Inducing Labor

What Does Inducing Labor Mean?

Inducing labor (or labor induction) is when doctors use medicines or other medical methods to bring on labor before a woman goes into labor on her own.

Usually, it's done when the health of the mother or the baby might be at risk if the pregnancy continues. Sometimes it's done before the pregnancy reaches full-term, if the risk of continuing the pregnancy outweighs the risk of the baby being born a little early.

Why Will Doctors Induce Labor?

Labor is usually allowed to take its natural course. But your doctor might suggest an induction if:

• Your water broke but you are not having contractions.
• Your baby still hasn't arrived 1–2 weeks after the due date.
• You have an infection in the uterus (called chorioamnionitis).
• You have a medical condition (such as gestational diabetes or high blood pressure).
• There is not enough amniotic fluid.
• There is a problem with the placenta.
• The baby is not growing as expect.

Sometimes a mother and doctor might choose an induction for non-medical reasons. This is called an elective induction. For example, a mom who has a history of rapid deliveries or lives far from a hospital might opt for an elective induction if there’s a concern that she might not make it to the hospital in time to deliver there.

Recent studies show that elective induction at 39 weeks of pregnancy can be a reasonable option for some women who are healthy and pregnant with their first baby, even without medical reasons. It is just as safe for the mother and baby as waiting for spontaneous labor to start, and can even make the mother less likely to need a C-section or to have some types of pregnancy-related problems (such as preeclampsia). Talk to your doctor about whether this could be an option for you.

How Is Labor Induced?

Ways that doctors may try to induce labor include:

• “Ripening” the cervix. This means making the cervix soft, thinned out, and ready for delivery. This can be done by giving the mom a hormone called prostaglandin (inserted into the vagina or taken by mouth), or by inserting a small tube (catheter) into the vagina with an inflatable balloon that slowly stretches the cervix (the opening of the uterus) open.
• Stripping (or sweeping) the membranes. The doctor can separate the amniotic sac (which houses the baby and amniotic fluid) from the wall of the uterus by sweeping a gloved finger between them to separate the thin membranes of the sac from the wall of the uterus. This triggers the body to release prostaglandin, just as it would have done had labor started on its own. Prostaglandin helps prepare the cervix for delivery and may bring on contractions.
• Breaking your water (also called an amniotomy). The doctor makes a small hole in the amniotic sac during a vaginal exam using a little plastic hook to break the membranes. If the cervix is ready for labor, amniotomy usually brings on labor in a matter of hours.
• Stimulating contractions of the uterus. If all other methods don't bring on regular contractions, the doctor will give a medicine called Pitocin through an IV line. (Pitocin is the synthetic form of oxytocin, a hormone that the body releases during labor to help the uterus contract.) It starts a small dose, which increases until labor is progressing well. While the Pitocin is given, the fetus and uterus are closely monitored. Pitocin also can be used to speed up labor that's going slowly or has stalled.

What Will It Feel Like?

• Stripping the membranes can be a little painful or uncomfortable, although it usually only takes a minute or so. You may also have some intense cramps and spotting for the next day or two.
• Having your water broken can be a little uncomfortable. You may feel a tug followed by a warm trickle or gush of fluid.
• With prostaglandin, you might have some strong cramping. 
• With Pitocin, contractions are usually more frequent and regular than in a labor that starts naturally.

What Are the Risks of Inducing Labor?

Usually, labor induction goes very smoothly. But as with all medical procedures, there are some risks:

• It might not work. Inducing labor is not like turning on a faucet. It might take a long time. Sometimes if all is well and the amniotic membrane is still intact, a woman can go home and schedule another attempt at induction. If it takes too long, or if there is a problem with the mother or the baby, a C-section might be needed. Induction does not make it more likely that a woman will need a C-section, though.
• It might bring on very strong contractions. These can:
  • affect blood flow to the baby
  • tear the uterus (this is very rare)
• There is a risk of infection in mother or baby if membranes are ruptured for too long before the baby is born.
• The muscles of the uterus might not contract as well after birth (called uterine atony). This can lead to excessive bleeding.
• It might mean the baby is born too early if there is a mistake in the estimated due date. Babies born too early can have problems with feeding, breathing, or maintaining body temperature. (But again, sometimes inductions are done early on purpose if the risk of health problems is greater than the risk of an early birth.)

What Else Should I Know?

Induction is not an option for every pregnancy. It may not be safe in women who have had a certain type of C-section in the past. It also won't be done for women whose baby or placenta is positioned a certain way in the uterus.

You might have heard tales about ways to induce labor at home, such as the use of castor oil. It is not safe to try to artificially start labor yourself by taking castor oil, which can lead to nausea, diarrhea, and dehydration. And herbs and herbal supplements meant to induce labor can be harmful.

Breast stimulation can cause uterine contractions by causing the release of oxytocin. But some studies suggest that the baby might have abnormal heartbeats after breast stimulation. Some women feel that having sex in late pregnancy can induce labor, but there is no real proof of this yet.

Talk to your doctor before doing anything to try to encourage your little one's arrival. Inducing labor is best left to medical professionals.