Risk of induction
Labor induction - Mayo Clinic
Overview
Labor induction — also known as inducing labor — is prompting the uterus to contract during pregnancy 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. An important factor in predicting whether an induction will succeed is how soft and expanded the cervix is (cervical ripening). The gestational age of the baby as confirmed by early, regular ultrasounds also is important.
If a health care provider recommends labor induction, it's typically because the benefits outweigh the risks. If you're pregnant, understanding why and how labor induction is done can help you prepare.
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Why it's done
To determine if labor induction is necessary, a health care provider will likely evaluate several factors. These include the mother's health and the status of the cervix. They also include the baby's health, gestational age, weight, size and position in the uterus. Reasons to induce labor include:
- Nearing 1 to 2 weeks beyond the due date without labor starting (postterm pregnancy).
- When labor doesn't begin after the water breaks (prelabor rupture of membranes).
- An infection in the uterus (chorioamnionitis).
- When the baby's estimated weight is less than the 10th percentile for gestational age (fetal growth restriction).
- When there's not enough amniotic fluid surrounding the baby (oligohydramnios).
- Possibly when diabetes develops during pregnancy (gestational diabetes), or diabetes exists before pregnancy.
- Developing high blood pressure in combination with signs of damage to another organ system (preeclampsia) during pregnancy. Or having high blood pressure before pregnancy, developing it before 20 weeks of pregnancy (chronic high blood pressure) or developing the condition after 20 weeks of pregnancy (gestational hypertension).
- When the placenta peels away from the inner wall of the uterus before delivery — either partially or completely (placental abruption).
- Having certain medical conditions. These include heart, lung or kidney disease and obesity.
Elective labor induction is the starting of labor for convenience when there's no medical need. It can be useful for women who live far from the hospital or birthing center or who have a history of fast deliveries.
A scheduled induction might help avoid delivery without help. 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 shows that inducing labor at this time reduces several risks, including having a stillbirth, having a large baby and developing high blood pressure as the pregnancy goes on.
It's important that women and their providers share in decisions to induce labor at 39 to 40 weeks.
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Risks
Uterine incisions used during C-sections
Uterine incisions used during C-sections
A C-section includes an abdominal incision and a uterine incision. After the abdominal incision, the health care provider will make an incision in the uterus. Low transverse incisions are the most common (top left).
Labor induction carries various risks, including:
- Failed induction. An induction might be considered failed if the methods used 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 the uterus to contract too much, 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. The longer the time between membrane rupture and labor, the higher the risk of an infection.
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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. Rarely, uterine rupture can also occur in women who have not had previous 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, which can lead to serious bleeding after delivery.
Labor induction isn't for everyone. It might not be an option if:
- You've had a C-section with a classical incision or major uterine surgery
- The placenta is blocking the cervix (placenta previa)
- Your baby is lying buttocks first (breech) or sideways (transverse lie)
- You have an active genital herpes infection
- The umbilical cord slips into the vagina before delivery (umbilical cord prolapse)
If you have had a C-section and have labor induced, your health care provider is likely to avoid certain medications to reduce the risk of uterine rupture.
How you prepare
Labor induction is typically done in a hospital or birthing center. That's because mother and baby can be monitored there, and labor and delivery services are readily available.
What you can expect
During the procedure
There are various ways of inducing labor. Depending on the circumstances, the health care provider might use one of the following ways or a combination of them. The provider might:
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Ripen the cervix. Sometimes prostaglandins, versions of chemicals the body naturally produces, are placed inside the vagina or taken by mouth to thin or soften (ripen) the cervix. After prostaglandin use, the contractions and the baby's heart rate are monitored.
In other cases, a small tube (catheter) with an inflatable balloon on the end is inserted into the cervix. Filling the balloon with saline and resting it against the inside of the cervix helps ripen the cervix.
- Sweep the membranes of the amniotic sac.
With this technique, also known as stripping the membranes, the health care provider sweeps a gloved finger over the covering of the amniotic sac near the fetus. This separates the sac from the cervix and the lower uterine wall, which might help start labor. -
Rupture the amniotic sac. With this technique, also known as an amniotomy, the health care provider makes a small opening in the amniotic sac. The hole causes the water to break, which might help labor go forward.
An amniotomy is done only if the cervix is partially dilated and thinned, and the baby's head is deep in the pelvis. The baby's heart rate is monitored before and after the procedure.
- Inject a medication into a vein. In the hospital, a health care provider might inject a version of oxytocin (Pitocin) — a hormone that causes the uterus to contract — into a vein. Oxytocin is more effective at speeding up labor that has already begun than it is as at cervical ripening.
The provider monitors contractions and the baby's heart rate.
How long it takes for labor to start depends on how ripe the cervix is when the induction starts, the induction techniques used and how the body responds to them. It can take minutes to hours.
After the procedure
In most cases, labor induction leads to a vaginal birth. A failed induction, one in which the procedure doesn't lead to a vaginal birth, might require another induction or a C-section.
By Mayo Clinic Staff
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Labor Induction | ACOG
Amniotic Fluid: Fluid in the sac that holds the fetus.
Amniotic Sac: Fluid-filled sac in a woman's uterus. The fetus develops in this sac.
Amniotomy: Artificial rupture (bursting) of the amniotic sac.
Anesthesia: Relief of pain by loss of sensation.
Breech Presentation: A position in which the feet or buttocks of the fetus appear first during birth.
Cervix: The lower, narrow end of the uterus at the top of the vagina.
Cesarean Birth: Birth of a fetus from the uterus through an incision (cut) made in the woman's abdomen.
Chorioamnionitis: A condition during pregnancy that can cause unexplained fever with uterine tenderness, a high white blood cell count, rapid heart rate in the fetus, rapid heart rate in the woman, and/or foul-smelling vaginal discharge.
Diabetes Mellitus: A condition in which the levels of sugar in the blood are too high.
Eclampsia: Seizures occurring in pregnancy or after pregnancy that are linked to high blood pressure.
Fetus: The stage of human development beyond 8 completed weeks after fertilization.
Fibroids: Growths that form in the muscle of the uterus. Fibroids usually are noncancerous.
Genital Herpes: A sexually transmitted infection (STI) caused by a virus.
Herpes causes painful, highly infectious sores on or around the vulva and penis.
Gestational Diabetes: Diabetes that starts during pregnancy.
Hemorrhage: Heavy bleeding.
Hormone: A substance made in the body that controls the function of cells or organs.
Hypertension: High blood pressure.
Intravenous (IV) Line: A tube inserted into a vein and used to deliver medication or fluids.
Kidneys: Organs that filter the blood to remove waste that becomes urine.
Laminaria: Slender rods made of natural or synthetic material that expand when they absorb water. Laminaria are inserted into the opening of the cervix to widen it.
Obstetrician–Gynecologist (Ob-Gyn): A doctor with special training and education in women's health.
Oxytocin: A hormone made in the body that can cause contractions of the uterus and release of milk from the breast.
Placenta: An organ that provides nutrients to and takes waste away from the fetus.
Placenta Previa: A condition in which the placenta covers the opening of the uterus.
Preeclampsia: A disorder that can occur during pregnancy or after childbirth in which there is high blood pressure and other signs of organ injury. These signs include an abnormal amount of protein in the urine, a low number of platelets, abnormal kidney or liver function, pain over the upper abdomen, fluid in the lungs, or a severe headache or changes in vision.
Prelabor Rupture of Membranes (PROM): Rupture of the amniotic membranes that happens before labor begins. Also called premature rupture of membranes.
Prostaglandins: Chemicals that are made by the body that have many effects, including causing the muscles of the uterus to contract, usually causing cramps.
Umbilical Cord: A cord-like structure containing blood vessels.
It connects the fetus to the placenta.
Uterus: A muscular organ in the female pelvis. During pregnancy, this organ holds and nourishes the fetus. Also called the womb.
Induction of labor in women with normal pregnancies of 37 weeks or more
Does a policy of inducing labor at 37 weeks or more of gestation reduce the risks for infants and their mothers compared with a policy of waiting until a later gestational age or until Will there be indications for labor induction?
This review was originally published in 2006 and subsequently updated in 2012 and 2018.
What is the problem? nine0008
The average pregnancy lasts 40 weeks from the start of a woman's last menstrual period. Pregnancies lasting more than 42 weeks are described as "post-term" and therefore the woman and her doctor may decide to give birth by induction. Factors associated with postnatal pregnancy and delayed delivery include obesity, first birth, and maternal age over 30 years.
Why is this important?
Protracted (term) pregnancy may increase risks for infants, including greater risk of death (before or shortly after birth). However, induction (stimulation or induction) of labor can also pose risks to mothers and their babies, especially if the woman's cervix is not ready for delivery. Current diagnostic methods cannot predict risks to babies or their mothers per se, and many hospitals have specific policies regarding how long a pregnancy can last. nine0003
What evidence did we find?
We searched for evidence (July 17, 2019) and identified 34 randomized controlled trials in 16 different countries involving more than 21,500 women (mostly at low risk of complications). The trials compared a policy of induction of labor after 41 completed weeks of gestation (>287 days) with a policy of waiting (expectant management).
Labor induction policies were associated with fewer perinatal deaths (22 trials, 18 795 babies).
Four perinatal deaths occurred in the induction policy group compared with 25 perinatal deaths in the expectant management group. Fewer stillbirths occurred in the induction group (22 trials, 18,795 infants): two in the induction group and 16 in the expectant management group.
Women in the induction of labor groups in the included studies were probably less likely to deliver by caesarean section than in the expectant management groups (31 studies, 21,030 women), and there was probably little or no difference when compared with assisted vaginal delivery (22 studies, 18,584 women). nine0003
Fewer infants were admitted to the neonatal intensive care unit (NICU) in the induction policy group (17 trials, 17,826 infants; high-certainty evidence). A simple test of the baby's health status (Apgar score) at five minutes after birth was likely to be more favorable in the induction groups than expectant management (20 trials, 18,345 infants).
An induction policy may make little or no difference for women who have had a perineal injury, and likely has little or no effect on the number of women with postpartum hemorrhage or breastfeeding at hospital discharge.
We are uncertain about the effect of induction or expectant management on length of stay in the maternity hospital due to the very low certainty of the evidence. nine0003
Among newborns, the number of children with trauma or encephalopathy was similar in both groups (moderate and low-certainty evidence, respectively). None of the studies reported the development of neurodevelopmental problems during follow-up of children and postpartum depression in women. Only three trials reported some measure of maternal satisfaction.
What does this mean? nine0003
An induction policy compared to expectant management is associated with fewer infant deaths and probably fewer caesarean sections; and probably has little or no effect on assisted vaginal delivery. Determining the best time to offer induction of labor to women at 37 weeks' gestation or more requires further study, as well as further study of women's risk profiles and their values and preferences.
Discussing the risks of induction of labor, including benefits and harms, can help women make an informed choice between induction of labor, especially if the pregnancy lasts more than 41 weeks, or expectant management—waiting and/or waiting until labor is induced. Women's understanding of induction, procedures, their risks and benefits is important to influence their choice and satisfaction. nine0003
Translation notes:
Translation: Alekseeva Lada Igorevna. Editing: Prosyukova Ksenia Olegovna and Ziganshina Lilia Evgenievna. Russian translation project coordination: Cochrane Russia - Cochrane Russia, Cochrane Geographic Group Associated to Cochrane Nordic. For questions related to this translation, please contact us at: [email protected]
Induction of labor or induction of labor
The purpose of this informational material is to familiarize the patient with the induction of labor procedure and to provide information on how and why it is performed.
nine0003
In most cases, labor begins between the 37th and 42nd weeks of pregnancy. Such births are called spontaneous. If drugs or medical devices are used before the onset of spontaneous labor, then the terms "stimulated" or "induced" labor are used in this case.
Labor should be induced when further pregnancy is for some reason unsafe for the mother or baby and it is not possible to wait for spontaneous labor to begin. nine0003
The purpose of stimulation is to start labor by stimulating uterine contractions.
When inducing labor, the patient must be in the hospital so that both mother and baby can be closely monitored.
Labor induction methods
The choice of labor induction method depends on the maturity of the cervix in the patient, which is assessed according to the Bishop scale (when viewed through the vagina, the position of the cervix, the degree of its dilatation, consistency, length, position of the presenting part of the fetus in the area pelvis).
Also important is the medical history (medical history) of the patient, for example, a past caesarean section or operations on the uterus. nine0003
The following methods are used to induce labor:
- Oral misoprostol is a drug that is a synthetic analogue of prostaglandins found in the body. It prepares the body for childbirth, under its action the cervix becomes softer and begins to open.
- Balloon Catheter – A small tube is placed in the cervix and the balloon attached to the end is filled with fluid to apply mechanical pressure to the cervix. When using this method, the cervix becomes softer and begins to open. The balloon catheter is kept inside until it spontaneously exits or until the next gynecological examination. nine0066
- Amniotomy or opening of the fetal bladder - in this case, during a gynecological examination, when the cervix has already sufficiently dilated, the fetal bladder is artificially opened. When the amniotic fluid breaks, spontaneous uterine contractions will begin, or intravenous medication may be used to stimulate them.
- Intravenously injected synthetic oxytocin - acts similarly to the hormone of the same name produced in the body. The drug is given by intravenous infusion when the cervix has already dilated (to support uterine contractions). The dose of the drug can be increased as needed to achieve regular uterine contractions. nine0066
When is it necessary to induce labor?
Labor induction is recommended when the benefits outweigh the risks.
Induction of labor may be indicated in the following cases:
- The patient has a comorbid condition complicating pregnancy (eg, high blood pressure, diabetes mellitus, preeclampsia, or some other condition).
- The duration of pregnancy is already exceeding the norm - the probability of intrauterine death of the fetus increases after the 42nd week of pregnancy. nine0066
- Fetal-related problems, eg, problems with fetal development, abnormal amount of amniotic fluid, changes in fetal condition, various fetal disorders.
- If the amniotic fluid has broken and uterine contractions have not started within the next 24 hours, there is an increased risk of inflammation in both the mother and the fetus. This indication does not apply in case of preterm labor, when preparation of the baby's lungs with a special medicine is necessary before delivery. nine0066
- Intrauterine fetal death.
What are the risks associated with labor induction?
Labor induction is not usually associated with significant complications.
Occasionally, after receiving misoprostol, a patient may develop fever, chills, vomiting, diarrhea, and too frequent uterine contractions (tachysystole). In case of too frequent contractions to relax the uterus, the patient is injected intravenously relaxing muscles uterus medicine. It is not safe to use misoprostol if you have had a previous caesarean section as there is a risk of rupture of the uterine scar.
