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?
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.
Most providers believe that going into spontaneous labor is the gold standard of labor. Especially on your first baby. It can be hard to wait until 40+ weeks when 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” (the term) has gotten confusing 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 too much in this article, so natural labor would just be referring to spontaneous labor which didn’t have medical intervention.
FYI, new research 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.
This research is the ARRIVE TRIAL and I have a whole bonus video about it in here so you can really understand what it means for you.
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 about when doctors can induce?
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.
They 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.
If you’re looking to learn more about inductions & the labor process, your first step is really to take a class. I love The Online Prenatal Class for Couples where in just a few hours you can get prepared for your entire hospital delivery. It has a chapter on inductions, and one on healthcare communication to help you get the best care.
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.
What this means for you: If your cervix is only 1 cm, and pretty thick — your induction will take longer (and frankly, be more miserable) than someone who is already 3-4 cm and their cervix is thinned. If you’d prefer not to have a really long induction, this is something to consider.
Hate vaginal exams? I also have a post on what to do if vaginal exams are uncomfortable.
When Will Your Healthcare Provider 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.
And yes, this is where the ARRIVE trial (which you can find here) comes in.
In the study 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, however other studies are starting to confirm these results.
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.
I have a whole podcast on reasons you might want to be induced:
How do doctors schedule inductions?
Most often they call the hospital and speak with someone who schedules the inductions and figures out a time that will work. The hospital only has specific # of times/day that they allow inductions, so the first one to call in would get that spot (although if there is a medical reason that would “bump” someone who has an “elective” induction).
A patient can NOT call in and schedule their own induction.
Can a doctor schedule the induction for the next day?
Very often they will, but sometimes the day is full or there isn’t enough staffing to take more patients.
Medical Reasons for An Induction of Labor
Today I’m going to share some of the common reasons why your doctor might induce you. There are a LOT of reasons, but I want to 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.
Gestational Diabetes
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 too big or too small, or too 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 conditions 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.
Induction methods
There are many induction methods that providers can use to start labor:
Membrane Stripping
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
Pitocin is the synthetic form of the hormone oxytocin that your body naturally creates. It is given via 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!
Can I induce myself?
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.
Interested in getting labor going? I actually created a whole guide book on starting your own labor that you might be interested in.
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!
I love what Samantha had to say:
“Presented real information with a blend of humor that encourages memory and a feeling of realness many online classes fail to achieve.”
Read more reviews of The Online Prenatal Class for Couples here
Or if you JUST want some induction information I have a class called Inductions Made Easy that explains all of in detail, including if it’s the right choice for you.
- 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.
As an evidence-based prenatal educator Hilary has delivered thousands of babies and has educated hundreds of thousands of parents from a diverse patient population to help them have a confident birth.
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