Why an Induction May Be Necessary Before Labor (2023)

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.

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.

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:

  • 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.

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.

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:

  • 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.

(Video) OB/GYN Explains Induction of Labor: Pros, Cons, and What You Need to Know

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?

What Is It Really Like to Give Birth?

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10 Sources

(Video) INDUCING LABOR? Do NOT Do These 5 Things! | The Induction Series Pt 5

Verywell Family uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

  1. American College of Obstetricians and Gynecologists. Avoidance of nonmedically indicated early-term deliveries and associated morbidities.

  2. American College of Obstetricians and Gynecologists. ACOG committee opinion no. 764: medically indicated late-preterm and early-term deliveries.Obstetrics & Gynecology. 2019;133(2):e151-e155. doi:10.1097/AOG.0000000000003083

  3. American College of Obstetricians and Gynecologists. Management of late-term and post-term pregnancies.

  4. American College of Obstetricians and Gynecologists. Labor induction.

  5. American College of Obstetricians and Gynecologists. Induction of labor at 39 Weeks.

  6. DeMaria AL, Sundstrom B, Moxley GE, Banks K, Bishop A, Rathbun L. Castor oil as a natural alternative to labor induction: A retrospective descriptive study.Women and Birth. 2018;31(2):e99-e104. doi:10.1016/j.wombi.2017.08.001.

  7. Carbone L, De Vivo V, Saccone G, et al. Sexual intercourse for induction of spontaneous onset of labor: a systematic review and meta-analysis of randomized controlled trials.The Journal of Sexual Medicine. 2019;16(11):1787-1795. doi:10.1016/j.jsxm.2019.08.002

  8. Ausbeck EB, Jauk VC, Xue Y, et al. Outpatient foley catheter for induction of labor in nulliparous women: a randomized controlled trial.Obstetrics & Gynecology. 2020;136(3):597-606. doi:10.1097/AOG.0000000000004041

  9. Ray A, Ray S. Antibiotics prior to amniotomy for reducing infectious morbidity in mother and infant. Cochrane Pregnancy and Childbirth Group, ed.Cochrane Database of Systematic Reviews. Published online October 1, 2014. doi:10.1002/14651858.CD010626.pub2

    (Video) SHOULD I GET AN INDUCTION | Only Get LABOR INDUCED After Answering These Questions

  10. Zhang H, Liu H, Luo S, Gu W. Oxytocin use in trial of labor after cesarean and its relationship with risk of uterine rupture in women with one previous cesarean section: a meta-analysis of observational studies.BMC Pregnancy Childbirth. 2021;21(1):11. doi:10.1186/s12884-020-03440-7

Additional Reading

Why an Induction May Be Necessary Before Labor (1)

By Robin Elise Weiss, PhD, MPH
Robin Elise Weiss, PhD, MPH is a professor, author, childbirth and postpartum educator, certified doula, and lactation counselor.

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(Video) Induction of Labor | Pros, Cons, C-section rate, ARRIVE trial | Explained by OB-GYN

FAQs

Why would you get induced before your due date? ›

Why is labor induced? Labor is induced to start contractions of the uterus for a vaginal birth. Labor induction may be recommended when there are concerns about the health of the woman or the fetus. It also may be recommended when labor has not started on its own.

What are some reasons to get induced early? ›

Most babies do not need to be delivered before a mother's due date. However, your doctor may recommend an earlier labor induction out of concern for your baby. Reasons for this can include very slow growth of the baby and very low (or very high) amniotic fluid levels.

What are the pros and cons of inducing labor? ›

Researchers have found that inducing labor after 37 weeks of pregnancy can lower the risk of perinatal mortality without increasing caesarean section rates. However, babies born to mothers who are induced are more likely to be admitted to a special care baby unit.

When is it medically necessary to induce? ›

Your provider may recommend inducing labor if your health or your baby's health is at risk or if you're 2 weeks or more past your due date. Inducing labor should only be for medical reasons. If your pregnancy is healthy, it's best to wait for labor to start on its own.

How can you avoid getting induced? ›

Top 5 Ways to Avoid Labour Induction
  1. 1 Nipple Stimulation. Inexpensive, medication-free and allows control over the labour induction process. ...
  2. 2 Birthing Ball. Birthing balls are excellent for relieving pain and increasing self-confidence during labour. ...
  3. 3 Dates. ...
  4. 4 Natural Oxytocin Push. ...
  5. 5 Acupuncture.
29 Dec 2021

Why do doctors want to induce at 39 weeks? ›

Research indicates that inducing labor at this time reduces several risks, including risks of having a stillbirth, having a large baby (macrosomia) and developing high blood pressure as the pregnancy advances. It's important that women and their providers share in decisions to induce labor at 39 to 40 weeks.

Can I refuse induction? ›

Ultimately you hold the power to accept or decline treatment, whether it's an induction or any other procedure. There is a possibility, however, you might get some blowback from your care provider.

What are the disadvantages of induced Labour? ›

Increased Risk of Complications

Inducing labor involves intervening in the body's natural processes by breaking the amniotic sac, using medication, or both. However it's done, it can lead to fetal distress (such as abnormal heart rate). 1 In addition, when labor is induced using medication, labor may take longer.

How can I ripen my cervix faster? ›

Are there natural ways to ripen the cervix?
  1. Acupuncture.
  2. Breast stimulation.
  3. Castor oil.
  4. Enemas (injection of water or liquid into the rectum to clear the colon).
  5. Herbal supplements.
  6. Hot baths.
  7. Sexual intercourse.
  8. Transcutaneous electrical nerve stimulation (TENS).
18 Nov 2021

Can a cervix ripen overnight? ›

It is not uncommon for the cervical ripening to take up to 24-36 hours!! It is also not uncommon to use different techniques to ripen the cervix. You may feel contractions during this process. If the contractions become painful, you will be able to request medication to relieve your discomfort.

How long does it take to give birth after being induced? ›

It can take up to two or three days to induce labor, but it usually takes less time. It may take more time if you're being induced before you're full-term or if it's your first baby.

Is it more painful to be induced? ›

Induced labour is usually more painful than labour that starts on its own, and you may want to ask for an epidural. Your pain relief options during labour are not restricted by being induced. You should have access to all the pain relief options usually available in the maternity unit.

Is being induced worse than natural labor? ›

Induced labour is usually more painful than natural labour. Depending on the type of induction you are having, this could range from discomfort with the procedure or more intense and longer lasting contractions as a result of the medication you have been given.

What percentage of inductions end in C section? ›

Women and their doctors chose the induction method: In general, it is done either by rupturing the amniotic sac or with hormonal medications that trigger labor. In the end, the C-section rate was less than 19 percent in the induction group, versus just over 22 percent in the standard-care group, the findings showed.

Can you request to be induced? ›

Some mothers request elective inductions for convenience, but these do come with risks. Doctors try to avoid inducing labor early because the due date may be wrong and/or the woman's cervix might not be ready yet.

Can I be induced early by request? ›

Can I request an elective induction? Elective labor induction is the initiation of labor for convenience when there's no medical need. For example, for women who live far from the hospital or birthing center or who have a history of rapid deliveries, a scheduled induction might help avoid an unattended delivery.

Can you choose to be induced? ›

It's your choice whether to have your labour induced or not. If your pregnancy lasts longer than 42 weeks and you decide not to have your labour induced, you should be offered increased monitoring to check your baby's wellbeing.

How can I get my water to break? ›

There are no proven safe ways for a woman to break her water at home. It can be dangerous if the water breaks before natural labor begins or before the baby is fully developed. During the natural process of labor, the water breaks when the baby's head puts pressure on the amniotic sac, causing it to rupture.

Videos

1. Induction of Labour at St George's Hospital
(St George's University Hospitals NHS Foundation Trust)
2. 3 reasons why natural labor induction may not work for you | naturally inducing labor
(Care About Little Ones)
3. What is labor induction? OB/GYN answers 5 common questions about inducing labor | Stanford
(Stanford Center for Health Education)
4. Preparing for Induction of Labour
(nhsuhcw)
5. PITOCIN INDUCTION | How is Labor Induced Using PITOCIN? | The Induction Series Pt 3
(Bridget Teyler)
6. Is routine induction of labor in a healthy pregnancy at 39 weeks reasonable?
(MDedge: news and insights for busy physicians)
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