
- A pessary that is placed by the cervix (such as dinoprostone, or Cervidil)
While these medications may start labor, they typically just get your cervix thinned and softened. This helps your cervix be ready for labor, which is typically started with IV oxytocin.
Dosing
It is not uncommon to receive several doses of these medications. Depending on the medication, it may be given every 4, 6 or 12 hours.
What to expect during cervical ripening
Cervical ripening can take hours or days. Some people feel pain and cramping during this time while others are quite comfortable. For pain, try warm baths, a hot compress, movement and position changes, or pain medications.
Your baby will be monitored throughout this process. Your care team will assess fetal heart rate and uterine tone. The goal is to start labor without causing too many contractions (uterine hyperstimulation) or fetal distress.
Your care team will also frequently assess your wellbeing. This includes blood pressure checks, temperature checks, and pain assessments.
Medications to start labor
When you think of labor induction, most people thing of Pitocin or Syntocinon. These drugs are the synthetic version of oxytocin, which is the hormone the body makes to start labor.
Oxytocin is administered through an IV. This drug is started at a low dose and gradually increased until it causes strong contractions. These contractions dilate the cervix and push baby lower into the birth canal.
What to expect with oxytocin induction
The goal of using oxytocin is to start active labor. This means that the goal is labor contractions every 2-4 minutes, lasting about 60-120 seconds, that are strong and cause cervical dilation.
That means when Pitocin is started, we want the onset of labor. These contractions of the uterus are painful and many people report Pitocin contractions to be more painful than spontaneous labor contractions.
Like with other labor induction methods, you and your baby will be monitored closely.
Potential side effects of Pitocin induction include increased pain, uterine hyper-stimulation, fetal distress, increased risk for uterine rupture and placental abruption, and prolonged use may increase risk of postpartum hemorrhage, or excess blood loss after birth. When used properly, oxytocin is generally safe to use.
Oxytocin infusions can also be used after birth to reduce blood loss and treat or prevent postpartum hemorrhage.
Other methods to induce labor
Breaking your water
Breaking the amniotic sac is another way your provider may induce labor. To do this, a small hook is placed through the cervix to snag the uterine sac. This causes amniotic fluid to leak out and can encourage the body to produce hormones that start labor. Another name for this is “artificial rupture of the membranes”.
There are a few risks with breaking water. Once your water breaks, you are more likely to develop an infection. Cervical exams should be limited after the bag of waters is broken. Additionally, your team will want to check your temperature for signs of infection more frequently. There is also a small risk that the umbilical cord could come through the cervix after the water is broken. This is an emergency situation that warrants a cesarean section.
Cervical balloon
A cervical balloon is an inflatable balloon that is placed through the cervix. A small, fluid filled balloon sits in on the cervix and in some cases, another balloon sits on the bottom of the cervix as well.
To place, a small, flexible tube about the size of a straw is inserted through a slightly open cervix. The balloon is then inflated with a saline solution.
Cervical balloons work by doing two things: manually putting pressure on the cervix which causes dilation, and separating the amniotic sac from the bottom wall of the uterus which causes a hormone release.
Cervical balloons can be very uncomfortable and can cause a lot of cramping. They are pretty low risk, as they are not a medication and do not affect the baby.
In clinical trials, using a cervical balloon with other methods of induction is proven to shorten the length of induction significantly. While it may be uncomfortable, they are definitely a safe and effective way to speed up labor inductions.
Why might you need a labor induction?
There are many reasons your healthcare provider may recommend induction. There are both medical reasons and social reasons for labor induction.
Some people choose an elective induction of labor. These are considered safe after 39 weeks gestation. As you approach your due date, you can talk to your healthcare provider about an elective induction and if you are a good candidate.
Some medical reasons for labor induction include:
- Problems with high blood pressure, like chronic or gestational hypertension
- Pre-eclampsia
- Diabetes, whether type 1, type 2, or gestational diabetes
- Fetal growth restriction
- Issues with blood clots
- Medical conditions that make continuing the pregnancy unsafe
- Issues with the placenta or baby’s heart tones
How long does it take to induce labor?
Labor inductions can take anywhere from hours to days. First-time parents are more likely to have a long induction versus people that have had babies before.
It can take a day or two to make labor start, and then it can take several hours to dilate enough to push. The earlier the gestational age and the lower the Bishop score, the more likely you are to have a long induction.
Risks of labor induction
As with anything, there are risks involved with labor induction. Many people with induced labor have great outcomes, but it is always important to know the benefits versus risks. Your healthcare team should discuss any safety concerns or risks with you before induction. There may also be risks to continuing the pregnancy that make induction safer.
Prolonged use of oxytocin is associated with risk for serious bleeding. Some people report more pain with labor induction. People are more likely to ask for an epidural with labor inductions versus a spontaneous labor (source).
There is also a risk of hyperstimulation of the uterus. This can increase the risk for uterus tears as well as excess blood loss.
There may be a risk to baby’s health with early delivery.
Labor inductions often mean more medical interventions than spontaneous labor. You will be monitored more closely for signs of medical problems or other adverse events which may lead to extra interventions.
Tips for a labor induction
- Take a birth preparation course. Knowing what your body is going through in the process of labor can be very empowering. The BirthSmarts course will teach you how to ask questions and advocate for yourself.
- Write a birth plan. While writing a specific birth plan does not guarantee your labor will follow a certain path, it can help you communicate your needs and preferences to everyone on your care team.
- Pack lots of comfort items and distractions. Things like movies, games, and comfort items will help you feel more relaxed
- Talk to your specialists about any health conditions. Knowing how your body may respond to pregnancy and birth can help you navigate the labor process
- Keep a positive mindset throughout. Advocate for breaks to eat, shower, and take a walk. Use birth mantras to keep positive thoughts alive.
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