Labor Induction

Most women go into labor on their own between 37 and 42 weeks of the pregnancy. When this does not happen or when there is a medical need, medicine or other methods may be used to induce labor. Labor induction causes a pregnant woman's uterus to contract. It also causes the cervix to soften (ripen), open (dilate), and thin out (efface). Usually, labor is not induced before 39 weeks of the pregnancy unless there is a problem with the baby or mother.

Whether your labor will be induced depends on a number of factors, including the following:

  • The medical condition of you and the baby.

  • How many weeks along you are.

  • The status of baby's lung maturity.

  • The condition of the cervix.

  • The position of the baby.

REASONS FOR LABOR INDUCTION

  • The health of the baby or mother is at risk.

  • The pregnancy is overdue by 1 week or more.

  • The water breaks but labor does not start on its own.

  • The mother has a health condition or serious illness such as high blood pressure, infection, placental abruption, or diabetes.

  • The amniotic fluid amounts are low around the baby.

  • The baby is distressed.

REASONS TO NOT INDUCE LABOR

Labor induction may not be a good idea if:

  • It is shown that your baby does not tolerate labor.

  • An induction is just more convenient.

  • You want the baby to be born on a certain date, like a holiday.

  • You have had previous surgeries on your uterus, such as a myomectomy or the removal of fibroids.

  • Your placenta lies very low in the uterus and blocks the opening of the cervix (placenta previa).

  • Your baby is not in a head down position.

  • The umbilical cord drops down into the birth canal in front of the baby. This could cut off the baby's blood and oxygen supply.

  • You have had a previous cesarean delivery.

  • There are unusual circumstances, such as the baby being extremely premature.

RISKS AND COMPLICATIONS

Problems may occur in the process of induction and plans may need to be modified as a situation unfolds. Some of the risks of induction include:

  • Change in fetal heart rate, such as too high, too low, or erratic.

  • Risk of fetal distress.

  • Risk of infection to mother and baby.

  • Increased chance of having a cesarean delivery.

  • The rare, but increased chance that the placenta will separate from the uterus (abruption).

  • Uterine rupture (very rare).

When induction is needed for medical reasons, the benefits of induction may outweigh the risks.

BEFORE THE PROCEDURE

Your caregiver will check your cervix and the baby's position. This will help your caregiver decide if you are far enough along for an induction to work.

PROCEDURE

Several methods of labor induction may be used, such as:

  • Taking prostaglandin medicine to dilate and ripen the cervix. The medicine will also start contractions. It can be taken by mouth or by inserting a suppository into the vagina.

  • A thin tube (catheter) with a balloon on the end may be inserted into your vagina to dilate the cervix. Once inserted, the balloon expands with water, which causes the cervix to open.

  • Striping the membranes. Your caregiver inserts a finger between the cervix and membranes, which causes the cervix to be stretched and may cause the uterus to contract. This is often done during an office visit. You will be sent home to wait for the contractions to begin. You will then come in for an induction.

  • Breaking the water. Your caregiver will make a hole in the amniotic sac using a small instrument. Once the amniotic sac breaks, contractions should begin. This may still take hours to see an effect.

  • Taking medicine to trigger or strengthen contractions. This medicine is given intravenously through a tube in your arm.

All of the methods of induction, besides stripping the membranes, will be done in the hospital. Induction is done in the hospital so that you and the baby can be carefully monitored.

AFTER THE PROCEDURE

Some inductions can take up to 2 or 3 days. Depending on the cervix, it usually takes less time. It takes longer when you are induced early in the pregnancy or if this is your first pregnancy. If a mother is still pregnant and the induction has been going on for 2 to 3 days, either the mother will be sent home or a cesarean delivery will be needed.