Occasionally our gynecologist recommends inducing labor. An induction should be fully justified and the benefits for mother and baby should outweigh the risks of doing so.
The natural methods to try to start labor spontaneously are: having sex, walking on uneven ground, climbing stairs, relaxing with a shiatsu massage or a bath, acupuncture or estheopathy among others.
But when those have not been effective, a medical induction may be proposed.
There are two types of techniques to induce labor, the mechanical ones and the pharmacological ones.
Pharmacological techniques consist of the use of synthetic hormones, usually prostaglandins are used to achieve effacement of the cervix and oxytocin for dilatation of the cervix. Sometimes only using prostaglandins, labor process is initiated and maintained without the need for intravenous oxytocin.
But in this post I will go into detail about mechanical techniques, which are probably the most unknown.
Among the mechanical techniques, there is the option of the Hamilton Maneuver and the Cook’s balloon insertion.
The Hamilton Maneuver can only be performed by a gynecologist or midwife if the cervix is slightly dilated (at least 1cm). The purpose of this technique is to detach the membranes (of the bag of waters) from the lower part of the uterus through a vaginal exploration.
The controversy surrounding this practice is based on the fact that it has sometimes been performed without the express consent of the woman, that is, without properly informing her of its implications. And this is considered obstetric violence.
The advantage of the Hamilton maneuver is that this detachment of the membranes causes an increase in prostaglandins, which is the hormone responsible for modifying the cervix. It is therefore considered a relatively physiological method.
It should be noted that vaginal exploration can be uncomfortable and even painful and there may be some spotting afterwards. The discomfort may continue for days afterwards. Statistically, labor may be triggered 24 to 48 hours later. The main risk is that the water bag may get broken during the intervention.
After performing the Hamilton maneuver the woman goes home and is usually given a period of one or two days to see what happens.
The introduction of Cook’s double balloon is advisable when it is not possible to perform the Hamilton maneuver (because the cervix does not have the minimum opening of 1 cm) or when it has not had the expected effect.
The objective is to achieve cervical ripening and to start the labor process with uterine contractions. This technique consists of introducing two deflated balloons on each side of the cervix. These are then filled with saline solution and left for up to 24 hours. Usually before then, there is the expected cervical ripening and the balloon drops by itself.
The balloon does not hurt but it is quite uncomfortable because the pressure is felt in the perineum and two tubes hang outside the vulva.
There are hospitals where after the Cook’s balloon is inserted and you are kept under observation with monitoring for a couple of hours, you are allowed to go home and come back within 24 hours or when labor starts.