A labor induction for pregnant women is an important choice to make with your healthcare provider. Starting labor contractions with medication does come with a risk of complications, but an induction of labor can also help get baby out of the birth canal for a successful vaginal delivery as well. So, WHEN will they induce you?
But first, let me explain why I know so much about the induction of labor:
Hi, I’m Hilary — The Pregnancy Nurse 👩⚕️. I have been a nurse since 1997 and I have 20 years of OB nursing experience, I am also the curly head behind Pulling Curls and The Online Prenatal Class for Couples. 🩺 I have helped thousands of families start and finish an induction of labor. I have talked to many about the risks and the benefits, and I have seen the outcomes of thousands of inductions.
If you’d like to get my helpful tips for just where you’re at in your pregnancy — sign up here:
Going into spontaneous labor is the gold standard of labor. Especially on your first baby it can be hard to wait until 40+ weeks until your body decides to labor on its own, or maybe your water breaks. Obviously the baby’s health is our #1 concern in this situation and the delivery unit will be sure to watch over the health of both of you carefully.
What is natural labor?
Natural labor has gotten a lot of flack in the last few years — but I want to define it for the case of this article. Natural labor would be one in which no medication was used to start labor. We won’t be focusing on pain management options to much in this article, so natural labor would just be referring to spontaneous labor which didn’t have medical intervention.
FYI new research (frankly, only ONE study — and it has yet to be duplicated) shows that possibly inducing at 39 weeks, even without a medical cause, could help mom feel less uncomfortable towards the end of pregnancy and possibly also have better outcomes for babies overall.
That being said, it is important that parents understand the risk of complications that can come with starting labor contractions with medication — so let’s get into it.
What does ACOG say?
ACOG stands for American College of Obstetricians & Gynecologists. It is the professional organization for OB/GYN’s in the US. Their standards of care (and making sure they keep their license) is taken from them.
Theys state that it is reasonable for obstetricians and health-care facilities to offer elective induction of labor to low-risk nulliparous women at 39 weeks gestation. However, that also depends on the hospital having enough staff, and the patient requesting it. SO, that mostly says if you WANT an induction of labor after 39 weeks, they should be willing to offer it. Keeping in mind that has to flex with what the hospital is able to offer (and at the time of the writing of this article, hospitals do not have a lot of staff).
That means that the hospital needs to take people in spontaneous labor, or those who medically need to be induced, before those who are choosing to have an induction. Similar to how the ER takes patients who are having a heart attack before those who have a small cut or a cold.
Pro Tip: Your Bishop Score
Knowing your bishop score can help you know if an elective induction of labor is really a good idea. The bishop score takes into account:
- Cervical Dilation (how open it is)
- Cervical effacement (how thick it is)
- Certical consistency (is it soft or hard)
- Baby’s station (how high or low the baby is in the pelvis)
BTW I have a whole post on vaginal exams and what this all means.
For most doctors they really only think an elective induction is a viable option as you progress into a large bishop’s score. If your cervix is rock hard and closed, an elective induction of labor may not be the smartest thing. When you start with a lower bishop’s score, it usually takes a larger amount of time for baby to be born.
If you like information like this — I know you’ll absolutely LOVE a prenatal class! I know it can be tempting to get bits and pieces off the internet and feel like you are prepared, but without a beginning to end prenatal class it is impossible to know if you have missed something, and studies show it is so much more important to prepare with your birth partner as well.
I 100% recommend this one. It can be done on your own timeline in just a few hours. It is created for couples to do together and to spark ideas about how they will handle labor and the baby. The reviews are fantastic.
When Will Your Doctor Schedule an Induction
If you have a medical reason for an induction, they will weigh the risks of the baby staying inside vs the baby coming out. We will talk about the medical reasons a doctor might induce you a bit later in this article.
If you are wishing for an elective induction (meaning you are requesting the induction and there is no medical reason) – your doctor will consider your due date.
Most often they will not offer an elective induction until 39 weeks of pregnancy. That is just one week shy of full term (or the end of pregnancy – your due date). Babies at this gestational age are likely to do fine outside the womb.
If you study this a lot, you will hear about the ARRIVE trial (which you can find here). In this they found that offering a 39 week elective induction of labor vs expectant management (that’s where doctors would just watch you and only act if they saw something was wrong) did not have any increased risks for the baby, had a lower chance of a cesarean – participants were more likely to have a vaginal delivery.
This is a pretty controversial study in obstetrics, and its findings have yet to be reproduced by another study, so the verdict is certainly out.
This is why it’s really important that you talk with your provider about your unique circumstances, especially about your bishop’s score to see if you’re truly a good candidate for an elective induction – if that is what you want.
As a note, some providers are really encouraging women to have an elective induction at 39 weeks due to that study, but remember you can always make up your own mind.
Medical reasons for An Induction of Labor
Today I’m going to share some of the common reasons why your doctor might induce yuo. There are a LOT of reasons, but I want to just touch on common ones. That’s why it is important to have this discussion with your own provider.
High Blood Pressure or Preeclampsia
High blood pressure is often a reason for an induction. Be it just maternal hypertension (high blood pressure with no signs of preeclampisa) or preeclampsia, both are indicators for an induction.
This is a reason that many women are induced. It can be Type 1, Type 2 or gestational diabetes. It depends on how well your blood sugar is controled, and what management you are doing (insulin, medication or diet-controlled).
Ruptured Amniotic Sac
Once your amniotic sac is ruptured, there is a risk of infection. The amniotic membrane helps protect baby from outside bacteria – but once that’s broken things can affect the baby. While this isn’t exactly induced labor – I normally call it a labor augmentation.
But, regardless of the terminology, if your water is broken and within a few hours your uterus is not contracting, they will likely want to induce those contractions with Pitocin.
There are other reasons like baby being to big or too small, or to much or too little amniotic fluid. All of these show an increased risk to baby staying in the womb rather than coming out. In other words, their health problems could be worse staying inside your uterus. In making the decision for an induction they will take into consideration any healthy problems, any medical conditioners that the baby might have and any risk factors for either of you.
BTW, if you want to know more about how they test for any issues in the third trimester you’ll love chapter two in this.
Risks of Induction
As with any medical procedure (including natural labor) there are potential risks of an induction.
There is an increased likelihood of cesarean section. As we are creating the contractions vs your body creating them – there is a chance of uterine rupture (meaning your uterus contracts so hard it pulls apart).
Baby’s heart rate can have an issue with the strong contractions. The placenta can come off of the uterus (called a placental abruption) because the contractions are so hard
This is why pregnant women who are having an induction of labor are monitored more closely and we are very careful with the medications we use. We will watch both baby’s heart rate and uterine contractions carefully to make sure that both are safe.
Before an induction of labor, your provider should go over the risks and the benefits of an induction.
There are many induction methods that providers can use to start labor:
Stripping membranes or sometimes called a membrane sweep is when your provider takes a gloved finger and “rings” it between your cervix and your bag of waters to separate the two and possibly stir up hormones in that area to get things started.
This is most often done in the doctor’s office (and may or may not work).
Foley Catheter Balloon
This is where a small balloon is placed in your cervix to help manually open it. It is basically just pushing against the sides of your cervix. This can be done in the doctor’s office (it stays in for usually 12 hours, or until it falls out on its own) or in the hospital (it can also be given with cervical ripening agents as talked about below).
Artificial Rupture of the Membranes
This is where your doctor takes something similar to a long crochet hook and tears a hole in your bag of water allowing it to escape.
This often makes uterine contractions strong and more effective. This is done in the hospital setting with monitors on. Once your water is broken you do need to have the baby in the next day or two due to an increased chance of infection if baby stays in loger.
Cervical Ripening Agents
These are medications that put hormones in your body that stimulate the softening of your cervix and the beginning of labor. The three most often used ones are:
The medication used is most often due to provider and hospital preference.
Pitocin is the synthetic form of the hormone oxytocin that your body naturally creates. It is given IV and used to create contractions.
Often pregnant people are given cervical ripening agents and then given pitocin after their cervix is 3 centimeters.
What is the Best Option For My Induction?
It really depends on you and your baby’s health history. Your needs, wants and wishes. That is why you have a provider you can discuss these options with!
Natural Ways to Make Labor Start
Many women who are not offered an induction by their healthcare provider may try home methods of induction, like castor oil, nipple simulation or spicy foods.
Remember, your provider is not starting an induction because they think that it is safer for the baby to wait until mother nature is ready for it. These “natural” methods are no safer (and in some case less safe – looking at you castor oil) than the methods the hospital uses.
The idea is that these will also release oxytocin into your bloodstream to make labor start.
Healthy women have the option of sometimes choosing when labor starts, but the best thing is to consult with your healthcare provider about what to do for baby’s birth, and how it would be most responsible to proceed.
Ok, now that you’ve learned a bit about inductions — let’s dive a bit deeper into how they happen and what to expect from start to finish at the hospital. You can do all of that in this prenatal class, and I guarantee you’ll feel more prepared to have your baby!
If you’re not quite ready for the full class — consider checking my freebie mini course here:
- About the Author
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A nurse since 1997, she has worked in various fields including pediatrics, geriatrics & hospice.
She has 20 years of labor and delivery experience in the San Jose, CA and Phoenix, AZ areas.