What Happens When Labor Is Induced?
As your due date approaches, you’re likely wondering when your baby will make their debut. Some people go into labor on their own, while others need to be induced. Labor induction can be for a medical reason. It could be because your baby is past the due date. Or it could be because you choose to be induced.
“Induction of labor is quite common,” says Bianca Falcone, M.D., an ob-gyn at Atrium Health in Charlotte, North Carolina. In fact, according to data published in The American Journal of Maternal/Child Nursing, more than 31% of births in 2020 were induced.
If you’re nearing the end of your pregnancy and your doctor mentions the possibility of inducing labor, you likely have a lot of questions. Here’s what to know about the labor induction process.
What Is Labor Induction?
Typically, in the weeks or days leading up to delivery, the pregnant person’s cervix starts to ripen, or thin out and open. Uterine contractions begin and gradually become stronger and more frequent. This is necessary for labor to progress.
Labor induction uses medications and/or techniques to move your body into labor. The goal is to achieve a vaginal delivery.
What Are Some Medical Reasons to Induce Labor?
Labor induction may be recommended when there are concerns about the birthing parent’s health or the baby’s health. Reasons to induce labor may include:
- A pregnancy that is overdue (41 weeks or more)
- Health issues the birthing parent had before they were pregnant, such as heart, lung, or kidney issues, as well as diabetes or hypertension
- Health issues that cropped up during pregnancy, such as preeclampsia or gestational diabetes
- A uterine infection
- Placenta issues
- The person’s water breaking without starting labor, also known as premature rupture of membranes (PROM)
- Low level of amniotic fluid, known as oligohydramnios
- Issues with the baby’s growth, known as fetal growth restriction
If labor induction is recommended for medical reasons, it means the risks to you or your baby are greater if you stay pregnant than if you’re induced.
Can I Have an Elective Induction?
Although there are medical reasons for labor induction, there are also elective reasons. Some people may choose to induce labor because of things like discomfort or convenience, says Monique De Four Jones, M.D., associate chief of labor and delivery at Long Island Jewish Medical Center, in New Hyde Park, New York.
An elective labor induction can be done if you’re at least 39 weeks pregnant and don’t have any other medical concerns. “Some people feel it reduces the chances of having a cesarean birth, having an adverse neonatal or maternal event, and the likelihood of macrosomia, which is having a large baby,” Jones explains. A large study supports that it’s safe and may reduce risks.
Whether your doctor recommends medical induction or you’re considering an elective one, it’s important to talk to your doctor about your individual health and pregnancy. They’ll help you decide whether you’re a good candidate for labor induction, discuss the risks, and talk you through your options.
When Should Labor Induction Be Avoided?
Just as importantly, there are some contraindications for labor induction, notes Jones. Certain people should not have an induction, including those who have or have had:
- A past cesarean section delivery using a vertical incision
- Major uterine surgery
- Prior uterine rupture
- Placenta previa (the placenta is blocking the cervix)
- Umbilical cord prolapse (the umbilical cord slips into the vagina before the baby)
- Current outbreak of genital herpes
- Invasive cervical cancer
- A fetus with an abnormal heart rate
How Is Labor Induced?
Labor can be induced with medications, devices, and other strategies that help kick-start the labor process. “Induction methods can vary depending on the patient’s cervical exam and reason for being induced,” explains Falcone.
Your doctor will use five factors to help make decisions about labor induction:
- How dilated your cervix is
- How effaced (thin) your cervix is
- How soft your cervix is
- How close your cervix is positioned to your birth canal
- How far your baby’s head has descended into your birth canal
Each of these factors are scored and added up to determine what’s called a Bishop score, which can range from 0 to 13. A higher Bishop score means you’re more likely to have a successful induction.
The Bishop score also helps the doctor determine what type of induction agent—or method—to use, Jones says.
Ways to induce labor include:
- Cervix-ripening medication: These are called prostaglandins and can be inserted vaginally or taken orally.
- Cervix-ripening device: A device similar to a catheter called a Foley bulb may be inserted and then inflated. This puts pressure on the inside of the cervix to help it dilate, like when a baby’s head is pushing on it.
- Stripping or sweeping the membranes: This is where a doctor manually separates the amniotic sac from the cervix and lower uterine wall to help release natural cytokines, which are proteins that help kick-start labor.
- Contraction-stimulation medication: The hormone oxytocin is what your body makes to naturally put you into labor. A synthetic form of oxytocin, known as Pitocin, can be delivered through an IV (intravenous drip) to bring on, speed up, or increase the intensity of contractions.
- Rupturing the amniotic sac: This is called an amniotomy. It’s where the doctor manually creates an opening in the sac to break the water, which helps keep labor progressing.
What to Expect During an Induced Labor
Labor induction is a highly individualized experience, Jones says. “Every patient is different.”
“[Throughout the process] normally you are in the hospital being monitored and your baby is being monitored, as well,” Falcone says.
Your Bishop score may help you understand what to expect in your unique situation, says Falcone. For example, someone with a lower score may experience a longer induction with more interventions. Someone with a higher score may experience a quicker period from induction to delivery—their contractions may come on fast and feel intense and painful.
The process can take hours, or it may take days. “Induction can seem like it takes a long time, and it can for some people, but it’s important to be patient, as we are trying to get you into active labor,” Falcone adds. Every labor truly is different, but especially with a first pregnancy, you can expect that the process will take around 24 hours.
Potential Risks of Labor Induction
Inducing labor does come with certain risks, such as:
- Chorioamnionitis, or an infection of the amniotic fluid, placenta, or membranes
- Infection, for you or your baby
- Low fetal heart rate
- Uterine rupture (which is rare)
- Failed induction, which is very rare and is when active labor (dilation of 6 centimeters or more) doesn’t happen within 12 to 18 hours despite all possible interventions
- Bleeding after delivery
Monitoring can help prevent these types of complications from occurring.
What’s more, not every labor induction is successful. In some cases, a C-section is needed to prevent or address issues that could be harmful to the birthing parent or baby.
Talk with Your Doctor
“There are so many different things that can go on during an induction,” Jones says. Because it’s a highly individualized experience that depends on your unique situation and induction plan, she recommends talking through the possibilities with your doctor beforehand to help prepare you for what’s ahead.
You may also ask others for support. You can take a birth class to help you understand the process of labor and/or work with a doula or birth coach. You can loop in a partner, family member, or friend about the plan for your induction and let them know how you’d like them to help you.
“It’s normal to be nervous about induction, labor, and delivery, along with this whole next chapter of your life,” Falcone says. “But discussing the process can make you feel more at ease.” A medical team’s end goal is always a healthy birthing parent and a healthy baby, she says.
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