Anticipating labour can be daunting knowing that sometimes it’s quite a long process, especially if you are facing a labour induction.
Chances are the words, “fastest way” sound a bit appealing if you need to be induced.
Well, researchers at the University of Pennsylvania Perelman School of Medicine believe they’ve found the fastest way to induce labour.
The Fastest Way To Induce Labour
Combining a medication called misoprostol and a mechanical method, the Foley bulb, resulted in labours on average four hours shorter labours when compared to other individual and combination methods.
Labour can certainly be a physical and mental challenge so reducing it by four hours must be a great thing, right?
Is A Faster Induction Best?
On one hand, this is great information for those facing a necessary induction, especially when time is important (e.g. preeclampsia).
On the other hand, is faster always necessary or safe? It’s likely that more research needs to be done to fully answer this question.
In the same way we need to weigh up whether an induction is necessary, we need to weigh the benefits and risks of different methods and combinations for each mother-baby pair.
What Are The Different Induction Methods?
Inductions can look very different depending upon what’s common in your region, your health and reason for induction, baby’s health, available medications, midwife/doctor preference, and your preference and consent.
Induction methods include:
- Artificial rupture of membranes (ARM) – breaking your waters
- Synthetic oxytocin – known as Pitocin or Syntocinon, given via IV drip
- Prostaglandins – gel or tablets inserted vaginally, sometimes oral medication
- Foley bulb catheter – a small balloon catheter placed in a slightly dilated cervix and used to increase dilation
- Any combination of the above.
You can read about each induction method in more detail: Why All Inductions Are Not The Same – 5 Induction Methods
What Is Misoprostol?
Misoprostol is a synthetic prostaglandin. There are several prostaglandins on the market; all work to soften and ripen the cervix but they can carry different benefits and risks.
Misoprostol is a pill which can be taken orally or used as a vaginal suppository to induce labour.
It’s also used for medical terminations (e.g. for a missed miscarriage) and the prevention or treatment of postpartum haemorrhage.
Is Misoprostol Safe?
Misoprostol is also known as Cytotec in some countries. Its original use was for the prevention and treatment of ulcers. As commonly happens with medications, other potential uses were discovered, one of which was inducing labour.
If you’ve been following birth news for many years, it’s possible you’ve heard this medication is very dangerous and should be avoided at all costs. Perhaps you’ve heard about serious uterine rupture and hemorrhage leading to death.
It’s extremely unfortunate that some mother-baby pairs were harmed or even lost their lives due to this medication, in many cases resulting due to a lack of established guidelines for use.
While there are still risks associated with the use of this drug, serious complications aren’t as common since guidelines were established by the International Federation of Gynecology and Obstetrics and the World Health Organisation.
Given the risks, both minor and serious, it’s important to be sure the benefits of inducing with misoprostol outweighs potential risks. Faster isn’t always a benefit greater than risks.
What Is A Foley Bulb?
A Foley bulb is a small balloon catheter placed into your cervix and inflated. This places pressure on your cervix in hopes it will encourage dilation. Once your cervix dilates to 3cm, the catheter will fall out on its own.
For some women, using just this method is enough to cause dilation which then stimulates contractions. For others, the manual dilation doesn’t cause contractions.
What Did Researchers Find When Looking For The Fastest Induction Method?
Every labour is unique, but often inductions can be longer than spontaneous labour. Labour and birth are complex hormonal processes and when we try to replicate it artificially, it’s not always as efficient.
It makes sense then, that researchers and medical providers will look for the most efficient methods. However, it’s also important to realise that faster labour isn’t necessarily better nor will the benefits always outweigh the risks.
And perhaps most importantly, a faster induction isn’t likely to have benefits which outweigh the risks when it comes to elective/not medically necessary inductions. Nonetheless, what the researchers found could have a big impact on obstetrical care.
The randomised controlled study involved 491 women who were put into four groups. What they found was:
- The combination of a Foley bulb and misoprostol showed an average labour of 13.1 hours
- Synthetic oxytocin and a Foley bulb showed an average labour of 14.5 hours
- Misoprostol alone showed an average labour of 17.6 hours
- Foley bulb alone showed an average labour of 17.7 hours
What Do These Results Mean For My Induction?
What this study shows is that a combination of a Foley and misoprostol results in a clinically significant shorter labour.
What this study doesn’t mean is a shorter labour is necessarily safer or necessary. It also doesn’t show the differences in risks associated with different induction methods.
When discussing induction methods with your maternity care provider, it’s important to consider some of the following:
- Is the induction medically necessary?
- What risk factors for labour complications might I already have (e.g. previous c-section, hypertension, etc.)?
- Which methods might be safer given my preexisting risks (e.g. avoiding misoprostol due to a previous csection)?
- Which method might be safest based on my baby’s health (does baby have any medical conditions)?
- What are the benefits of each labour induction method based on mine and my baby’s specific situation?
- What are the risks of each labour induction method based on our specific situation?
How Do I Weigh The Benefits And Risks Of An Induction?
Every labour is unique. For that reason, there’s not a simple answer when it comes to whether or not an induction is best and which method is best.
However, there are best practice guidelines/recommendations, and it’s important to learn about and discuss inductions with your maternity care provider.
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