Nonpharmacologic approaches to cervical priming and labor induction

Nonpharmacologic and alternative methods of cervical ripening are highly efficacious, safe, and, in general, have more favorable cost advantages when compared with their pharmacologic counterparts. Unfortunately, there have been limited research efforts to precisely determine the overall usefulness and the most clinically efficient application for many of these. These methods also share similar time courses to affect cervical change and are, in general, not as rapid as pharmacologic applications. Thus, limitations of time may ultimately determine the choice between alternative methods and pharmacologic modalities. Most of these alternative methods require more than 12 to 18 hours, and some even days to accomplish favorable changes in the cervix to promote ripening and subsequent labor initiation. These methods have also been shown to be efficient and safe, the most important criteria for any ripening agent, for both the maternal and fetal compartments. These alternative methods will continue to occupy an appropriate place in the armamentarium of cervical ripeners and labor-inducing agents.