What does it mean to induce labor? If your labor doesn't start on its own, your healthcare provider can give you medication and use other techniques to bring on (induce) contractions. She can use some of the same methods to augment, or speed up, your labor if it stops progressing. According to the Centers for Disease Control, more than 1 in 5 births in the United States is induced.
Why would my labor have to be induced?
Your provider may recommend induction when the risks of waiting for labor to start on its own are higher than the risks of having a procedure to get your labor going. This may be the case when:
- You're still pregnant a week or two past your due date. Experts advise waiting no longer than that to give birth because it puts you and your baby at greater risk for a variety of problems. For example, the placenta may become less effective at delivering nutrients and oxygen to your baby, increasing the risk of a stillbirth or serious problem for your newborn.
- Your water breaks and your labor doesn't start on its own. Once your membranes have ruptured, you and your baby are at increased risk of infection. So your provider will help you weigh the risks and benefits of induction versus those waiting to see if you go into labor on your own. Your provider will be more likely to hold off on inducing labor if your baby is premature.
- You have tests showing that your placenta is no longer functioning properly, that you have too little amniotic fluid, or that your baby isn't thriving or growing as he should.
- You develop preeclampsia, a serious condition that can endanger your health and restrict the flow of blood to your baby, or gestational hypertension, a milder version of pregnancy-induced high blood pressure that may evolve into preeclampsia.
- You have a chronic or acute illness that threatens your health or your baby's health. Such conditions can include high blood pressure, diabetes, kidney disease, or cholestasis of pregnancy.
- You previously had a stillbirth.
You also might have an elective induction for logistical reasons – if you live far away from the hospital or know you have very rapid labors, for example. In those situations, your healthcare provider should wait until you're at least 39 weeks to schedule your induction.
How is labor induced?
This depends in large part on the condition of your cervix at the time. Here are three scenarios:
Your cervix is unripe
If your cervix hasn't started to soften, efface (thin out), or dilate (open up), it's considered "unripe," which means you're not yet ready for labor.
In that case, your provider would use either medication or "mechanical" methods (see below) to ripen your cervix before starting the induction. This often shortens the length of labor, and may end up jump-starting labor as well, possibly allowing you to avoid having infusions of the labor-induction drug oxytocin.
To ripen your cervix and induce labor, your healthcare provider may:
- Use prostaglandins. You may have medicine that contains synthetic prostaglandins inserted into your vagina, or you may be given an oral dose of misoprostol (a form of prostaglandin). Prostaglandins act like hormones, and this medication helps ripen your cervix and, as mentioned above, sometimes stimulates contractions so you don't need oxytocin.
- Use a Foley catheter or cervical ripening balloon. Instead of using medication, your provider may ripen your cervix by inserting a thin tube with one or two tiny, uninflated balloons on the end. When these balloons are filled with fluid, the pressure on your cervix stimulates your body to release its own prostaglandins, which can make your cervix soften and open. (When your cervix begins to dilate, the balloon falls out and the tube is removed.)
If your labor doesn't start from these methods alone – which is common, – you'll eventually be given an IV infusion of oxytocin. This drug (often referred to by the brand name Pitocin) is a synthetic form of the hormone that your body produces naturally during spontaneous labor.
Your cervix is partially dilated
If your cervix is already somewhat dilated, your provider may:
Strip or sweep your membranes. Your provider inserts her finger through your cervix and manually separates your amniotic sac from the lower part of your uterus. This causes the release of natural prostaglandins, which may help further ripen your cervix and possibly get contractions going.
In most cases, this procedure is done during an office visit. You're then sent home to wait for labor to start, usually within the next couple days. Many moms-to-be find this procedure uncomfortable or even painful, although the discomfort is short-lived.
- Rupture your membranes. If you're at least a few centimeters dilated, your provider can insert a small hooked instrument through the cervix to break your amniotic sac. This procedure (amniotomy) causes no more discomfort than a vaginal exam. This would only be done after you’ve been admitted to the hospital.
Your cervix is ripe
If your cervix is very ripe and ready for labor, there's a small chance that rupturing the membranes alone will be enough to get your contractions going. If that doesn't happen, your provider will:
Use oxytocin (Pitocin). Your provider may give you oxytocin through an IV pump to start or augment your contractions. She can adjust the amount you need according to how your labor progresses.
How long does it take to go into labor after induction starts?
The amount of time it takes to go into active labor after the start of induction varies widely. The riper your cervix, the shorter the likely interval from start of induction to active labor and delivery.
Once your membranes are ruptured, either artificially or spontaneously, you'll probably progress faster, especially if you’re already having contractions and your cervix is ripe. You'll also likely progress to active labor more quickly if you've had a baby before.
Your provider will usually continue administering medication, such as prostaglandins, or using mechanical ripening methods, such as a balloon in the cervix, for up to 12 hours, unless active labor begins before that or there's a problem with your baby’s heart rate. After 12 hours, he or she should be able to give you a rough estimate of how much longer you can expect to wait before active labor begins.
Once you reach active labor (about 5-6 centimeters dilated), you'll likely continue to dilate for another four or five hours before delivering your baby, if you're a first-time mom. Progress will probably be quicker if this is your second or third time around.
What risks are associated with inducing labor?
Although induction is generally safe, there are some risks, which may vary according to your individual situation and the methods used. Here are possible risks and inconveniences:
- Overly strong contractions. Oxytocin, prostaglandins, or nipple stimulation (explained below) occasionally cause contractions that come too frequently or are abnormally long and strong. This, in turn, may stress your baby. To assess the frequency and length of your contractions as well as your baby's heart rate, you'll need to have continuous electronic fetal monitoring during an induced labor. You'll probably have to lie down or sit still while being monitored, but some hospitals offer telemetry, which means you can walk around during the process with a small version of the fetal monitor attached to you.
- Rupture. In rare cases, prostaglandins or oxytocin can also cause placental abruption, or even uterine rupture, although ruptures are extremely rare in women who have never had a c-section or other uterine surgery. Commonly used prostaglandins such as misoprostol and “cervidil” (dinoprostone), are associated with a relatively high rate of rupture in women attempting a vaginal birth after a cesarean (VBAC) and should never be used in women with a scarred uterus. Some experts don't think women attempting VBAC should be induced with oxytocin either.
- Long wait time. Inducing labor can take a long time, especially if you start with an unripe cervix, and this process can be hard on you and your partner psychologically and physically. Sleep deprivation and dealing with pain for long periods may exhaust you and make it harder to push the baby out when the time comes. (On the other hand, the seemingly endless wait for labor to begin may be even more trying among women who go past their due date.)
- You might still need a c-section. If induction doesn't work, you'll need a c-section. Having a c-section after a long labor or unsuccessful induction is associated with higher rates of complications than you might have with a planned c-section.
Remember that your healthcare provider should recommend inducing your labor only when she believes that waiting for labor to begin would be riskier for you and your baby than intervening.
Are there any circumstances in which my labor shouldn't be induced?
Yes. You'll need to have a c-section rather than an induction whenever it would be unsafe to labor and deliver vaginally. You might need a c-section if:
- You have tests that indicate that your baby can't tolerate contractions or otherwise needs to be delivered immediately.
- You have placenta previa, a condition that means your placenta is positioned unusually low in your uterus, either next to or covering your cervix.
- Your baby is in a breech or transverse position, meaning that he's not coming headfirst.
- You had a previous c-section with a "classical" (vertical) uterine incision or another uterine surgery, such as a procedure to remove fibroids (myomectomy).
- You're having twins and the first baby is breech, or you're having triplets or more.
- You have an active genital herpes infection.
Are there any techniques I can try at home to get my labor going?
No do-it-yourself methods for starting labor have been proven consistently to be both safe and effective. Here's the scoop on some of the techniques you may have heard about:
- Sexual intercourse: Semen contains prostaglandins, and having an orgasm may stimulate contractions. A few studies have shown that having sex at term may reduce the need for labor induction, but others have found no effect on promoting labor.
- Nipple stimulation: Stimulating your nipples releases oxytocin and may help start labor. While it's a time-honored approach, more research is needed to determine how effective it is. And because there's a possibility of overstimulating your uterus (and stressing your baby), it's probably safer to try in the hospital while being monitored.
- Castor oil: Castor oil is a strong laxative. Although stimulating your bowels may cause contractions, there's not a lot of definitive research showing that it helps induce labor – and you're likely to find the effect very unpleasant. However, if it means avoiding a longer induction, it may be worth trying. It can also lead to diarrhea and dehydration, so it’s important that you stay hydrated if using castor oil.
- Herbal remedies: A variety of herbs are touted as useful for labor induction, but there isn't enough evidence to prove that any of them are safe or effective. Some are actually risky because they can overstimulate your uterus and also may be dangerous to your baby for other reasons.
- Bumpy car ride: There's no evidence that labor might start just because a pregnant mom finds herself on a gravel road or hits a few speed bumps. A bumpy ride won't hurt her baby, either. Unborn babies are well protected from life's minor bumps by the uterus and surrounding fluid. Always err on the side of safety, however, and wear a seat belt, even in the back seat.
- Spicy food: No spice or food has been scientifically proven to get labor started. Some people theorize that spicy food causes contractions by stimulating the digestive system. Others suggest that spicy food increases production of the hormone prostaglandin, which can also help move labor along. But a mom's gastrointestinal tract and her uterus are not connected. An upset stomach or diarrhea could release prostaglandins into the body's circulation and stimulate mild uterine cramping, but that's unlikely to be enough to cause labor.
How can I prepare for a scheduled labor induction?
These four tips can help make the induction process more enjoyable:
Bring entertainment. Some inductions take a very long time to get going, particularly if your cervix isn't ripe at the outset. In this case, you may be in the hospital for many hours before you even feel your first contraction. It's a good idea to bring something to keep yourself entertained, such as books, magazines, or games. You might consider making a “labor playlist” on your phone – soothing music that distracts and relaxes you. Or you can ask your partner to do that for you, as long as you’re sure his/her choices won’t annoy you! In the early phase of the induction, before the contractions get strong and regular, try lowering the lights and minimizing noise so that you can nap as much as possible.
Take it slow.You'll be more comfortable (and more likely to end up with a vaginal delivery) if the induction happens gradually. For example, unless your cervix is already ripe, your practitioner will almost always start by ripening your cervix so that it will dilate more easily. And if /when you're given Pitocin, it's easier on you if the dosage starts low and is slowly increased (every 30 to 45 minutes). This allows you to adjust emotionally and physically as your labor progresses.
Relax. Once your contractions get going, you can use comfort measures like relaxation, aromatherapy, massage, and position changes. Getting on all fours in the bed or on the floor on a blanket and arching your back like a cat can help distract you from the pain and sometimes can turn a stubborn baby in the face-up position.
Ask for pain meds or an epidural if needed. If you want to, you can still labor without pain medications, but don't feel bad if you choose medications at some point. Especially in a scheduled induction, where you’re likely to be in labor for a long time, an epidural can allow you to sleep for several hours at a time.