An Overview of Induction Methods by an L&D Nurse

Today we’re going to talk all about induction methods and the reasons you might need to be induced. But before we go there, let’s start with the basics!

What is a labor induction?

Induction of labor is exactly what it sounds like – you aren’t in labor yet, so we put you into labor (or we attempt to put you into labor!).

You see, there comes a point in pregnancy where the risk of continuing the pregnancy is actually greater than the benefits of keeping baby inside. And that point can vary for different mamas!

There are several different induction methods that can be used, which you will learn about in this article!

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What is labor augmentation?

Before we get more into labor induction, I want to address labor augmentation real quick. Because sometimes there is confusion between the two!

Augmentation of labor is done when you’re already in labor, but things stop progressing. Basically, we attempt to jumpstart things to get them going again.

Let’s say you are in labor and then something happens that causes your contractions to either stall or space out. If that happens, your cervix will stop dilating. And if you stall out for too long, a C-section can be necessary.

But, before we turn to a C-section, we can use similar methods that we use to induce labor to augment your labor – aka get it going again.

Reasons for induction of labor

The truth is, there are tons of reasons why you may need an induction. Medical inductions occur for a variety of reasons and are often unique to your situation. What’s safe or recommended for one woman isn’t necessarily going to be the same for another who’s at the exact same point of her pregnancy.

But let’s take a look at some of the more common reasons for induction:

  • Overdue: Most practices consider this to be past 41 weeks, but some wait even longer, up until 42 weeks
  • Gestational hypertension: This is the condition of high blood pressure during pregnancy
  • Preeclampsia: This is a pregnancy complication that involves high blood pressure and other signs of organ damage
  • Gestational diabetes: Not everyone with GDM will be induced, it has to do with how well your blood sugars were controlled during pregnancy
  • Growth issues (IUGR or macrosomia): This is when baby isn’t growing as quickly as expected, usually characterized as being below the 10th percentile for gestational age based on an ultrasound, OR it’s a baby that’s much bigger than expected for gestational age
  • Prolonged premature rupture of membranes (PPROM): You’ve broken your water early in your pregnancy. In this case, induction is usually recommended around 34-35 weeks, unless a medical condition warrants earlier induction
  • History of third-trimester stillbirth: This is usually offered as sort of an elective induction because it’s been shown to reduce the risk of a subsequent stillbirth
  • Cholestasis: This is a liver condition that can occur in the third trimester. The most common symptom is extreme itching in the hands and feet
  • Oligohydramnios/Polyhydramnios: These are conditions that have to do with the amount of amniotic fluid surrounding baby
  • Any other medical condition that puts you or baby at risk to continue the pregnancy safely

Related Reading: Natural Ways to Induce Labor

Elective inductions (Planned IOL)

An elective induction means that you choose to have an induction and there is no medical indication behind the induction. Some providers offer elective induction at 39 weeks of pregnancy and beyond.

The decision to electively induce is very personal, and please do remember that in many cases it is safer to let your body go into labor spontaneously, if possible. However, there are some instances where elective induction IS a safer and better choice.

This is a topic that I go over more in-depth inside of Birth It Up: The Natural Series and Birth It Up:  The Epidural Series. Both are complete online birth classes that have a bonus lesson all about the medical induction of labor.

Medications to induce labor

There are a couple different medications the providers use for labor induction. These are usually used at the beginning of induction. Most of them are inserted vaginally and work to prep your cervix. The exception on this list is IV Pitocin (but more on that below).

These medications all help your cervix relax so that it can open more easily. The most common intravaginal medications are Cervidil, misoprostol (Cytotec), and laminaria.

Pitocin is another method that induces or augments labor – but is given through an IV instead of vaginally.

These are all basically a synthetic version of magical labor-inducing hormones called prostaglandins!

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Cervidil induction

Cervidil is a prostaglandin that’s inserted vaginally. It helps relax the cervix prior to the induction of labor. Cervidil is like a big Qtip that gets placed into your vagina, up near your cervix.

While it is in there, prostaglandins will slowly be released, which encourages softening of the cervix. Cervidil is usually kept in for 12-24 hours. You may experience some mild contractions while it’s in place.

Cytotec induction aka misoprostol induction

Misoprostol (brand name: Cytotec) is another prostaglandin that’s inserted vaginally or taken orally to help get the cervix soft and ripe, in order to kickstart labor. Cytotec is a pill but serves a similar purpose as Cervidil. 

Laminaria for labor induction

Laminaria is actually derived from seaweed and contains thyroid hormones. Cool, huh?! It is used in labor to help ripen and open the cervix. Laminaria is typically not used as frequently as Cervidil and Cytotec in the United States. 

Pitocin induction (oxytocin for IOL)

Pitocin is a medication that’s given through your IV to get your labor started. This is by far the most common labor induction method!

It’s the man-made form of the same hormone your body naturally produces when you’re in labor – oxytocin. By giving you Pitocin synthetically, we are attempting to tell your body that you’re in labor!

What’s the goal of a Pitocin induction?

Ultimately, the goal is to get you contracting every 2-3 minutes with strong contractions that are effectively dilating your cervix.

The catch is that we don’t want your contractions to be too close together!

It’s very important that your uterus can adequately relax in between your contractions to avoid stressing out your baby and to reduce your risk of a uterine rupture (but don’t worry – that is super rare!).

At any point during your Pitocin induction, your nurse can turn down your Pitocin or turn it off entirely if we notice your contractions are getting too close together or it seems to be stressing out baby.

Foley bulb induction and Cook catheters

A Foley bulb or Cook catheter is a catheter that’s manually inserted inside your cervix to mechanically dilate the cervix.

In addition to mechanically dilating your cervix, Foley bulbs and Cook catheters provoke your body to release some prostaglandins around your cervix. They work really great if they are used properly and in the right circumstances.

Usually, Foley bulbs aren’t meant to do the job on their own, but occasionally, I’ve seen a woman have a Foley bulb placed, start contracting, and not need any Pitocin. But 95% of the time you’ll get a Foley bulb placed, in addition to getting either a medication, like Cytotec or Pitocin started. 

What exactly is a foley bulb?

A Foley bulb is a long, flexible catheter about the thickness of a McDonald’s straw (you know how they are a little thicker than normal straws). It’s nice and bendy and is usually made of latex or similar material if you have an allergy to latex.

It’s got an opening on one end that can hook up to a syringe, and the other end is a balloon-type mechanism that can be filled with fluid (this is the part that goes into your cervix).

What is a Cook catheter?

A Cook catheter is similar to a Foley bulb, it just has two silicone balloons at its end. The first balloon is inflated with water on the uterine side of the cervix, while the second balloon is inflated on the vaginal side of the cervix.

How is a Foley bulb placed?

First off, no needles go inside you. A needle is used to draw up the fluid that is placed inside the Foley bulb, and sometimes women get a little nervous at seeing the needle in action. No worries, it’s not going anywhere near you. 

Your provider will have you lay on your back with your feet together and knees relaxed down to the side (kind of like a butterfly position). Some providers may put your feet in stirrups – just like during a pap smear or vaginal exam.

  1. They’ll use their hands or a speculum to place the Foley bulb in your vagina
  2. Then it is moved through your cervix. This can be a bit uncomfortable (you might feel lots of cramping, and may have some contractions after the procedure)
  3. Once your provider has the balloon part of the Foley bulb through your cervix, your nurse will start to fill the bulb with water until your provider says to stop
  4. Once it’s filled up, it stays in your cervix for anywhere from 30 minutes to 12 hours. I know, that’s a REALLY long range, but it all depends on HOW dilated you were to begin with and if you have any contractions while the Foley bulb is in
  5. Typically, if you are having your first baby and your cervix is 1 centimeter dilated or less, your Foley bulb will stay in overnight…PREPPING your cervix for labor (Pitocin) the next day

Related Reading: How to Prepare For Labor Induction: Tips From A Labor Nurse!

Artificial rupture of membranes (AROM) to induce labor

This is actually the second most common way to attempt labor induction. Also, I must add during your labor induction you may have SEVERAL different methods used. Totally common and okay!

Artificial rupture of membranes aka breaking your water is a form of induction. I’ve heard of many hospitals using this method FIRST, as a means to get labor started, but at my hospital, we don’t typically do that.

Usually, breaking your water is something that we use in conjunction with Pitocin. It’s usually done later, after you’ve been contracting for some time and baby’s head is low. This is when it works the best!

Have a better understanding of labor induction methods?

Hopefully, this overview helps you better understand the various labor induction methods out there, and the notion that you probably aren’t going to experience just one.

Often these different methods are used in conjunction with one another for maximum effectiveness.

If you’ve got an induction on the horizon, know that our online birth classes take the place of a hospital birth class PLUS they include full-blown bonus lessons about planned inductions, caring for your newborn, partner support, and so much more.

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Liesel Teen, BSN-RN
Founder, Mommy Labor Nurse

Meet Liesel Teen

Hi there. I’m Liesel!

As a labor and delivery nurse, I’ve spent countless hours with women who felt anxious — even fearful — about giving birth. I want you to know it doesn’t have to be that way for you!

When you know what to expect and have the tools to navigate the experience, you’ll feel confident and in control.

I believe you deserve a better birth — no matter how you deliver.