Inducing Labor: What Happens When You're Induced?

These days practitioners aim to carry all pregnancies to term, or until 39 weeks — which means labor should not be induced electively before then.

But situations do sometimes arise when nature needs a little nudge. Here’s why your doctor might induce labor and what to expect if it happens to you.

What does it mean to induce labor?

Your practitioner may determine it’s time to induce, or start, labor contractions using medications or other methods if a pregnancy is postterm (that is, you’ve reached 42 weeks) or your health or your baby’s is at risk.

Why might your doctor induce labor?

There are a number of reasons your practitioner may decide to induce labor, including:

• You're overdue. If there's no sign of action from your uterus, your practitioner may induce you around 42 weeks.
• There’s a complication. Sometimes conditions like preeclampsia, diabetes, gestational diabetes, issues with the placenta or problems with amniotic fluid (low levels or infection) make it risky to continue the pregnancy.
• Your membranes ruptured. If your water has broken and contractions have not started on their own within 24 hours, your doctor may induce.
• Your baby isn’t thriving. If tests suggest your baby is mature enough to deliver, your practitioner may opt for induction.
• You live far from the hospital. You may be induced if you live far from where you’re delivering or have had a previous short labor because there’s concern that you might not make it to the hospital or birthing center in time. Known as an elective induction, it should be scheduled at the place where you plan to deliver no earlier than 39 weeks.

How will your practitioner induce labor?

If you do end up needing to be induced, the process involves a number of steps, though you usually won’t go through all of them:

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• Cervical ripening. Usually your cervix will open up naturally on its own once you’re ready to go into labor. However if your cervix shows no signs of dilating and effacing (softening, opening, thinning) to allow your baby to leave the uterus and enter the birth canal, your practitioner will need to get the ripening rolling. She’ll usually do this by applying a topical form of the hormone prostaglandin (either a gel or a vaginal suppository) to your cervix. Your cervix will be checked after a few hours; often, this will be enough to get labor and contractions started. However if the prostaglandin is doing its work ripening the cervix but contractions haven’t started, the process continues on to the following steps. (Note that sometimes if you’ve had a C-section or other previous uterine surgery, you won’t be given prostaglandin to try to prevent uterine rupture. And in some cases, your practitioner may use a mechanical agent to ripen the cervix, such as a catheter with an inflatable balloon or graduated dilators, instead.)
• Membrane stripping. If your bag of waters (amniotic sac) is still intact, your practitioner may get labor started by swiping her finger across the fine membranes that connect the amniotic sac. This causes the uterus to release prostaglandin, just as it would if labor began naturally, which should in turn cause the cervix to soften and contractions to start. This process isn’t always pain-free, and while it isn’t meant to break your water it sometimes does.
• Rupturing the membrane. If your cervix has already begun to dilate and efface on its own but your water hasn’t broken, your practitioner might jump-start your contractions by artificially rupturing the membranes. In other words, she’ll break the bag of waters that surrounds your baby manually using an instrument that looks like a long crochet hook with a sharp tip. It might feel uncomfortable, but it shouldn’t be painful. This is one of the procedures that the latest American Congress of Obstetricians and Gynecologists (ACOG) guidelines suggest may not be necessary in all women with low-risk pregnancies.
• Pitocin. If neither the prostaglandin gels nor the stripping or rupturing of the membranes has brought on regular contractions within a couple of hours, your practitioner will slowly give you the medication Pitocin (a synthetic form of the naturally-occurring hormone oxytocin) via an IV to induce or augment contractions. When Pitocin is used, contractions — which usually start about 30 minutes later — are usually stronger, more regular and more frequent than those where labor has begun naturally (though if this is your first baby, you won't have anything to compare it with). If you’re considering an epidural, you might want to ask your practitioner about getting it started while you’re getting the Pitocin so it’s in place once labor does start.

When you might get a C-section instead

There are some circumstances where labor shouldn’t be induced and a C-section is preferable, including:

• The need (because of fetal distress, for instance) for immediate delivery
• If there is any doubt that your baby can fit through your pelvis
• If you've had a previous C-section and you're attempting a vaginal birth
• If the placenta is near or covering your cervix (placenta previa)
• If there’s a prolapsed cord (the cord has slipped down into the vagina before the baby's head)
• If you’re experiencing a genital herpes outbreak
• Possibly, if you're carrying multiples
• Possibly, if your baby is breech

Keep in mind that ACOG now recommends that practitioners try to minimize interventions during labor in low-risk pregnancies where Mom is progressing normally and baby is doing well with the goal of reducing inductions and C-sections.

ACOG suggests that certain procedures that may have happened sooner or more often in the past be delayed or avoided altogether if possible, unless they become necessary.

Does labor induction have risks?

While in the majority of cases labor induction goes smoothly, complications sometimes arise. They include:

• The uterus contracts too quickly, causing changes in fetal heart rate or umbilical cord problems
• Infection in mother or baby
• Uterine rupture
• Increased risk of C-section
• Bleeding after delivery

However know that throughout the process your baby will be continuously monitored via electronic fetal monitoring, which will help your practitioner to assess how he or she is dealing with the stress of induced labor and take steps to protect both of you.

For low-risk pregnancies where labor is progressing normally and not being induced, ACOG suggests that intermittent, rather than continuous, fetal monitoring may be appropriate in some cases, but be sure to discuss this with your doctor or midwife.

Is it safe to try to induce labor yourself?

While there are plenty of natural methods you can use to try to bring on labor (and plenty of old wives' tales to go along with them), it's hard to prove that any of them will do the trick.

Some women swear by them, but none of the homegrown methods passed from mom to mom has been documented as consistently effective. That's probably at least partly due to the fact that when they do appear to work, it's difficult to establish whether they actually worked — or whether labor, coincidentally, started on its own at the same time.

Still, if you're at the end of your rope (and who isn't by 40 weeks and beyond?), you might want to try some natural ways to induce labor.  

What happens if labor induction doesn't work?

Very occasionally, labor induction doesn’t work, especially if the cervix isn’t effaced and dilated. If this is the case for you, your practitioner may try to induce labor again or opt for a C-section.