Induction of labor is when the childbirth process is initiated with the help of certain medicines or techniques before it naturally begins on its own. Typically, a pregnant person will have their labor induced when delivering early is clearly the healthiest choice for themselves or their baby.

Since there are some risks associated with inducing labor, the decision to deliver before your due date is an important one that you will make with your doctor or midwife, usually later in your pregnancy, That said, there are a few instances when you might know earlier in your pregnancy that induction is the safest route to a smooth delivery.

Why Is Labor Induced?

Pregnant people have a variety of reasons for wanting to have their labor induced. However, the American College of Obstetricians and Gynecologists (ACOG) recommends labor induction only when there are clear health or safety benefits. Some of the medical reasons that justify initiating an early delivery include:

  • Fetal conditions: If your baby is experiencing certain health conditions, ACOG recommends an early delivery. These include intrauterine growth restriction (IUGR), multiple gestation (if your baby is a twin or triplet), or when there is too little or too much amniotic fluid.
  • Diabetes (gestational or type I and II): ACOG recommends that pregnant people with gestational diabetes or preexisting diabetes should have labor induced before week 40, especially if they are having trouble managing symptoms or are on medication. Maternal diabetes can put a baby at risk for being overly large, experiencing shoulder injuries during childbirth, or being stillborn.
  • Hypertension or preeclampsia: Uncontrolled high blood pressure during pregnancy can lead to serious, even fatal complications. It’s recommended that pregnant people with severe gestational hypertension or preeclampsia (hypertension with protein in the urine) be induced early.
  • Placental/Uterine Conditions: Having placenta previa, a previous uterine rupture, or a prior cesarean delivery (c-section) are examples of structural concerns in the womb that might call for an early delivery.
  • Post-term pregnancy: A baby who has not been born by 42 weeks gestation is at risk for being stillborn, experiencing shoulder injuries or meconium aspiration in the birth canal, or having seizures. For this reason, ACOG says that it’s valid to induce birth starting at 41 weeks and recommends inducing birth at 42 weeks.
  • PROM (premature rupture of membranes): If your water breaks prematurely, your doctor may recommend that you deliver as early as 34 weeks.

What Is Elective Induction of Labor?

An elective induction is a planned delivery that’s not prompted by a medical need. It’s often desired for the convenience of a doctor, a midwife, or the family of a pregnant person. It may be done to get the practitioner that you want, to aid in family scheduling, or to try to pick a certain birth date.

ACOG generally frowns upon inductions for non-medical reasons but notes that special circumstances might make scheduling an elective induction a reasonable option, such as when a pregnant person lives very far away from a hospital. In these cases, it’s important to wait to induce until 39 weeks, when the baby is full-term.

How Is Labor Induced?

Labor can be induced in several ways, depending on how close you are to your due date and whether you have begun to show signs of pending labor. Some of the more common methods, which are often combined, include:

There is mounting evidence that healthy women undergoing their first childbirth experience may be at lower risk of needing a c-section or developing dangerously high blood pressure when induced at 39 weeks. ACOG and the Society for Maternal-Fetal Medicine have both concluded that elective induction at 39 weeks is therefore a reasonable choice for first-time parents. It’s worth discussing these findings and your options with your doctor early in your pregnancy.

  • Stripping the membranes: During a vaginal exam late in a healthy pregnancy, your doctor or midwife might insert their finger into your cervix and attempt to separate it from the amniotic sac without breaking your water. Less an induction method than a way to coax approaching labor along, membrane stripping can prompt your body to release natural chemicals that soften (or “ripen”) your cervix.
  • Prostaglandins: Another early step in labor induction is the insertion of cervix-softening prostaglandins into your vagina via a gel or suppository.
  • Pitocin: This is the synthetic version of oxytocin, a natural hormone that starts contractions. Pitocin is given via an IV line, and you’ll be monitored to gauge its effectiveness. Dosing can be increased to create a realistic contraction pattern.
  • Amniotomy: Doctors may break your water artificially after giving you Pitocin if your cervix is thin and dilated. Doctors gently nick the amniotic sac in this painless procedure to create a hole through which fluid can release, stimulating labor.
  • Foley bulb: This is a catheter with a balloon that is placed through the cervix and expanded. The pressure from the device promotes dilation and contractions.

At-Home Methods of Labor Induction

Some parents try at-home methods of labor induction. Though many parents swear by these methods, there is scant research showing they bring on labor any faster than Mother Nature. Any method to try to bring on labor, even ones billed as “natural,” should be discussed with your doctor or midwife. Some common at-home induction tricks include:

Sometimes labor stalls or is delayed at various stages, posing a risk to your health or your baby’s health. Then, a practitioner may prescribe an augmentation of your labor. There are multiple methods of augmentation that are similar to those used to induce labor, including the use of medications, amniotomy, and other techniques.

  • Castor oil: This is typically taken orally in a variety of recipes. It can cause diarrhea, so it should only be used with the advice of your practitioner.
  • Nipple stimulation: This can include manual or oral stimulation of the nipples. Some use a breast pump to help release natural oxytocin in an attempt to prompt the beginnings of labor.
  • Relaxation and visual imagery: Whether it brings on labor or not, these are great ways to promote rest, which is beneficial at the end of pregnancy and will help you when labor does finally start.
  • Sex: Sexual intercourse probably won’t speed up the onset of labor, according to recent research reviews. However, in low-risk pregnancies, it’s perfectly safe to try.

What Are the Risks of Inducing Labor?

There are some risks associated with inducing labor before it naturally begins on its own. For this reason, it’s crucial you and your caregiver discuss how the benefits of induction outweigh the potential downsides before scheduling a delivery. The risks of induction may include:

Cesarean delivery: Contractions can start with the introduction of medication, but your cervix can’t always be convinced to open. Sometimes induction is stopped and you’re sent home to try again later; other times, for the health of your baby, a c-section is the best option.

Fetal distress: Inducing labor can bring on uterine tachysystole, an abnormally high rate of contractions, causing your baby’s heart to race. Compared with the use of medications to induce labor, techniques like the use of a Foley bulb catheter have been shown to reduce the chance of excessive contractions.

Infection: As with any invasive procedure when an instrument is used internally, an amniotomy can lead to infection.

Uterine rupture: The force of labor contractions brought on by Pitocin can result in a tear in the uterus, particularly if you have had a prior c-section.

What to Ask If Labor Induction Is Suggested

If your doctor or midwife suggests inducing labor, be sure to ask them to explain their rationale. Here are some questions to consider asking your practitioner when considering an induction:

  • Why are you recommending induction of labor?Are there any alternatives to inducing?What would happen if I were to wait for labor to begin naturally?Is there some additional testing that we can do to help guide my decision?What does induction of labor look like for your practice? For my situation? What methods would be used?If there are added risks, what can be done to mitigate them?What are the risks of induction for me personally? For my baby?