Labor Induction

Sometimes, babies have a mind of their own. That’s true even when it comes to delivery. 

That’s probably why something like 25% of all babies delivered in the United States are induced. Labor induction involves speeding up the delivery process by stimulating uterine contractions before they begin naturally. Typically, labor is induced to increase the chances of a successful vaginal delivery.

Generally labor induction is safe. In some cases, however, inducing may raise the risk of certain complications. And while it’s possible to induce under elective circumstances, your OBGYN or Midwife will usually not recommend this procedure unless it is medically warranted. The vast majority of inductions are performed under very specific conditions, resulting in a successful birth and a healthy baby!

What are Some Strategies/Methods for Labor Induction?

The strategies and methods used to induce labor will depend on several factors, including how ready your cervix appears, your OBGYN or Midwife’s recommendation, and your preferences. If your cervix is not soft and ready for labor, your OBGYN or Midwife will use a two stage approach:

• First, your OBGYN or Midwife will use methods designed to help the cervix prepare for labor.
• Second, once the cervix is soft and ready, your OBGYN or Midwife will focus on methods that induce uterine contractions.

If your cervix is already soft and prepared for labor, then your OBGYN or Midwife will likely skip to the second step and focus on inducing contractions.

Techniques for Preparing the Cervix for Labor

• Membrane stripping: This technique involves separating the amniotic sac from the uterine wall. Such a separation is conducted manually (your OBGYN or Midwife would gently perform this procedure). Once the amniotic sac is separated, your body may begin releasing hormones that encourage the cervix to soften and prepare for labor. Usually, labor does not begin immediately, nor is the bag of water typically broken. You may experience some cramping and light vaginal bleeding due to the procedure.

• Cervical ripening with catheter/balloon: This technique uses a mechanical dilation process, during which a small balloon connected to a catheter is inserted into your cervix. The catheter is used to fill the balloon with sterile fluid, which puts pressure on your cervix. This pressure encourages your cervix to open–at which point, the balloon either falls out or is removed.

• Prostaglandins: Mechanical dilation and membrane stripping rely on providing your body with physical cues that then encourage certain hormonal releases. In some cases, your OBGYN will opt to rely on hormones more directly. In these situations, a hormone called prostaglandin will be used to open the cervix. This can help prepare your cervix and often can even make the labor process shorter. However, this particular method is not recommended for women who are attempting vaginal birth after C-section (VBAC), as it could increase the risk of a uterine rupture.

Techniques for Inducing Contractions

• Membrane rupture: Also known as breaking your bag of waters, this strategy is an option for women who have already given birth once before. When the bag of waters is broken, the amniotic fluids that compose the “waters” may soften the cervix and cause contractions that begin labor.

• Pitocin:  Pitocin can be used to directly start contractions. Usually, Pitocin treatments begin with small doses of the medication, gradually increasing until labor begins. Pitocin is administered via an IV drip, so you’ll be closely monitored by your Midwife or OBGYN during this time. 

It can be difficult to predict how long an induction may take. Going from your first contraction to holding your baby in your arms could take anywhere between a few hours to a few days. As long as you and your baby remain healthy during the process, your OBGYN or Midwife will monitor your progress patiently.

Labor induction is usually performed either in a hospital or birthing center, but sometimes you’ll be sent home to wait for labor to begin. 

Home Remedies for Induction

Many patients are already familiar with some “home remedies” which popular culture suggests can successfully induce labor. Everything from sexual intercourse to a vigorous walk to drinking a bit of castor oil may help you go into labor.

While few of these home remedies will cause active harm, it’s worth noting that there is no evidence that most such home remedies actually work. The exception is nipple stimulation, which has been shown in research to help successfully encourage your uterus to contract and get you ready for labor.

If you’re thinking about labor induction, you should definitely talk to your OBGYN or Midwife about options that work.

When Is Labor Usually Induced?

Inducing labor is not something that should be undertaken lightly. Your OBGYN or Midwife will factor in your current health, the health of your baby, and the risks involved when deciding whether to recommend induction. In general, however, labor is most commonly induced for the following reasons:

• You’re coming up on two weeks past your delivery date. If labor hasn’t started naturally, your OBGYN or Midwife may consider inducing labor.
• Risks to your health or to your baby’s health crop up near the delivery date. These risks could include everything from high blood pressure and gestational diabetes to placental abruption or an infection of the uterus. Your OBGYN or Midwife will know which particular possible complications can best be addressed by inducing labor.
• There are abnormalities with your baby. This is especially true if there are anomalies with the heart rate of your baby. Likewise, if your baby is not growing at the rate they should be, your OBGYN or Midwife may recommend inducing.
• Labor does not begin after your water breaks. That’s because your bag of water helps protect you and your baby from infections. So if your water breaks and contractions do not begin, your OBGYN or Midwife may recommend inducing labor to help minimize the chances of an infection setting in.

This list is not comprehensive. Your OBGYN or Midwife may have other medical reasons for recommending an induction on a case by case basis.

In some cases, induction may be considered for non-medical reasons. For example, if you live far away from a hospital, you may wish to induce at a planned time rather than risk a hasty drive to the emergency room.

These types of decisions should be made on a case-by-case basis, and only after taking the time to weigh risks and benefits. That’s because inducing labor does pose risks–so most OBGYNs and Midwives will seek to avoid doing so unless it is medically necessary.

When to Avoid Inducing

If everything is progressing normally, your OBGYN or Midwife will want to avoid labor induction, letting your baby and your body set the schedule. However, there are some instances when your OBGYN or Midwife may avoid inducing labor even if other indications would normally suggest that it’s the best course of action.

Your OBGYN or Midwife will avoid labor induction if:

• Your baby is not positioned properly. If your baby is not oriented with its head down, towards your pelvis, then they likely are not ready to be delivered vaginally. If your baby is sideways or feet first, your OBGYN or Midwife will not induce labor.
• The cervix is being covered by the placenta. 
• You had previously undergone a C-Section, and that C-Section required major surgery or a specific type of incision. 
• You experience umbilical cord prolapse. This occurs when the umbilical cord slips into your vagina before delivery.

Are There Risks Involved with Inducing?

For many women, there are some risks involved with inducing labor. Your OBGYN or Midwife will help you evaluate those risks, especially in relation to potential benefits. If induction is performed before the 39th week, your baby could experience health complications. 

For example, one risk with employing Pitocin is that your contractions may begin to happen too frequently, and this can lower your baby’s heart rate. For this reason, you’ll wear a fetal heart rate monitor so your OBGYN or Midwife can monitor your baby’s safety. 

Induction may increase your chances of needing a C-Section, but this depends on a variety of other risk factors, so it’s best to talk to your OBGYN or Midwife about the pros and cons.

Talk About Labor Induction

If you have questions about when labor is induced (and when it isn’t), the best place to get individualized answers is from your OBGYN or Midwife. While it might sound like an unwanted outcome at first glance, inducing labor can be a great way to increase your chance for a successful vaginal delivery. Sometimes your baby just needs a little encouragement to say hello to the wider world!

Our midwives track their patients’ induction rates. If you’d like to learn more about those rates or have questions, please contact us at our Wilmette or Glenview offices!