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What is it
A small dose of misoprostol may be placed in the cheek, under the tongue, or in the vagina to ripen the cervix and start contractions.
How your body works here
Misoprostol is a prostaglandin E1 analog. Prostaglandins are the body's own cervical-ripening hormones — they loosen the collagen scaffolding in the cervix and sensitize the uterus to oxytocin. Giving synthetic prostaglandin does chemically what the body normally does over days or weeks, which is why contractions can become intense quickly.
Benefits (B)
- Effective at ripening the cervix and initiating labor.Review sources ↓
- Inexpensive and widely studied.Review sources ↓
Risks (R)
- Uterine tachysystole (contractions too close together) which may affect fetal heart rate.Review sources ↓
- Not recommended for people with a prior cesarean or uterine surgery due to risk of uterine rupture.Review sources ↓
- Nausea, fever, chills, diarrhea.Review sources ↓
Alternatives (A)
- Cervidil (dinoprostone).Review sources ↓
- Mechanical methods (Foley, Cook).Review sources ↓
- Pitocin without cervical ripening if cervix is already favorable.Review sources ↓
Evidence summary
Misoprostol is used off-label in many countries for obstetric indications and is included in WHO essential medicines for labor induction in specific contexts. Major guidelines do not recommend it for people with a prior cesarean.
Sources
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Questions to ask your provider
- Is this safe given my history?
- How often will my baby's heart rate be monitored?
- What is the plan if contractions become too strong?
Intuition & Nothing/Wait (the I and N in BRAIN)
What is your gut telling you? What happens if you do nothing or wait?
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