Perinatal Neonatal


Induction of Labor

There are many reasons a practitioner may decide to induce labor: A woman is overdue and there's no sign of action from the uterus. The mom has a condition like preeclampsia or diabetes and continuing the pregnancy would be problematic for both her and her baby. A baby isn't thriving inside the womb. The placenta isn't functioning properly. The amniotic fluid is infected or too low or has ruptured and the mom hasn't started having contractions within 24 hours. Various situations arise that make a practitioner decide that nature needs a little nudge. About 20 percent of all labors are induced. If you're among them, the method of induction will be based on how ripe — or unripe — your cervix happens to be. Here's the lowdown: If your cervix isn't ripe (i.e. it's not soft, nor dilated, nor effaced), your practitioner will apply a topical form (either a gel or a vaginal suppository) of the hormone prostaglandin to your cervix to help it soften, thin, and dilate. Less often, your practitioner may use a mechanical agent to ripen the cervix (such as a catheter with an inflatable balloon or graduated dilators), though prostaglandins are still the ripener of choice these days.

  • If your bag of waters (amniotic sac) is still intact, your practitioner may strip the membranes by swiping his or her finger across the fine membranes that connect the amniotic sac to the uterus to release prostaglandin, or break your water (also known as an artificial rupture of membranes), to get labor started.
  • If neither the prostaglandin gels nor the stripping or rupturing of the membranes has brought on regular contractions, your practitioner will slowly administer intravenous Pitocin, a synthetic form of the hormone oxytocin, until contractions are well established. (Contractions brought on by Pitocin are usually stronger, more regular, and more frequent than those of a labor that has begun naturally — but if this is your first baby, you won't have anything to compare it with.)
  • Your baby will be continuously monitored via electronic fetal monitoring to assess how he or she is dealing with the stress of induced labor.

There are some circumstances where labor should not 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 you've had a previous C-section and you're attempting a vaginal birth if there is a prolapsed cord (if the cord has slipped down into the vagina before the baby's head)
  • if you have genital herpes
  • possibly, if you're carrying multiples
  • possibly, if your baby is breech

    Once your contractions are in full swing, your labor should progress just as a non-induced labor does (learn more about the phases of labor).

What are the risks?

Inducing labor carries various risks, including:

  • The need for a C-section. Labor induction is more likely to result in the need for a C-section — particularly if you've never given birth before and your cervix hasn't already begun to thin, soften and dilate (unfavorable cervix).
  • Premature birth. Inducing labor too early might result in a premature birth, which poses risks for the baby, such as difficulty breathing.
  • Low heart rate. The medication used to induce labor — oxytocin or a prostaglandin — might provoke too many contractions, which can diminish your baby's oxygen supply and lower your baby's heart rate.
  • Infection. Inducing labor increases the risk of infection for both mother and baby.
  • Umbilical cord problems. Inducing labor increases the risk of the umbilical cord slipping into the vagina before delivery (umbilical cord prolapse), which might compress the cord and decrease the baby's oxygen supply.
  • Uterine rupture. Uterine rupture is a rare but serious complication in which the uterus tears open along the scar line from a prior C-section or major uterine surgery. An emergency C-section is needed to prevent life-threatening complications.
  • Bleeding after delivery. Labor induction increases the risk that your uterine muscles won't properly contract after you give birth (uterine atony), which can lead to serious bleeding after delivery.

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