If your doctor or midwife has concerns about your health or your baby's health toward the end of your pregnancy, he or she might suggest speeding up the process. This is called inducing labor, or induction. Instead of waiting for labor to start naturally, your doctor or midwife will use drugs or a procedure to start it sooner.
WomensHealth.gov: "Spot the Signs of Labor."<br> March of Dimes: "Signs of Labor."<br> Mayo Clinic: "Water breaking: Understand this sign of labor."
Induction can be the right choice for some women, but it has risks. Most experts say it's best to let labor begin on its own and progress naturally unless there's a clear medical reason.
Why Is Labor Induced?
Induction is very common -- 1 out of 4 women in the U.S. starts labor with induction. Many times it's done for medical reasons, but it can be elective.
Why do some women need to have labor induced?
You are 1 to 2 weeks past your due date. After 41 weeks, you and your baby are at greater risk for complications.
Your water breaks but labor doesn’t start. Once your water breaks, you and your baby have a higher risk of infection. You might not need induction right away, though. Check with your doctor or midwife. Sometimes it's still safe to let labor begin on its own. After your water breaks, your doctor will limit the number of vaginal exams performed because of the potential for infection.
A test showed your baby might have a problem. If your baby is not growing normally or has an abnormal heart rate, your doctor or midwife might want to induce labor.
Reasons Not to Induce
Being a little "late" is not a reason to induce. However, studies show that inducing labor at 39 weeks does not raise the risk for having a C-section. It also does not raise the risk of birth complications for the baby.
Some doctors recommend "elective" inductions for non-medical reasons. Maybe you live far from the hospital and your doctor worries that you won't get there in time. Or maybe your doctor asks you to accommodate his or her schedule. Experts say you should reconsider, though. Because induction poses some risks, experts say that women shouldn't be induced unless it's medically necessary.
You also don’t want to be induced too early. Babies born before 39 weeks are more likely to have health problems, longer hospital stays, and time in neonatal intensive care.
How Is Labor Induced?
There are a few ways a doctor or midwife can induce your labor. These are listed from most to least common.
Stripping the membranes. In this procedure, your doctor or midwife will use a gloved finger to gently separate the amniotic sac from the wall of the uterus at the cervix. This releases hormones that can trigger contractions. You can get it done in your doctor's or midwife's office. It can be uncomfortable.
Afterward, you will probably go home to wait for contractions. You might have cramping and spotting.
Studies disagree about how well membrane stripping works. Considering that and the discomfort it causes, talk over the pros and cons with your doctor or midwife beforehand.
Hormones. At the hospital, your doctor will give you hormones called prostaglandins to open the cervix and trigger contractions. If you’ve had a C-section in the past, your doctor will not use this treatment, because it raises the risk of uterine rupture.
Mechanical dilation. Another way your doctor or midwife triggers labor is with a balloon catheter. At the hospital, your doctor inserts a thin tube through your vagina into your cervical opening. Then the doctor uses water to inflate the balloon at the end of the tube, causing your cervix to expand.
Medications. The medicine Pitocin (oxytocin) can start contractions. You get this at the hospital through an IV tube in your arm. Your doctor or midwife starts with a small dose and gradually increases it until your contractions are strong and frequent enough for your baby to be born.
Some women go into labor and deliver within a few hours after induction. Others take 1 or 2 days to start labor.
If none of these methods starts your labor, you'll most likely need a C-section, especially if your water has broken.
What Are the Risks of Inducing Labor?
Generally, inducing labor is safe, but there are risks:
Longer hospital stay. If you're induced, you may be in the hospital longer during labor and delivery. If you wind up needing a C-section after induction, your time in the hospital will be even longer.
Increased need for pain medicine. Inducing labor might cause contractions to come on stronger and more often than they would naturally. You're more likely to need an epidural or another medicine to manage the pain.
Increased risk of infection. Breaking the amniotic sac can lead to infection if you don't deliver within a day or two after induction.
Health problems for your baby. Women who are induced before the 39th week for medical reasons may deliver a baby who has problems with breathing. These babies have a higher risk of long-term developmental problems.
Complications during delivery. Induction, especially with medications, might not be safe for women who’ve had a previous C-section or other surgery to the uterus. They have a higher risk of uterine rupture. Intense contractions also cause the placenta to detach from the wall of the uterus, called placental abruption. Both of these conditions are serious but rare, even with induction.
If your doctor or midwife recommends induction, ask questions. You want to be absolutely sure that it's the best decision for your health and your baby's health.
Can I Induce Labor Myself?
Tales abound of home remedies that supposedly bring on labor, but there is no scientific evidence to back them up. These methods include:
- Having sex
- Gently stimulating your nipples
- Herbal remedies including blue or black cohosh (some herbs can be dangerous if you don’t use them properly)
- Drinking small amounts of castor oil
Don’t try any of these home methods without first talking to your doctor or midwife. Some could pose risks.