Induced Labor: When, Why, How

For many women, the labor process begins naturally on its own. For some, a little intervention may be needed to help things along. Sometimes mom’s prefer this too, and that is okay!

Labor induction means using interventions to help labor start. This could be before the due date (for medical or personal reasons), or after the due date if labor has not started naturally. Inductions may be a part of a woman’s desired birth plan, or quite a surprise recommendation if a medical issue develops.

Despite some common concerns about inducing labor, it’s no more dangerous or necessarily painful than labor and delivery that begins on its own. Here’s what you need to know about induced labor, when induction is recommended, what to expect, and how to plan.

Why Your OBGYN May Recommend Inducing Labor

Your OBGYN may recommend inducing labor for medical reasons to keep you and/or your baby safe and healthy. The recommendation to induce labor isn’t made lightly, especially if it is before 39 weeks gestation. When weighing the risks and benefits of delivery, your OBGYN weighs the risk of continuing the pregnancy with the risk of an earlier delivery. It is always a balance we pay close attention to for the safest outcome for mom and baby.

Medical reasons to induce labor before 39 weeks of pregnancy include, but are not limited to:

Gestational hypertension or chronic hypertension: high blood pressure during pregnancy that can progress to preeclampsia
Preeclampsia: high blood pressure in pregnancy that is associated with spilling protein in your urine, possible liver and kidney effects, risk of seizure and stroke
Gestational diabetes: especially if medications are needed to control blood sugar levels
Fetal Growth restriction: baby is not growing as expected, concerning that the placenta is not functioning optimally
Oligohydramnios: low amount of amniotic fluid around the baby (seen on ultrasound), another sign the placenta may not be functioning well
Cholestasis: a build up of bile acids that causes intense itching and can be associated with stillbirth

Reasons to induce labor after 39 weeks of pregnancy:

Late term pregnancy (if a woman is more than two weeks past her due date)
New development of high blood pressure (as above)
Age (many women can have healthy pregnancy’s after age 40, however, we know that delivering at 39 weeks improves outcomes for these moms and babys)
Abnormal fetal heart rate on monitoring
Maternal weight (moms with higher BMI’s likely benefit from inducing prior to 40 weeks).
Maternal desire (delivery at 39 weeks is safe, healthy, and can be a great experience!)

Until recently, inductions were only done for medical reasons, as advised by a doctor. Elective inductions—when a mom requests to be induced at 39 weeks or later—weren’t offered. It was thought to increase the risk of C-sections. A well-done study in 2018 (called the ARRIVE trial) showed that if induction is done in a safe way, the risk of C-section may actually be reduced.

Reasons women choose induced labor (when no medical reason is present):

Personal reasons (scheduling work, family help with other children, do not like the unpredictability of labor, etc.) .
Aches and pains of the third trimester
Just ready to meet their baby!

How Inducing Labor Works

Cervical Exam

A lot of the process depends on how “ready” your cervix is for labor (or in medical lingo, how “ripe” it is). A pelvic exam or cervical check will let us know how dilated, soft, and thin your cervix is and it’s location in the pelvis. We use these factors to determine what we call a Bishop score. A Bishop score of 8 or more (which means more dilated, soft, or thin) does not require any additional cervical ripening. If your Bishop score is <8, we recommend a few more things to get your cervix ready for labor. If we skip this part, that may increase the risk of needing a C-section. Performing appropriate cervical ripening reduces your C-section risk to baseline, as if you came in labor on your own.

Cervical Ripening

If the Bishop score is less than 8, then your OBGYN will recommend cervical ripening. This can be done with a balloon that helps the cervix soften, thin, and dilate and/or a medication called misoprostol (we give this by mouth, you may read about it given vaginally also). A balloon placement can be uncomfortable, but is generally very well tolerated. We offer this in the clinic (the balloon can stay in up to 12 hours) to shorten the amount of time you need to be in the hospital. The most common thing, however, is to have it placed in the hospital to be given with misoprostol at the same time.

Pitocin (oxytocin)

When your cervix is ready for labor, the next recommended step is oxytocin administration through an IV. Pitocin is not scary! It is the same molecule your body makes to cause contractions, we can just give it in controlled doses through an IV. The dose ranges from 0.5 mu/min to 30 mu/min. Every body reacts differently to the dose and we cannot predict who will need more or less.

Throughout ripening and induction, the baby’s heart rate will be monitored to ensure they are not stressed in labor.

Artificial rupture of membranes (AROM)

If your cervix is ready for labor and your baby is in a good position, we can induce labor by breaking your water. This can also be done as a step after cervical ripening during an induction. This allows your own body to take over the labor process in some instances.

Common Concerns & Questions About Induced Labor

Is it safe to induce labor?

We continuously monitor the baby through a fetal heart rate monitor to ensure labor isn’t stressing the baby. This is commonly done in spontaneous labor also.

We used to think that being induced increased your risk of needing a C-section. Prior to 2018, this elective induction wasn’t an option because of this concern. After the ARRIVE Trial in 2018, we understand that inductions do not increase your risk of needing a C-section and it actually likely lowers your risk (28 inductions to prevent one C-section). After 39 weeks, a baby is fully developed but only continues to grow, the placenta can start to get tired, and there is a higher likelihood of developing preeclampsia and these are some reasons elective induction can be a good idea.

How long does it take to deliver after induced labor?

Like every aspect of pregnancy and labor, the answer is: it depends. Some women will deliver in hours while other times it takes 24 hours or greater. This is true of spontaneous labor also, but the difference is with induction the majority of time you are in the hospital for the process.

Is induced labor more painful than labor that begins on its own?

The answer to this question is also a little tricky. Many studies have shown that pain with induced labor is not greater than spontaneous labor. Pitocin is the same hormone your body uses to cause labor and contractions hurt! Women perceive more pain as labor starts if they start from a place of no labor! Women who undergo induction are more likely to receive an epidural for labor pain control.

How should I prepare for an induction?

A benefit of labor induction is that you can plan ahead a little bit more.

Eat a healthy, light, bland breakfast before coming to the hospital. Toast and scrambled eggs are popular!
Bring your hospital bag with you. (This blog post will give you all the insider information about what to pack.)
If you choose to let many people know when you’re getting induced, remind them that it could still take more than 12 hours. That way, you may receive fewer messages asking “Is your baby here yet?”

Can I induce labor without medication?

If your pregnancy is passing weeks 40 or 41, you may wonder if there’s any way you can speed things along naturally.

Some women swear that sipping herbal teas, snacking on dates and pineapples, or going for extra long walks helped induce labor. However, there is no research data to support these methods.

One activity, however, has been shown to help move things along: sexual intercourse. Sperm contains prostaglandins, which help soften the cervix. Orgasm releases oxytocin, which causes uterine contractions.

Nipple stimulation can also cause contractions but is not recommended without monitoring because it is so unpredictable.

Finally, a membrane strip can be performed in the doctor’s office after 39 weeks. This is done after your cervix has begun to dilate. A membrane strip (or membrane sweep) is when your OBGYN inserts their fingers into your cervix, makes a sweeping motion, and loosens the amniotic sac from the uterus. It can help your body release prostaglandins which will soften your cervix and help your body prepare for labor. (This method is not offered if you test positive for Group B Strep.)

Induced Labor: Like regular labor, only more planned.

You may have fears or concerns about induced labor, especially if your OBGYN is recommending it for medical reasons. While going into labor naturally is typically preferred by patients with the perception that your body and baby are ready, induced labor can be just as safe—or safer. Many women that consider induction worry about missing the experience of going into labor at home. This is valid! But we like to keep in mind, especially when medical reasons come up, that mom and baby’s safety is our priority. We want your experience to be all that you hope for, and that is possible with induction.

Your OBGYN carefully balances the pros and cons of inducing labor versus continuing expectant management. If you have any questions or concerns, always talk to your midwife or OBGYN. At Madison Women’s Health, we value clear, transparent, and caring communication with every one of our patients.

Dr. Ashley Durward has been providing healthcare to women in Madison since 2015 and joined Madison Women’s Health in 2019, specializing in high and low risk obstetrics, contraception and preconception counseling, management of abnormal uterine bleeding, pelvic floor disorders, and minimally invasive gynecologic surgery.