What Is Labor Induction?
If your doctor or midwife has concerns about your health or your baby's health toward the end of your pregnancy, they 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.
Induction can be the right choice for some, but it has risks. And it doesn’t always work. If it doesn’t, you may need another induction or a C-section. Most experts say it's best to let labor begin on its own and progress naturally unless there's a clear medical reason to induce.
Why Is Labor Induced?
Usually, your body goes into labor without much prompting. But if you or your baby is at risk, your doctor may want to induce labor.
Induction is common -- 1 out of 4 births in the U.S. start with induction. Many times it's done for medical reasons, but it can be elective (meaning you choose to induce for conveneince).
Why does labor sometimes need to be induced?
You’re 1-2 weeks past your due date. Studies show that inducing labor at 39 weeks doesn’t raise the risk for having a C-section or birth complications for the baby. After 41 weeks, you and your baby are at greater risk for complications. Being a little "late" isn’t a reason to induce. 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.
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 problem puts you or your baby’s health at risk. Examples are infection (chorioamnionitis), too little amniotic fluid (oligohydramnios), and placental abruption. If you have conditions like diabetes, high blood pressure, preeclampsia, or eclampsia, your doctor or midwife might want to induce labor.
If your baby isn’t growing as it should be or has an abnormal heart rate, your doctor or midwife might want to induce labor.
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 their 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.
Your cervix prepares for labor by:
- Ripening, which is also called softening
- Opening, also called dilation
- Thinning, also called effacement
These things may start to happen but then stall. Or your water may break, but contractions don’t follow. In these cases, a doctor may choose to induce labor to stimulate the body’s progress.
Other conditions that call for inducing labor are:
- Lung disease
Reasons Not to Induce
You doctor shouldn’t induce if:
You had a C-section before that involved a classical incision or major surgery.
The placenta covering your cervix (placenta previa).
Your baby is in the wrong position (sideways or feet-first).
How Is Labor Induced?
Some ways to possibly induce your labor are:
Stripping (or sweeping) the membranes.Your doctor inserts a gloved finger into your vagina and up into your cervix to separate your water (amniotic) sac, or bag, from your uterus without breaking the sac. Your doctor uses this technique to urge your body to release prostaglandins, hormones that stimulate labor. As the water sac separates from your uterus, your cervix may soften and contractions may begin.
Your membranes can only be swept once your cervix opens enough for your doctor to insert a finger. Membrane sweeping to induce labor works for 1 in 8 women. It’s one of the less risky labor-induction techniques.
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 won’t 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 oxytocin (Pitocin) 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.
Acupuncture. In parts of Asia, it has been used for centuries to induce labor. Some studies suggest it can help women who are 40 weeks or less pregnant, but may not help bring on labor in women who are post-term, or 41 weeks or more pregnant.S
Sex. Another strategy that gets positive reviews from doctors and midwives is inducing labor the same way you started your pregnancy: by having sex.
Although there's no proof sex can start labor, there is a good reason why it might. Sex releases prostaglandins. If you’re comfortable with having sex, it won't hurt to try. Make sure your water hasn’t broken and your doctor or midwife has given you the green light.
- Long walks. Going for a walk is good exercise, but experts don’t think it will help bring on labor.
- Spicy foods. It's a popular theory, but there's no direct connection between the stomach and the uterus. So there's no reason to think a particular type of food will bring on contractions.
- Castor oil. Some experts recommend taking a small amount of castor oil after the 38th week. But castor oil brings on diarrhea and could cause dehydration.
- Cohosh. Some people try starting labor with cohosh, but doctors caution that this herb contains plant-based chemicals that may act like estrogen in the body.
- Evening primrose oil. This herb has substances that your body changes into prostaglandins, which soften your cervix and get it ready for labor.
- Red raspberry leaf tea. Some people think this herbal tea helps bring on spontaneous labor. The verdict is still out, but the tea is chock full of iron and calcium, which can be healthy for you and your baby. Studies show it’s safe to drink during pregnancy.
You may go into labor and deliver within a few hours after induction. Or it may take 1 or 2 days to start labor. If none of these methods start your labor and staying the course isn’t a good option, you'll most likely need a C-section -- especially if your water has broken.
Don’t try any of these methods without first talking to your doctor or midwife. Some can cause side effects or pose risks.
What Are the Risks of Inducing Labor?
Induction doesn’t work for everyone, and every pregnant mom’s body reacts differently to induction technique. 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 need 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.
Possible Risks of Not Inducing Labor
Your health. If you let your pregnancy go past full-term, you're at greater risk of a difficult delivery as your baby continues to grow in utero. You’re also at an increased risk for a type of high blood pressure that's associated with pregnancy after your due date.
Your baby’s health. Your baby is also at risk as your pregnancy stretches on. With each passing week, the placenta becomes less effective at passing nutrients and blood to your baby. A baby that grows larger than your birth canal will allow for may be stressed during delivery. A C-section may become unavoidable.
Staying pregnant longer can increase the risk of your baby passing their first meconium stool in utero. If your baby breathes meconium in the birth canal, it greatly increases their risk of developing an infection. A baby born after 42 weeks of gestation also has an increased risk of sudden infant death syndrome (SIDS).