Drug-free induction techniques

Sep 28, 2007 at 9:29 p.m. ET

There are a number of ways your doctor or midwife may choose to induce labor without using medications. Obstetrician/Gynecologist David Barrere discusses the various procedures.

What are some labor induction techniques my doctor or midwife might use that don't involve medications?

The expert answers
As we discover and understand more about the physiology of labor, we're finding additional methods to facilitate it. The choice of method must be based upon the individual patient. No single, perfect method exists that works for all patients.

Office procedures
Laminaria/osmotic dilators: In some instances, osmotic dilators can be placed within the cervix. As they accumulate water over time, they swell, causing slow mechanical dilation of the cervix.

Stripping membranes: During a cervical exam, the examiner's finger bluntly separates the fetal membranes from the uterine wall. This releases the hormones and other chemicals (phospholipases) contained in this space and stimulates contractions. In a study of women at or over 40 weeks of gestation, two-thirds were in labor within 72 hours after this procedure, as opposed to only a third who were examined without membrane stripping.

Hospital methods
Rupture of membranes/amniotomy ("breaking the water"): This often works because it releases hormones and phospholipases. Also, without the cushion of the amniotic fluid, the fetal head rests directly on the cervix, possibly causing reflex uterine contractions.

Foley bulb: A Foley catheter, typically used to drain the bladder, has an inflatable bulb at the tip to hold it in place. For labor induction, a 30cc bulb is placed in the cervix and inflated. Mechanical stretch can cause reflex uterine contractions and force dilation to about 3 centimeters. In some situations, saline is infused through the catheter, which can help separate the membranes from the uterine wall, releasing hormones and phospholipases.