induction of labor


 What is labor induction?

Inducing labor, or labor induction, is a procedure in which your doctor or midwife uses methods to help you go into labor. In most cases, it’s best to let labor happen on its own, but there are some exceptions. Your doctor may decide to induce you for medical reasons, or if you’re 2 weeks or more past your due date. Talk to your doctor about whether labor induction is right for you.

Reasons for inducing labor

In a perfect world, you’ll go into labor right on cue at the 40-week mark. Yet sometimes the process doesn’t proceed as smoothly as expected, and baby runs late. Certain medical problems can make an extended pregnancy risky for you and your baby, including:Your doctor may need to induce labor if your amniotic sac (water) breaks, but you haven’t started getting contractions. Contractions are a sign that labor has started, and your cervix has begun to open (dilate). A lack of contractions could mean that your body isn’t preparing for delivery like it should. You might prefer to induce if you live far from a hospital, or you have a history of delivering quickly. Inducing labor may also be medically necessary after 42 weeks. At this point, the placenta can no longer provide enough oxygen and nutrients for your baby. Preeclampsia is one reason for inducing labor. If you have high blood pressure during pregnancy, delivering your baby early could prevent dangerous complications.

How to induce labor

There are a few ways to speed up the process if your baby is behind schedule. The safest and most effective way is to see your doctor. Medicines or medical techniques can bring on labor more quickly. The other option is to try to induce labor on your own. Before you try anything, talk to your doctor or midwife. Make sure the method you’re attempting is safe, and that your pregnancy is at the optimal time to induce. A few foods have been touted to bring on contractions. One type of fruity tea in particular is a popular labor inducer.

Medicine to induce labor

Two types of medications induce labor. Drugs called prostaglandins soften, or “ripen” the cervix to ready it for delivery. You can take these drugs by mouth, or they can be inserted as a suppository into your vagina. The next type of drug kick-starts contractions. Pitocin is the most common medication. You get it through an IV. Your cervix needs to be ready for labor or the medicines won’t work. Learn the pros and cons of using medicine to induce labor.

Labor induction methods

Medicine isn’t the only way to get your labor started. Membrane stripping and breaking your water are two other options. These may be done at your doctor’s office. Stripping the membranes involves the amniotic sac. Your doctor uses their fingers to push the amniotic sac away from the cervix. To break your water, the doctor pops open the amniotic sac with a small plastic hook. Your baby will then move its way to the top of your cervix in preparation for delivery. You could go into labor days, or even hours later. Membrane stripping is generally considered safe. Yet experts disagree on whether this practice is worth doing. Learn more.

Natural ways to induce labor

For a more “natural” approach — one without medical intervention — you can try inducing labor on your own. Studies haven’t verified that these methods work, so check with your doctor or midwife before you try any of them. One of the easiest and safest ways for women to induce labor on their own is to take a walk. The gravity from your movements may help slide your baby down into position. Although a walk may not speed you to your delivery date, it’s good for you in generalHave sex, if you feel up to it. Semen contains hormones called prostaglandins, which make your uterus muscles contract. Having an orgasm yourself will also stimulate your uterus — a win-win. You can also try acupuncture. It may work as well as membrane stripping, and it could save you a doctor’s office visit.

Exercises to induce labor

There’s no evidence that getting more active will put you into active labor, but it’s good for your health and pregnancy. Exercise reduces your risk of a C-section and gestational diabetes. It’s safe for most women to exercise during their pregnancy. Still, it’s a good idea to check with your doctor before lacing up your sneakers. Certain conditions may mean you should avoid exercise completely during pregnancy.

Pineapple to induce labor

Deep inside the core of a pineapple is an enzyme called bromelain that breaks down proteins. That property makes it a key ingredient in many meat tenderizers. The theory behind using bromelain for labor induction is that it might break down tissue in your cervix. Your cervix naturally softens and ripens to prepare for delivery. There’s no scientific evidence that this theory is true, however. Bromelain might work well on meat, but it’s not very active in the human body. Plus, pineapple could worsen pregnancy heartburn.

Acupressure to induce labor

Like acupuncture, this treatment stimulates certain points along your body’s energy pathway. The difference lies in the application. Instead of using needles, acupressure stimulates these points using massage-like pressure. Several pressure points around the body are thought to trigger labor. One sits just above your ankle on the back of your shinbone. Another is in the center of your palm. To perform acupressure on yourself, press down on one of these points for a few seconds. Then, massage the area. Acupressure might also make your labor less uncomfortable. Learn which pressure points work best for easing labor pain.

Induction at 39 weeks

While it’s usually best to let nature take its course, inducing labor may be a good idea if there’s a problem with your pregnancy or your baby. If you’re healthy, an induction might help you avoid a C-section. A 2018 study found that women in their first pregnancy who were induced at 39 weeks were less likely to need a C-section than those who waited. Complication rates didn’t differ between the two groups. Ask your doctor whether it makes sense to induce at 39 weeks if:
  • this is your first pregnancy
  • you’re only carrying one baby
  • you and your baby are healthy
C-sections can be risky, causing complications like bleeding and infection. While they may be necessary in certain cases, these surgical deliveries can also cause more problems with future pregnancies.

Labor induction process

Your labor will be induced in a hospital or birthing center. The process will differ based on which technique your doctor uses to induce labor. Sometimes doctors use a combination of methods. Depending on the techniques your doctor tries, it can take anywhere from a few hours to several days for your labor to start. Most of the time, induction will lead to a vaginal delivery. If it doesn’t work, you might need to try again or have a C-section.

What to expect during labor induction

What you can expect depends on the method of induction:
  • Prostaglandins come as a suppository that goes into your vagina. After a few hours, the medicine should trigger labor.
  • You’ll get Pitocin through an IV. This chemical stimulates contractions and helps to speed the labor process.
  • During amniotic sac rupture, the doctor will place a plastic hook inside your vagina to open up the sac. You may feel a warm rush of water as the sac breaks. When your water breaks, your body’s prostaglandin production increases, which should start your contractions.
The hospital staff will monitor your contractions to see how your labor is progressing. Your baby’s heartbeat is also monitored.

Labor induction risks

Health concerns and a long pregnancy are reasons why you might consider labor induction. It’s not a decision to make lightly, because inducing labor can have some serious risks. Risks include:
  • premature birth
  • slowed heart rate in the baby
  • uterine rupture
  • infections in both mother and baby
  • excessive bleeding in the mother
  • umbilical cord issues
  • lung problems in the baby
  • stronger contractions
  • vision and hearing problems in the baby
  • poor lung and brain development
Labor inductions don’t always work. If your induction isn’t successful, you may need to have a C-section.

Labor induction side effects

The drugs and techniques used to induce labor can cause side effects in both you and your baby. Pitocin and other medicines that ripen your cervix can intensify your contractions, making them come faster and closer together. More intense contractions may be more painful for you. Those faster contractions can also affect your baby’s heart rate. Your doctor might stop giving you the drug if your contractions are coming too quickly. Rupturing the amniotic sac may cause the umbilical cord to slip out of your vagina before your baby. This is called prolapse. Pressure on the cord can reduce your baby’s oxygen and nutrient supply. Labor needs to start within about 6 to 12 hours after rupturing your amniotic sac. Not going into labor within that time frame increases the risk of infection to both you and your baby.

Bishop score for induction

The Bishop score is a system your doctor uses to figure out how soon you’ll deliver, and whether to induce labor. It gets its name from obstetrician Edward Bishop, who devised the method in 1964. Your doctor will calculate your score from the results of a physical exam and ultrasound. The score is based on factors like:
  • how far your cervix has opened (dilated)
  • how thin your cervix is (effacement)
  • how soft your cervix is
  • where in the birth canal your baby’s head is (fetal station)
A score of 8 or above means you’re close to starting labor, and induction should work well. Your odds of a successful induction go down with a lower score.

Induction vs. labor that isn’t induced

Induction uses medicines or medical techniques to start your labor. “Natural” labor happens on its own. The length of a labor that happens without medical intervention varies. Some women deliver within a few hours of their first contractions. Others have to wait several days before they’re ready to deliver. When you go into labor naturally, first the muscles of your uterus start to contract. Your cervix widens (dilates), softens, and thins (effaces) to prepare for your baby’s delivery. During active labor, your cramps become stronger and come more often. Your cervix widens from 6 centimeters (cm) to 10 cm to accommodate your baby’s head. At the end of this stage, your baby is born.

What does labor induction feel like?

What labor induction feels like depends on how your doctor induces your labor. Membrane stripping is slightly uncomfortable. Expect some cramping afterward. You’ll feel a slight tug when the doctor breaks your amniotic sac. Afterward, there will be a rush of warm fluid. Using medicine to induce labor produces stronger and faster contractions. You’re more likely to need an epidural when you’re induced than if you start labor without induction.

Benefits of waiting

Unless you or your baby’s health is at risk, waiting for labor to come on its own is the best decision. The biggest benefit of waiting for labor to naturally occur is that it reduces the risk of complications from induced labor. Labor induced without good reason before 39 weeks can lead to more complications than benefits. But if your doctor induces labor for medical reasons, it could improve both your health and the health of your baby. Weigh all the benefits versus the risks with your doctor before you decide to have an induction. If your doctor is pressuring you because of scheduling issues, get a second opinion.