Since I know that many of us who choose hospital births are often faced with the option or pressure to induce, I thought it would be helpful to have some information available of pros and cons of different MEDICAL induction techniques. Then, at a later date, I will post 'natural' or 'herbal' induction techniques to this same thread.
Definitions:
Induction- attempting to start labor before labor has started
Augmentation- attempting to speed labor once it has started
Non-Hormonal Induction/Augmentation Techniques:
Foley Catheter- a method of induction through forced dilation. This method includes inserting a catheter into the vagina, with a balloon attached to the end, which is placed in the cervical opening. Then, throughout a period of time, the balloon is slowly inflated to force cervical dilation.
Pros: many consider it a 'gentle induction'. No synthetic hormones are used.
Cons: greatly increased risk of infection. Increased risk of PROM (premature rupture of membranes - water is broken with no contractions), increased incidence of incomplete dilation, cervical swelling, and pelvic pain.
Stripping/Sweeping the Membranes- This technique involves a medical care giver inserting their fingers or scraping instrument into the vagina, past the cervix, and into the opening of the uterus. Then, in a 'sweeping motion', the bag of waters outermost layer (chorion) is broken away from (the seal) the cervical opening and uterine wall. This induction technique is made effective by the irritation created by the procedure causing the production of oxytocin, along with the forced dilation that is created by the manipulation of the cervix required to accomplish this procedure.
Pros: an outpatient procedure. Considered non-invasive.
Cons: increased risk of infection, increased incidence of PROM, can cause bleeding and pelvic pain with no labor.
Breaking The Bag of Water- aka AROM (artificial rupturing of membranes) or amniotomy. Both an induction and an augmentation technique. This involves snagging and tearing the chorion and amnion of the bag of waters with a amnihook. This is done in hopes that, the increased pressure of the fetus' skull against the cervix will cause dilation and enough irritation that oxytocin will either begin to be produced (induction) or production will increase (augmentation).
Pros: can be very effective. Considered non-invasive. Can be an outpatient procedure. Generally does not indicate the need for continous fetal monitoring, can shorten 1st stage labor by, an average of, 1 hour.
Cons: greatly increased risk of infection, increased risk of fetal bradycardia, cord prolapse, swelling of the cervix, incomplete dilation, or non-established contractions (necessitating another form of induction), increased contraction discomfort is reported, and can cause too fast of a labor.
Synthetic Hormonal Induction/Augmentation Techniques:
Misoprostol/Cytotec:There is a commission out there to stop cytotec use because of the amount of women who have experienced the side effects commonly associated with Cytotec use. There is also a linkherewhich is the label from Misoprostol and its side effects. Note: THIS IS NOT AN FDA CERTIFIED METHOD OF INDUCTION BECAUSE OF THE HIGH INCIDENCE OF RISKS WITH INDUCTION. This method of induction is that it is a cervical ripener - meaning that it is intended to soften, efface, and assist in dilation as a means of induction. It is administered through pill form. the pill is inserted vaginally and set against the cervix. Once administered, it cannot be removed. Also, 'smaller doses' are not a guarantee of less medication as the pill was not scored, manufactured evenly, nor manufactured with the intent to be broken.
Pros: fast acting, considered reliable
Cons: not FDA approved. Has the highest incidence of reported iatrogenic complications of all induction methods, cannot be removed once administered. Generally requires continuous fetal monitoring, and prosterate lie. Side effects include: fetal cranial nerve palsies, fetal death, maternal death, severe postpartum hemmhorage, uterine tetany, decreased uteroplacental blood flow, uterine rupture, necessitating hysterectomy, amniotic fluid embolism, placental retention, maternal and fetal shock, fetal bradycardia, uterine tachysystole, and higher incidence of c-section. Higher incidence of infection than pitocin.
Cervadil:Another vaginally inserted induction method. Generally in pill, wafer, or gel form, it is a synthetic prostaglandin. If administered as gel or wafer through 'tampon insert' or by a string, it can be removed once administered (in case of side effects). It has many of the same side effects as Cytotec, with a much smaller % of reported incidences. It is considered safer, though more expensive, as it carries less risk in ratio to reported incidences.
Pros: effective cervical ripener - considered less invasive than other means of induction. No IV required. Can be an overnight administration (administered, then sent home).
Cons: must remain reclined. Usually requires continuous fetal monitoring. Side effects include: fetal death, maternal death, severe postpartum hemmhorage, uterine tetany, decreased uteroplacental blood flow, uterine rupture, necessitating hysterectomy, amniotic fluid embolism, fetal bradycardia, uterine tachysystole, and higher incidence of c-section.. Carries higher risk of infection than pitocin.
Pitocin:an IV administered induction/augmentation method. It is a synthetic form of oxytocin, the hormone that regulates and initiates contractions. Once administered, it can be accelerated, reduced, and stopped at any time. The most regulatory of the three methods, it is also considered the 'safest'.
Pros: considered the safest, it can be regulated more easily than Cervadil or Cytotec. It carries a lower incidence of infection as it is not vaginally inserted. Can be mobile during administration.
Cons: it is more aggressive and invasive. 'continuous administeration' requires an IV pole. Generally requires continuous fetal monitoring. Risks include: Nausea/vomiting, stomach pain, maternal cardiac arrest, maternal respiratory distress, decreased maternal cardiac output, dizziness, lightheadedness, swelling, postpartum hemmhorage, seizures, headache, blurred vision, fetal and neonatal bradycardia, increased incidence of newborn jaundice, newborn seizures, feteal and maternal death.
