A breakdown of the most commonly used methods for inducing labor from stripping membranes and using pitocin, and everything in between!

If you do an internet search for “pros and cons of induction,” the first thing that comes up is induction cooking. So hopefully this post will help you unravel the birth induction process, since Google isn’t helping as much as it should. (Note: it does help if you add “birth” in front of induction.)

There are several things you should know about induction. First of all, it’s become more common. In the 1990s, about 9.6% of births were induced. By 2018, that number had risen to 27.1%, and 37.8% of first-time moms. If your medical team is suggesting induction, it might be because you’ve gone two weeks past your due date, because your water has broken but active labor hasn’t started, or because of risk factors associated with your pregnancy and/or birth. 

Another thing to keep in mind is that induction takes time. When we watch movies with women in labor, it’s usually about five minutes of screaming, and then the baby appears. Induction — like labor itself —  is a slow process, and that’s not a bad thing; it means that your body is taking the time to process what’s happening, and find its way to labor. (Though it can be unpleasant when you’re waiting for it to take hold.)

Stripping the Membranes

In this procedure, your doctor or midwife will use a finger to separate the amniotic sac (which holds your baby) from the walls of the uterus. This can release prostaglandins (hormones that help ripen the cervix naturally and/or initiate contractions) and  trigger labor.

Pros: Membrane is fast, and can be done at your doctor’s office. It is a very  low risk intervention to you and your baby and doesn’t require any monitoring of you or the baby before, during or after. 

Cons: It can be painful, and may not induce labor or labor might still take some time to start. 

The most common side effect is spotting.

Cervical Ripening

For most first-time parents, the first step of induction is to use a cervical ripening agent. The most common of these are Cytotec and Cervidil. Cytotec is a medication that can be  taken orally or placed intravaginall, while Cervidil is inserted vaginally. You may be sent home after receiving one of these drugs, or you may be asked to stay in the hospital for monitoring.

Pro: Cervical ripening will usually cause fairly mild reactions in your body, and since it’s non-invasive, getting the ripening agent doesn’t usually come with much pain. 

Con: This might not be enough to push you into full labor, and you may need another agent to help move things along after getting a cervical ripening medication. 

Side effects are usually mild, and include backache, some spotting, and mild cramps.

Foley Bulb

A Foley bulb is a catheter that is inserted into your cervix during a procedure similar to a pelvic or cervical exam. The device looks like a small round balloon at the end of a tube, and puts pressure on the cervix to help the cervix dilate without needing additional medication or medical intervention. 

Pro: Foley bulbs have a high rate of success in inducing labor. In one study, more than 69% of women who receive this procedure move into labor afterwards, and over 66% of them had a vaginal birth. Another study reported over 50% of women entered active labor after the use of a Foley bulb. The use of a foley bulb is also very low risk for mom and baby, and additional monitoring is not usually necessary before, during, or after the insertion of a foley bulb. 

Cons: The experience of having the Foley bulb inserted can be uncomfortable. Although some women report that the feeling is similar to a pelvic exam (pressure and discomfort), others have experienced significant pain during the procedure. And it can take time; you may have the Foley bulb in your cervix for up to 12 hours.

Side effects can include spotting and pain. 

Pitocin

Pitocin is one of the most well-known forms of induction. Its reputation is… mixed, in part because it’s kind of the Fast and Furious option. Pitocin is a synthetic version of the oxytocin that your body produces naturally. So when it’s injected into your bloodstream (through an IV), your body gets a rush of BABY TIME chemicals, which might move things along faster.

Pro: Pitocin gets things moving. Although it can take different lengths of time depending on your body, Pitocin tends to kick labor into gear. It can be used on it’s own, it can be used in combination with a foley bulb, and/or it can be used after receiving a cervical ripening agent like Cytotec or Cervidil. 

Con: Pitocin’s reputation is mixed for a reason. When labor starts, it tends to be more intense than labor without intervention. And because it’s a medication that is continuously delivered to your body through an IV, continuous monitoring of you and your baby is medically necessary. This means you will be hooked up to a monitor to assess your baby’s heart rate and contractions at all times. This can cause limitations to how much you are able to move around while getting pitocin. Studies have shown that women who receive Pitocin are more likely to get an epidural, too, possibly because of the more painful labor, and/or because of the limitations in being able to move around more freely. 

Side effects of pitocin include increased risk of fetal distress, increased chance of c-section, and possible uterine rupture. 

Whatever methods you decide to use or to avoid, remember that you are part of your medical team. If you have questions, ask them. Don’t feel as if you cannot request pain medication or support through something that is hard for you. Labor has become more medical, there’s no question about that. In a way, it’s a good thing; these procedures have saved many lives. But it can also be intimidating, and easy to forget that you have a voice in all this. Hold on to what matters to you. Tell your team when you’re in pain or scared or have questions.  There is almost always another option if you don’t like the one presented to you, so don’t be afraid to ask “What are my options?”. Your medical team is there to  help you through this, and you should feel comfortable and confident asking questions and in their ability to care for you safety and compassionately. 

Sources for Induction Post: 

BMC Pregnancy and Birth, “Maternal perceptions of the experience of attempted labor induction and medically elective inductions: analysis of survey results from listening to mothers in California,” https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-020-03137-x 

“Evaluation of the efficacy and safety of Foley catheter pre-induction of labor,” https://pubmed.ncbi.nlm.nih.gov/23700844/

Verywell family, https://www.verywellfamily.com/what-is-a-foley-catheter-induction-of-labor-2758962 

Mayo Clinic, Water Breaking, https://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/in-depth/water-breaking/art-20044142 

How effective is membrane sweeping? https://www.healthline.com/health/pregnancy/membrane-stripping