Later in pregnancy your doctor may start discussing an induction of labor with you. Many people feel like their doctor is pushing induction on them, but I want to explain why they may push an induction and what you can do to respond (as well as make a thoughtful answer for yourself).
But first, how do I know all of this? 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 thousand of patients with their inductions, and talked to them about their doctor’s reasoning behind it… I think I can help you too.
Your first step towards understanding this complicated subject is to understand more about labor and your body. The Online Prenatal Class for Couples is meant to get you prepared for labor (or an induction) in just a few hours.
Why Doctors Push Inductions
I see it ALL over social media — that doctors push needless inductions on patients. And while this can be true — I do think some other things are at play here:
Medical Reasons for Inducing Labor:
If your doctor finds a medical reason to induce you, it is their obligation to offer you an induction.
They may encourage an induction depending on how bad the medical problem is, or if they think that you or your baby’s safety is at risk.
I talk a LOT about reasons for induction in my post on induction of labor at 37 weeks, but the most common reasons that doctors find are:
- Diabetes (especially if you are having difficulty controlling it)
- High blood pressure
- Large baby
- Small baby that isn’t growing well
- Illness (like a bad flu or Covid)
- Post-dates (someone who’s nearly 42 weeks of pregnancy, most often)
So many people say that a big baby isn’t a reason for an induction, but if your doctor finds out through an ultrasound that the baby seems large, and may be difficult to push out if you wait to go into labor on your own, and doesn’t offer an induction, that would be malpractice.
Oh, and we do go over a LOT of the testing for this in chapter 2 in here, it’s so important to understand WHY you’re doing the testing to understand what to do next.
When your doctor talks about induction, I feel it’s best to think that they are OFFERING you an induction. It is ultimately your choice what you are going to do. By thinking of it as an offer, it allows you to weigh the risks and the benefits.
Remember your placenta really only works for about 41-42 weeks, which is why they will really encourage you to have an induction before 42 weeks of pregnancy. It is just so hard to make sure that baby is still growing and thriving at that point the general idea of thought is that it is better to deliver baby. You increase the risk of a stillborn substantially at that point. Personally, after seeing a lot of really poor outcomes after 42 weeks I can see why a provider would push so hard for you to have an induction at that point.
It is important to note that medical inductions are the only reason people are induced before 39 weeks of pregnancy. Elective inductions, at this time, are only offered after at least 39 weeks (or the week before your due date) — at the very earliest.
The Arrive Trial
The Arrive trial showed that offering at 39 week induction of labor could be safer than expectant management after 39 weeks (which basically means just watching to see how the patient does). It is pretty controversial, and I actually ended-up doing a whole video about it in here just because I think it is important that patients at 39 weeks understand it.
But, for me — it boiled down to a few things:
- How “ripe” is your cervix at 39 weeks — if it doesn’t seem like an induction will take long, it may be better.
- Are you having any disconcerting signs of pregnancy, increasing blood pressure, etc? — an induction may be better/safer if you are OK with it.
- Are you OK with the medical interventions? Inductions often mean more monitoring, more vital signs, and less ability to do whatever you want during labor.
A LOT of my friends find that induction at 39 weeks is something they are ready for — their body is tired and they are ready to be done.
But, a lot of people’s cervix isn’t ready or they would prefer not to, and that’s fine too. The margins on that study aren’t huge, and you really need to take into consideration you, your baby and your pregnancy in making this choice.
It is, however, valid for your doctor to offer a 39 week induction of labor due to that study.
I will say that prior to this study the largest body of thought was that elective inductions before 40 weeks increased cesarean sections and were more problematic than helpful. So, it was a big change after that study.
Again, without OFFERING it, they’re not giving you all the options!
A lot of hospitals are overcrowded right now and may not be offering 39 week elective inductions of labor (being induced without a medical reason). So, even if you want to be induced, your provider may not be able to do that depending on the healthcare resources they can utilize.
Their Schedule/Your Needs
Your provider may be going out of town, or off for a holiday, or perhaps they only take call one night a week.
I think it’s kind of them to offer you an induction in those cases.
Perhaps you’d like to be delivered by them, and would like to make the choice for that. Either way, it’s important that they communicate to you that they won’t be “on” when you have your baby, so you know what to expect.
Perhaps you don’t care at all, in which case you can say “no thanks” and see them at your next appointment.
Obstetrical providers HAVE to have someone covering them 24/7 365 days a year to see their patients. You may not know that provider, but they must have competent skills to see you at this point in your pregnancy. In some hospitals the doctor will have the hospitalist cover them. This is a doctor in the hospital who only covers deliveries.
Why Choose an Induction over “Natural Labor”?
So, this brings us to the question why someone might choose an induction vs going into labor on their own.
I actually talked about this on my podcast (it’s a great listen if you have a few minutes, it’s not long):
Evidence from the Arrive Trial
The arrive trial showed that more women ended-up with cesareans, or having high blood pressure to the point that they needed treatment before going into labor.
It’s a valid reason to think that maybe a 39 week induction is for you, if it’s an option.
Obviously, if you and your provider believe your medical reasons are a reason to be induced you’ll find that it’s worth it.
I find so many women saying they would never be induced, but I can guarantee that if they found out their baby was no longer growing, or they were having high enough blood pressures to have a seizure they would reconsider that plan.
How Do Doctors Induce Labor?
Both doctors and midwives in the hospital can induce labor.
Mechanically: Like rupturing your amniotic sac (called artificial rupture of membranes or AROM), inserting a foley bump to stretch your cervix or even stripping your membranes can be considered a low-risk “induction” of labor (that may or may not work)
Or with medications like:
The first 3 medications are prostaglandins, and are most often given before your cervix is 3 centimeters. If you still need medications to make you contract after 3 cm they will use pitocin for your labor induction.
All of these medications are given to start contractions of your uterus (or to also help soften the cervix).
How to Decide An Induction is Right for You?
It can be hard to figure out if an induction is right for you. Communication is hard, in general, and in the medical profession that stakes seem even higher.
I have a whole healthcare communication video in here that can help you talk with your provider more easily!
Get informed consent
Informed consent includes 3 things (and should be given for any medical procedure):
- Risks (like baby coming too early, or a possible cesarean section of the induction fails
- Benefits (baby being able to thrive outside the womb, or your condition improving while not also growing a baby)
- Alternatives (waiting, different types of inductions can all be alternatives)
It’s important that you understand these three things before you make the choice that seems best for you. And, it is your provider’s job (doctor or midwife) to give them to you.
Take Your Time
This doesn’t mean you have to make a choice right away. Ask your provider if you have time to go home and think about it. An alternative option is to schedule the induction and then cancel it if you just don’t think it’s right for you. Both are viable options.
You could also ask the provider to go see another patient and then come back after you (and possibly also your partner) have talked about it.
I know all of that can seem similar to dealing with a used car salesman — but we want you to decide you’re making the right choice for yourself! Don’t be intimidated by that.
Can You Change Your Mind About An Induction?
Here’s the good news – yes. As I said above, even when it is scheduled you can change your mind about the induction, and wait for labor to come on it’s own.
I would recommend making the choice to call off the induction prior to coming into the hospital, otherwise you are taking healthcare resources that could go to another patient who needs or wants it.
However, even if the induction is happening and just not working you can make the choice to go home. Depending on your needs or circumstances they may encourage you NOT to do that (up to even having you sign an “against medical advice” form) — but I’ve definitely sent patients that we could just not get going into labor home. They’ve gone on to have a baby a few days (even weeks) later successfully.
I should note that not all of these patients ended-up having a vaginal delivery. Sometimes their cervix never opened, and they ended up having a c-section. But the majority came in with a cervix that was more ready to for labor and they ended-up with a vaginal delivery.
Hopefully this helps you understand more about where your provider is coming from, so you can make the right choice for yourself. I am the first to say that you can have all the studies but until you take a specific person, their circumstances and desires — you can’t really make a good call overall
Come join me in The Online Prenatal Class for Couples where we prepare you for your hospital delivery in just a few hours!
And, if you’re not quite sure you’re ready for that whole thing, check out my free prenatal class. It’s your first step toward getting in the driver’s seat of your birth.
- 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.