Editing Labor induction (section)

== Methods ==
Methods of inducing labor include both pharmacological medication and mechanical or physical approaches.<ref name=":5" />

Mechanical and physical approaches can include [[artificial rupture of membranes]] or membrane sweeping. Membrane sweeping may lead to more women spontaneously going into labor (and fewer women having labor induction) but it may make little difference to the risk of maternal or neonatal death, or to the number of women having [[c-sections]] or spontaneous vaginal births. There are also risks associated with membrane sweeping. The risks include irregular contractions, [[Obstetrical bleeding|bleeding]], and in 1 out of every 10 women an [[amniotic sac]] rupture, which can lead to a formal induction within 24 hours of the rupture if labor hasn't been induced.<ref name=":4">{{cite journal |last1=Finucane |first1=EM |last2=Murphy |first2=DJ |last3=Biesty |first3=LM |last4=Gyte |first4=GM |last5=Cotter |first5=AM |last6=Ryan |first6=EM |last7=Boulvain |first7=M |last8=Devane |first8=D |title=Membrane sweeping for induction of labour. |journal=The Cochrane Database of Systematic Reviews |date=27 February 2020 |volume=2 |issue=2 |pages=CD000451 |doi=10.1002/14651858.CD000451.pub3 |pmid=32103497|pmc=7044809 }}</ref>

The use of intrauterine catheters are also indicated. These work by compressing the [[cervix]] mechanically to generate release on [[Prostaglandin|prostaglandins]] in local tissues. There is no direct effect on the [[uterus]]. Results from a 2021 systematic review found no differences in [[Caesarean section|cesarean delivery]] nor [[neonatal]] outcomes in women with low-risk pregnancies between inpatient nor outpatient cervical ripening.<ref>{{Cite book |last1=McDonagh |first1=Marian |url=http://www.ncbi.nlm.nih.gov/books/NBK569292/ |title=Cervical Ripening in the Outpatient Setting |last2=Skelly |first2=Andrea C. |last3=Hermesch |first3=Amy |last4=Tilden |first4=Ellen |last5=Brodt |first5=Erika D. |last6=Dana |first6=Tracy |last7=Ramirez |first7=Shaun |last8=Fu |first8=Rochelle |last9=Kantner |first9=Shelby N. |date=2021 |publisher=Agency for Healthcare Research and Quality (US) |series=AHRQ Comparative Effectiveness Reviews |location=Rockville (MD) |pmid=33818996}}</ref>

===Medication===
* [[Intravaginal administration|Intravaginal]], endocervical or [[extra-amniotic administration]] of [[prostaglandin]], such as [[Prostaglandin E2|dinoprostone]] or [[misoprostol]].<ref name="pmid15043790">{{cite journal |vauthors=Li XM, Wan J, Xu CF, Zhang Y, Fang L, Shi ZJ, Li K |title=Misoprostol in labor induction of term pregnancy: a meta-analysis|journal=Chin Med J (Engl)|volume=117 |issue=3 |pages=449–52 |date=March 2004 |pmid=15043790 }}</ref> [[Prostaglandin E2]] is the most studied compound and with most evidence behind it.{{Citation needed|date=August 2018}} A range of different dosage forms are available with a variety of routes possible. The use of misoprostol has been extensively studied but normally in small, poorly defined studies. Only a very few countries have approved [[misoprostol]] for use in induction of labor.{{Citation needed|date=August 2018}}
* [[Intravenous therapy|Intravenous]] (IV) administration of synthetic [[oxytocin]] preparations is used to artificially induce labor if it is deemed medically necessary.<ref name=":0" /> A high dose of oxytocin does not seem to have greater benefits than a standard dose.<ref>{{cite journal|last1=Budden|first1=A|last2=Chen|first2=LJ|last3=Henry|first3=A|title=High-dose versus low-dose oxytocin infusion regimens for induction of labour at term.|journal=The Cochrane Database of Systematic Reviews|date=Oct 9, 2014|volume=10|issue=10|pages=CD009701|pmid=25300173|doi=10.1002/14651858.CD009701.pub2|pmc=8932234|s2cid=205201341}}</ref> There are risks associated with IV oxytocin induced labor. Risks include the women having induced contractions that are too vigorous, too close together (frequent), or that last too long, which may lead to added stress on the baby (changes in baby's heart rate) and may require the mother to have an emergency [[caesarean section]].<ref name=":0" /> There is no high quality evidence to indicate if IV oxytocin should be stopped once a woman reaches active labor in order to reduce the incidence of women requiring caesarean sections.<ref name=":0">{{Cite journal|last1=Boie|first1=Sidsel|last2=Glavind|first2=Julie|last3=Velu|first3=Adeline V.|last4=Mol|first4=Ben Willem J.|last5=Uldbjerg|first5=Niels|last6=de Graaf|first6=Irene|last7=Thornton|first7=Jim G.|last8=Bor|first8=Pinar|last9=Bakker|first9=Jannet Jh|date=2018-08-20|title=Discontinuation of intravenous oxytocin in the active phase of induced labour|journal=The Cochrane Database of Systematic Reviews|volume=2018|issue=8|pages=CD012274|doi=10.1002/14651858.CD012274.pub2 |pmid=30125998|pmc=6513418}}</ref>
* Use of [[mifepristone]] has been described but is rarely used in practice.<ref name="pmid16647925">{{cite journal |vauthors=Clark K, Ji H, Feltovich H, Janowski J, Carroll C, Chien EK |title=Mifepristone-induced cervical ripening: structural, biomechanical, and molecular events |journal=Am. J. Obstet. Gynecol. |volume=194 |issue=5 |pages=1391–8 |date=May 2006 |pmid=16647925 |doi=10.1016/j.ajog.2005.11.026 }}</ref>
* [[Relaxin]] has been investigated,<ref name="pmid11406079">{{cite journal |vauthors=Kelly AJ, Kavanagh J, Thomas J |title=Relaxin for cervical ripening and induction of labor |journal=Cochrane Database Syst Rev |issue=2 |pages=CD003103 |year=2001 |volume=2010 |pmid=11406079 |doi=10.1002/14651858.CD003103 |pmc=8693181 }}</ref> but is not currently commonly used.
* mnemonic; ARNOP: [[Antiprogestogen|Antiprogesterone]], relaxin, [[nitric oxide]] donors, oxytocin, prostaglandins

===Non-pharmaceutical===
* Membrane sweep, also known as membrane stripping, Hamilton maneuver, or "stretch and sweep". The procedure is carried out by a [[midwife]] or doctor as part of an internal vaginal examination. The midwife or doctor inserts lubricated, gloved fingers into the vagina and inserts their index finger into the opening of the cervix or neck of the womb. They then use a circular movement to try to separate the membranes of the amniotic sac, containing the baby, from the cervix. This action, which releases hormones called prostaglandins, may prepare the cervix for birth and may initiate labour.<ref>{{cite web |title=Stretch and sweep |url=https://www.pregnancybirthbaby.org.au/stretch-and-sweep |website=www.pregnancybirthbaby.org.au|date=24 March 2021 }}</ref> While this process can cause discomfort, bleeding, and irregular contractions and carries the risk of breaking the amniotic sack,<ref>{{Cite journal |last1=Boulvain |first1=Michel |last2=Stan |first2=Catalin M |last3=Irion |first3=Olivier |date=2005-01-24 |editor-last=Cochrane Pregnancy and Childbirth Group |title=Membrane sweeping for induction of labour |journal=Cochrane Database of Systematic Reviews |volume=2005 |issue=1 |pages=CD000451 |language=en |doi=10.1002/14651858.CD000451.pub2 |pmc=7032890 |pmid=15674873}}</ref> many would still choose to have membrane sweeping carried out for their next birth.<ref name=":4" /> 
* [[Artificial rupture of membranes|Artificial rupture of the membranes]] (AROM or ARM) ("breaking the waters")
* Extra-amniotic saline infusion (EASI),<ref name=Guinn2004>{{Cite journal | last1 = Guinn | first1 = D. A. | last2 = Davies | first2 = J. K. | last3 = Jones | first3 = R. O. | last4 = Sullivan | first4 = L. | last5 = Wolf | first5 = D. | title = Labor induction in women with an unfavorable Bishop score: Randomized controlled trial of intrauterine Foley catheter with concurrent oxytocin infusion versus Foley catheter with extra-amniotic saline infusion with concurrent oxytocin infusion | doi = 10.1016/j.ajog.2003.12.039 | journal = American Journal of Obstetrics and Gynecology | volume = 191 | issue = 1 | pages = 225–229 | year = 2004 | pmid = 15295370 }}</ref> in which a [[Foley catheter]] is inserted into the [[cervix]] and the distal portion expanded to dilate it and to release prostaglandins.
* Cook Medical Double Balloon known as the Cervical Ripening Balloon with Stylet for assisted placement is approved by the [[Food and Drug Administration|FDA]] in the United States. The Double balloon provides one balloon to be inflated with [[Saline (medicine)|saline]] on one side of the uterine side of the cervix and the second balloon to be inflated with saline on the vaginal side of the cervix.