Inducing labor: When to wait, when to induce

Nature controls most aspects of labor — but sometimes nature needs a nudge. When health care providers decide women and their babies would benefit from delivering sooner rather than later, they might suggest inducing labor.

Why would I need to be induced?

Labor induction — also known as inducing labor — refers to stimulating the uterus to contract before labor begins on its own for a vaginal birth. A health care provider might recommend inducing labor for various reasons, primarily when there's concern for the mother's or baby's health. For example:

• When nearing one to two weeks beyond the due date, and labor hasn't started on its own (postterm pregnancy)
• When labor doesn't begin after the water breaks (premature rupture of membranes)
• Having an infection in the uterus
• When the baby has problems, such as not growing at the expected pace (fetal growth restriction)
• When there's too little amniotic fluid surrounding the baby (oligohydramnios)
• Developing diabetes during pregnancy (gestational diabetes) or having diabetes before pregnancy
• Having high blood pressure
• When there are problems with the placenta, such as peeling away from the inner wall of the uterus before delivery (placental abruption)
• Having a medical condition such as kidney disease or obesity

Can I wait for labor to begin naturally?

Nature typically prepares the cervix for delivery in the most efficient, comfortable way. However, when there's concern about mother's or baby's health or the pregnancy continues two weeks past the due date, inducing labor might be the best option.

Why the concern after two weeks? When a pregnancy lasts longer than 42 weeks, amniotic fluid might begin to decrease. And there's an increased risk of having a baby who is larger than average (fetal macrosomia). There also is an increased risk of C-section, stillbirth and the baby breathing in fecal waste (meconium aspiration).

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. In such cases, a health care provider will confirm that the baby's gestational age is at least 39 weeks or older before induction to reduce the risk of health problems for the baby.

As a result of recent studies, women with low-risk pregnancies are being offered labor induction at 39 to 40 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 do anything to trigger labor on my own?

Probably not.

Techniques such as exercising or having sex to induce labor aren't backed by scientific evidence. Avoid herbal supplements, which could harm the baby.

What are the risks?

Labor induction isn't for everyone. For example, it might not be an option for you if you've had a C-section with a classical incision or major uterine surgery, if your placenta is blocking the cervix (placenta previa), or if your baby is lying buttocks first (breech) or sideways (transverse lie) in the uterus.

Inducing labor also carries various risks, including:

• Failed induction. An induction might be considered failed if appropriate induction methods don't result in a vaginal delivery after 24 or more hours. In such cases, a C-section might be necessary.
• Low fetal heart rate. The medications used to induce labor — oxytocin or a prostaglandin — might cause abnormal or excessive contractions, which can lessen the baby's oxygen supply and lower the baby's heart rate.
• Infection. Some methods of labor induction, such as rupturing the membranes, might increase the risk of infection for both mother and baby.
• Uterine rupture. This is a rare but serious complication in which the uterus tears along the scar line from a prior C-section or major uterine surgery. An emergency C-section is needed to prevent life-threatening complications. The uterus might need to be removed.
• Bleeding after delivery. Labor induction increases the risk that the uterine muscles won't properly contract after giving birth (uterine atony). This can lead to serious bleeding after delivery. Occasionally blood products are needed for serious bleeding.

Inducing labor is a serious decision. Work with your health care provider to make the best choice for you and your baby.