Getting induced before or at 37 weeks is something each pregnant mamma and her partner should consider carefully. This article will review WHY you might want/need to be induced, how it might happen and why you might want to wait if possible.
How do I know about inductions?
Hi, I’m Hilary. I’ve been an L&D nurse since 2001, and I’ve started (and delivered) COUNTLESS inductions. I’d love for you to let me walk with you through your pregnancy:
Induction At or Before 37 Weeks
Reasons for an Early Induction
Full term for a pregnancy is 40 weeks, so a 37 weeks (or before) induction is pretty early.
While 3 weeks might not SEEM like a long time, when you are trying to create an entire human inside your body, every minute counts.
Also, something to keep in mind is that even early ultrasounds are not 100% accurate. Most predict your due date plus or minus 2 weeks. Which means at a point where you think you are 37 weeks, you could actually be 35 or 39 weeks (and anywhere in between). Which could be a big difference!
This early, you’d want to be sure to get informed consent before scheduling an induction. That means you understand the risks, benefits and any alternatives of the procedure.
This early, you would be induced mainly if your health or the health of your baby was severely impacted.
Baby is Too Small
This is also known as IUGR (intra-uterine growth restriction) or SGA (small for Gestational Age). At this point in time for this early of an induction, you would likely have had several ultrasunds that would chart that the baby in’t growing well (or blood flow studies called doppler scans) that show baby isn’t getting enough blood flow.
They do often induce for bag babies, but rarely would they do that at 37 weeks.
Cholestasis of Pregnancy
This is where the bile duct is blocked. Women often have a rash/itchiness on belly and abdomen. Your doctor would then order bile salts tested to see if that is the issue.
Because there is a high incidence of stillbirths, depending on the severity of you blockage, they can induce at 37 weeks.
FYI, once baby is delivered the rash/itching usually goes away.
Learn more about cholestasis here.
Too Little Amniotic Fluid
If they do an ultrasound (often what’s called a BPP — and I go into most of the 3rd trimester testing in this free course) they might find that you don’t have enough fluid.
This can be problematic as fluid give the baby and umbilical cord more room in the womb.
There are ways to try to increase the fluids. We find many women are severely dehydrated (especially since I practice in Phoenix) and fluids can help you get closer to full term.
Preeclampsia is a smooth muscle disorder that is diagnosed through lab work and blood pressures taken at rest.
The only way to cure it is to deliver the baby and the placenta.
It can cause issues (including seizures) and can restrict the baby’s growth similar to IUGR if not taken care of. While they would proabably prefer you got closer to 38 weeks, sometimes they will induce you at 37 weeks.
Learn more about preeclampisa on my sister site.
There are two types of diabetes
This is diabetes that happens just during pregnancy. Some people are diagnosed early on or at around 30 weeks.
Most women, if controlled, can go past 37 weeks but if their sugars aren’t controlled they might need to be induced early.
Type 1 or Type 2 diabetic
These people have had diabetes before pregnancy and will continue to have it afterwards as well. Their body has more health-related concerns, and they will often be induced ahead of time.
Having a previous stillborn baby can be a reason for an early delivery. While 37 week is pretty early, it can be the best option for maternal and fetal well being.
A history of a stillborn makes your entire pregnancy different. Doctors are aware
While these are some of the most common reasons, there are other reasons including congenital anomalies they found on the ultrasound and other reasons.
There are other reasons you might be induced. I go into the vast majority in my online prenatal course.
An elective induction (an induction without a medical indication) should not happen at 37 weeks. ACOG (obstetrician’s professional organization) recommends against it, and it can be difficult to explain to your insurer.
How They Induce You at 37 Weeks
Manual Induction Methods
There are couple of manual induction methods (manual meaning something physical happens to your cervix):
As long a your cervix is open enough that they can get the tube in, they can insert a foley bulb.
That’s basically a tube with a balloon at the end. They fill the balloon with water and that manually opens the cervix with time.
Normally, it goes in for 12 hours. Some doctors will place it in the office, and some place it in the hospital.
It is mildly uncomfortable, but it ins’t too invasive.
Rupture Your Amniotic Fluid Bag
Your doctor can come rupture your membranes (break your amniotic fluid sac) to see if that will get labor started. Most often, at 37 weeks this isn’t enough to get you going. Often, once you have had a cervical ripening agent (see below) they will break your water after that to hurry things along.
Cervical Ripening Methods
This means that your cervix is less than 3 cm and needs to ripen (yes, like fruit) so that it will open up as we make you have harder/faster contractions.
All of these start with smaller contractions and don’t normally put you into labor on their own (but sometimes they do). The idea is to give these medications until your cervix is 3 centimeters and then we move to Pitocin (see below).
Misoprostil / Cytotec
This is a small pill that is given orally, placed by your gums/under your tongue to disolve or vaginally.
This is a gel we place in your vagina. It’s similar to a Monistat plunger I have used for a yeast infection before.
This is like a flattened tampon (or a tiny stiff tea bag) that is placed in your vagina next to your cervix for 12 hours and then removed.
Pitocin is the main induction method. It can also be given before the cervical ripening agents — it is up to your doctor.
It is given IV and is more high risk than the other method. Your blood pressure and fetal well being are more frequently assessed with pitocin (and you will need to be monitored continuously).
That all being said, we use pitocin frequently in labor and delivery, it isn’t unusual at all — and we are educated on how to use it safely. I have a whole article on Pitocin inductions.
What to expect at an induction
An early induction is usually a bit of an “uphill” battle as your cervix and mother nature are not normally on your side (this is totally different if you go into labor that early on your own).
This is a method of ranking how conducive to an induction your cervix is. It takes into account how many centimeters you are, how soft your cervix is and how effaced (or thin) it is. I go into all the info on vaginal exams on this post on my other site.
While a low bishop’s score wouldn’t stop us from inducing someone who really needed it done, it can tell you how long it might take, and that information is worth discussing with your doctor.
How long will a 37 week induction take?
The textbook case once you are in labor is 1 centimetre per hour plus 2 hours of pushing on your first baby (much less on subsequent babies).
However, that only starts once you’re IN labor. That means your cervix is actively opening. That might take a while to get mother nature on your side with medication (and cervical softening by the agents we listed above).
Risks of an early induction
The risk of an early induction is similar to the risks of induction at any stage. Once you add any intervention at any stage it does increase the risks.
Your induction is also likely to be lengthier than an average induction where someone is closer to 40 weeks.
AND, there is always the chance it will fail and you will need a cesarean section. With an elective induction, there is always the chance that if you fail you can go home and wait a few days, possibly try again. If you NEED the baby out, they will need to do a cesarean section.
Why Not to Get Induced at 37 Weeks
Going full term is best for you and your baby, if your doctor recommends an induction early, be sure to understand why and if it can be pushed later.