As your projected due date draws near, you may find that your surrogate and her care provider are talking about the potential need or desire for an induction of labor. In simplest terms, a labor induction is a medically caused labor. Some intended parents even desire an induced labor so that they can have better odds at planning for and being present at the time of birth.
You should know that many doctors and hospitals will have policy and rules surrounding when an induction can be done. Most medical professionals will not allow an induction for non-medical reasons before the 37th (and often not before the 38th) week of pregnancy. In most cases doctors will not allow an induction unless the benefits of ending the pregnancy early outweigh the risks of continuing the pregnancy.
However, if an induction is advised, your surrogate will have a few options to consider. While the most effective induction methods are medical, there are some that are a bit more natural. Here’s a look at the types of inductions doctors can use, and what they may mean for your birth plan.
Membrane Sweep- Many doctors will choose to do a membrane sweep in the days leading up to or just past the assigned due date. This process, also called “stripping” the membranes, is completed in the doctor’s office during a normal visit. During the regular cervical check the doctor will run his/her finger around the opening of the cervix, separating the amniotic sack from the bottom of the uterus. While not guaranteed to result in labor, the process can cause the body to release prostaglandins and jump start labor within a matter of days.
Old Wives’ Tales-Some surrogates and intended parents choose to try to stimulate labor through more natural home methods before choosing a medical intervention method. Common practices include nipple stimulation, consumption of Castor Oil, or sexual intercourse. None of these methods have been found scientifically effective.
Pitocin Administration– Perhaps the most common induction method is to administer a drug called oxytocin. This drug, more commonly referenced by the brand name Pitocin, is administered through IV and acts as a synthetic version of the hormone a woman’s body produces on its own during the onset of spontaneous labor. The amount of the drug can be adjusted until the optimum level is found to jump start contractions and force labor to begin.
Membrane Rupture- Also referred to as “breaking the water”, this method is generally only performed on women who are already several centimeters dilated. The practitioner will use a plastic hook to rupture the amniotic sack and spill the fluid. This process is done in the labor and delivery unit, as most doctors require a birth within 24 hours of membrane rupture to lower the risk of infection. If the rupture alone does not jump start labor, the doctor may begin administering Pitocin as well.
Foley Catheter- In this method the doctor will use a small catheter to insert an uninflated balloon into the cervix. The doctor will then slowly begin to fill the balloon with water over the course of the next several hours. This will put weight and pressure on the top of the cervix, usually forcing it to slowly ripen and open. At this point the body will begin to produce labor hormones on its own. As the cervix continues to ripen and open, the balloon will fall out, signaling that labor has begun. This method can be generally be completed without the use of synthetic hormones.
While induction of labor is generally a safe practice, there are instances in which no induction should be attempted due to increased risks. A diagnosis of Placenta Previa, a baby in breech or transverse position, and presence of genital herpes are occasions in which an induction is not recommended.
The choice to induce is generally made between the surrogate and her doctor. Frequently the doctor will have preferred methods and may not be open to other options. If you have any questions about the procedure, you should ask your surrogate well in advance of the procedure so that she can have time to ask her OBGYN if she does not already know the answer.