One of the most important pieces of information in pregnancy is the estimated due date (EDD). So much depends on it - from the start and end of maternity leave to the calculation of the weeks and corresponding tables for the child's height and weight (the fact that we wish this were handled more critically is another matter) to the nervous wait for the birth. The EDD is actually not much more than a very rough estimate and in only four out of 100 births is the date on which the child is actually born.
Some babies arrive earlier or are delivered for health reasons. Others, especially in your first pregnancies, take a few days or weeks longer. Mother and baby are monitored every two days from week 40+0 (+0 here means 40th week of pregnancy +0 days) in order to detect possible complications early. Induction of labor is offered from 41+0 if everything goes smoothly. According to the current guidelines for induction of labor, induction is recommended from 41+3 and strongly recommended from 42+0. The time of two weeks from the due date is called overdue, from 42+0 gynecologists speak of postponing labor.
And why? Labor is induced because complications sometimes arise during the so-called transfer of the child that can endanger both mother and child. This includes the fact that the amount of amniotic fluid is insufficient as the child continues to grow, or the placenta can no longer supply the child adequately, or the child becomes too large for a vaginal birth. None of this has to happen at all, but it is a reason for induction -- and the things that your gynecologist and midwife look for when monitoring.
And yet: It is of course your own decision at any time and under any circumstances whether you want to follow a recommendation for induction. No woman can be forced to undergo an induction. And if you decide to do so, there is not just one way to do it - there are very different options, which we have listed for you here.
Induction of labor is aimed primarily at two things: allowing the cervix to "ripen" and stimulating contractions. During pregnancy, it is tightly closed to protect the child and only begins to relax and open when labor begins. The body's own hormones, so-called prostaglandins, are released for this purpose. Another hormone is also relevant for contractions: oxytocin. This substance, also known as the happiness hormone, is released primarily when you feel comfortable and well looked after.
"Natural" methods of inducing labor
Before you are induced by the midwife, gynecologist or in the hospital using mechanical or medicinal methods, there are a few tips that you can try at home beforehand. The effectiveness of these has been much less well studied than with the methods described below, just for your information. And even if some of them are very likely to be effective, side effects cannot be ruled out. Therefore, you should only try all of the methods listed here after consulting your midwife or gynecologist.
There are no good studies, but why not: Unprotected sex can probably stimulate labor. It is suspected that the prostaglandins contained in sperm can trigger contractions - and the same effect is achieved by the release of the hormone oxytocin in your body when you have an orgasm. However, due to the risk of infection, it is better not to do this if the amniotic sac is already broken.
It has been scientifically proven that nipple stimulation can trigger labor. To do this, the nipples are massaged with gentle pressure for a long period of time, for one minute at a time. After a short break, rub, knead and twist again for a few minutes. And do this for an hour (says science). You have to like it, but it is said to be very helpful: by stimulating the nipples, your body releases oxytocin, a hormone that stimulates and maintains contractions.
Two old home remedies that you should only use in consultation with your midwife are the castor oil cocktail and clove oil tampons. The cocktail consists of a small amount of castor oil mixed with juice and water. Even if the data is rather unclear, it has been scientifically proven that castor oil can actually stimulate contractions. But it also has various side effects, such as diarrhea, nausea and strong contractions. It also seems unclear whether the castor oil passes through the placenta into your child's bloodstream. So it is a home remedy that can be very effective under certain circumstances, but should only be used with caution and under supervision.
Clove oil tampons are said to help your cervix to ripen because of the circulation-stimulating effect of clove oil. To do this, a tampon is soaked in a mixture of clove leaf oil and a neutral oil and inserted into the vagina. Please, please talk to your midwife before using them, not all women can tolerate clove oil. Also, do not use if the amniotic sac is open, risk of infection!
Introduction with mechanical methods
There are a few so-called "mechanical" methods that are intended to stimulate the cervix during labor induction so that the body's own hormone prostaglandin is released. This hormone both ripens the cervix (i.e. makes it soft and permeable) and triggers contractions. Sometimes these mechanical methods are also combined with hormones (see next section).
The so-called amniotic sac separation is done relatively often: your midwife or gynecologist uses their finger to separate the outer shell of your amniotic sac from the edge of the cervix. This can be repeated several times. The advantage is that the intervention in the birth process is relatively conservative and no medication is used. Despite all the precautions, some women - especially first-time mothers - report that they found this method quite painful.
The same applies to stimulating the cervix with a so-called balloon catheter. This is a small tube with two balloons at the tip. One balloon is placed in front of the inner cervix and one in front of the outer cervix, and both are slowly filled with a liquid. The aim of this method is that by stimulating the cervix, your body releases the prostaglandins (hormones) that are important for birth in order to allow the cervix to ripen further and stimulate contractions. Studies show that this often works just as well with a balloon catheter as with the direct administration of hormones - with fewer side effects such as storms of contractions or excessively strong contractions. However, this method can be painful due to the pressure exerted by the balloons. During the birth, a little extra oxytocin is sometimes needed to stimulate more contractions or to maintain contractions. Important: This method must not be used if you have had a previous cesarean section.
The method of inducing labor using rods works on a similar principle to the balloon catheter, but is a little more gentle. These are inserted vaginally and carefully pushed into your cervix. The rods are made of a material that absorbs fluid and swells up considerably. This pressure is intended to stimulate the cervix to ripen or open further. In contrast to the balloon catheter, this method can also be used after a previous Caesarean section or surgery on the uterus.
It can also happen that you are already in labor, but for various reasons the birth needs to be accelerated. In this case, the amniotic sac can be opened by making a (painless!) cut with a small instrument. However, this is only done if your cervix is already ripe and your baby's head is in a good position.
Drug-induced birth
In order for labor to be induced with medication, the cervix must first be ready. This opening can also be accelerated by medication that contains artificial prostaglandins. These are hormones that are applied directly to the cervix as a suppository or gel.
If the cervix is already ripe but there are no or only weak contractions, you can be given more hormones. Prostaglandins are also used here, as is the classic drip, which is usually given as an infusion and thus goes directly into the woman's bloodstream. The drip contains the hormone oxytocin, which also plays a major role in natural contractions. Because the hormone is not produced by your body, but is added from outside, you will be closely monitored to ensure that the contractions do not come too strongly or too frequently.
Prostaglandins also include the active ingredient "Misoprostol", which caused a lot of excitement in 2020. The excitement was because the drug Cytotec was used here, which is not officially approved for the induction of labor (so-called off-label use). Important to know: It was not the basic effect of the drug that was questioned, but above all the lack of studies on the correct dosage of the drug for induction of labor. However, several drugs containing the active ingredient Misoprostol are currently in the final stages of clinical trials for the induction of labor and may be approved in 2021 (as of March 2021).
Induction with externally administered hormones can start your labor or - if labor has already begun - speed it up. This often works well and in many cases the baby is born within 24 hours of the start of induction - but there are also a whole series of cases in which it takes significantly longer or doesn't work at all. And of course there can also be side effects that we don't want to withhold from you: The biggest challenge with drug-induced labor induction is to dose the hormones in such a way that contractions are as natural as possible. But sometimes that's not so easy and can lead to the most common complication: the storm of contractions. This causes contractions that may be stronger and often occur without the important breaks in between. As a result, the woman may experience severe pain and a racing heart and the baby may experience irregular heartbeats. Other possible side effects are nausea, vomiting and fever and low blood pressure. Very rarely (less than 1 in 1000 induced births) an amniotic fluid embolism or a rupture of the uterus can occur.
Don´t forget: your birth, your decision
In this article, we want to give you objective information about induction of labor so that you can make your own decisions. That's why we're writing here that induction is always an intervention in the natural birth process - but we certainly don't want to discourage you from doing it. Because even if an induced birth, especially with medication, turns out differently than you might have hoped (a permanent CTG on your stomach, although there are now great mobile alternatives that you can walk around with; often an access for the medication in the back of your hand; more frequent vaginal examinations during birth; and more frequent use of anesthesia such as epidurals), it can still be a beautiful and self-determined experience in which you can make and help shape many decisions.
