Types of inducing labor

Inducing Labor (for Parents) - Nemours KidsHealth

It's common for many pregnant women, especially first-time mothers, to watch their baby's due date come and go without so much as a contraction. The farther away from the expected delivery date (called the EDD) you get, the more anxious you might become. You may start to wonder — is this baby ever going to come?

Late pregnancy can be challenging — you may feel large all over, your feet and back might hurt, you might not have the energy to do much of anything, and you're beyond ready to meet the little one you've nurtured all this time. Which is why waiting a little longer than you'd expected can be particularly hard.

Still, being past your due date doesn't guarantee that your doctor (or other health care provider) will do anything to induce (or artificially start) labor — at least not right away.

What Is It?

Labor induction is what doctors use to try to help labor along using medications or other medical techniques. Years ago, some doctors routinely induced labor. But now it's not usually done unless there's a true medical need for it. Labor is usually allowed to take its natural course. However, in some situations, a health care provider may recommend induction.

Why It's Done

Your doctor might suggest an induction if:

your water broke but you are not having contractions
your baby still hasn't arrived by 2 weeks after the due date (when you're considered post-term — more than 42 weeks into your pregnancy)
you have an infection in the uterus (called chorioamnionitis)
you have certain risk factors (e.g., gestational diabetes or high blood pressure)
there is not enough amniotic fluid
there is a problem with the placenta
the baby is not growing appropriately

Induction also can be appropriate under certain circumstances, as with a mother who is full term and has a history of rapid deliveries or lives far from a hospital.

Some mothers request elective inductions for convenience, but these do come with risks. Doctors try to avoid inducing labor early because the due date may be wrong and/or the woman's cervix might not be ready yet.

Page 2

How It's Done

Some methods of induction are less invasive and carry fewer risks than others. Ways that doctors may try to induce labor by getting contractions started include:

Stripping the membranes. The doctor puts on a glove and inserts a finger into the vagina and through the cervix (the opening that connects the vagina to the uterus). He or she moves the finger back and forth to separate the thin membrane connecting the amniotic sac (which houses the baby and amniotic fluid) to the wall of the uterus. When the membranes are stripped, the body releases hormones called prostaglandins, which help prepare the cervix for delivery and may bring on contractions. This method works for some women, but not all.
Breaking your water (also called an amniotomy). The doctor ruptures the amniotic sac during a vaginal exam using a little plastic hook to break the membranes. If the cervix is ready for labor, amniotomy usually brings on labor in a matter of hours.
Giving the hormone prostaglandin to help ripen the cervix. A gel or vaginal insert of prostaglandin is inserted into the vagina or a tablet is given by mouth. This is typically done overnight in the hospital to make the cervix "ripe" (soft, thinned out) for delivery. Administered alone, prostaglandin may induce labor or may be used before giving oxytocin.
Giving the hormone oxytocin to stimulate contractions. Given continuously through an IV, the drug (Pitocin) is started in a small dose and then increased until labor is progressing well. After it's administered, the fetus and uterus need to be closely monitored. Oxytocin is also frequently used to spur labor that's going slowly or has stalled.

What Will It Feel Like?

Stripping the membranes can be a little painful or uncomfortable, although it usually only takes a minute or so. You may also have some intense cramps and spotting for the next day or two.

It can also be a little uncomfortable to have your water broken. You may feel a tug followed by a warm trickle or gush of fluid.

With prostaglandin, you might have some strong cramping as well. With oxytocin, contractions are usually more frequent and regular than in a labor that starts naturally.

Page 3

Risks and Precautions

Inducing labor is not like turning on a faucet. If the body isn't ready, an induction might fail and, after hours or days of trying, a woman may end up having a cesarean delivery (C-section). This appears to be more likely if the cervix is not yet ripe.

If the doctor ruptures the amniotic sac and labor doesn't begin, another method of inducing labor also might be necessary because there's a risk of infection to both mother and baby if the membranes are ruptured for a long time before the baby is born.

When prostaglandin or oxytocin is used, there is a risk of abnormal contractions developing. In that case, the doctor may remove the vaginal insert or turn the oxytocin dose down. While it is rare, there is an increase in the risk of developing a tear in the uterus (uterine rupture) when these medications are used. Other complications associated with oxytocin use are low blood pressure and low blood sodium (which can cause problems such as seizures).

Another potential risk of inducing labor is giving birth to a late pre-term baby (born after 34 and before 37 weeks). Why? Because the due date (EDD) may be wrong. Your due date is 40 weeks from the first day of your last menstrual period (LMP).

Babies born late pre-term are generally healthy but may have temporary problems such as jaundice, trouble feeding, problems with breathing, or difficulty maintaining body temperature. They may also be more likely than full term babies to have developmental or school problems later on.

Even though inductions do come with risks, going beyond 42 weeks of pregnancy can be risky, too. Many babies are born "post-term" without any complications, but concerns include:

A vaginal delivery may become harder as the baby gets bigger. As babies get bigger, the chance of an injury during delivery, such as a broken bone, increases.
The placenta that helps to provide the baby with nourishment is deteriorating.
The amniotic fluid can become low or contain meconium — the baby's first feces. If the baby breathes in meconium, it can cause breathing problems.

Old wives' tales abound about ways to induce labor, such as the use of castor oil. It is not safe to try to artificially start labor yourself by taking castor oil, which can lead to nausea, diarrhea, and dehydration. And herbs and herbal supplements meant to induce labor can be harmful. Breast stimulation can cause uterine contractions by causing the release of oxytocin. However, some studies have suggested that the baby might have abnormal heartbeats after breast stimulation. Some women feel that having sex in late pregnancy can induce labor, but there is no conclusion on this yet.

Talk to your doctor before doing anything to try to encourage your little one's arrival. Inducing labor is best left to medical professionals — you may cause more harm than good.

As frustrating as it can be waiting for your baby to finally decide to arrive, letting nature take its course is often best, unless your doctor tells you otherwise. Before you know it, you'll be too busy to remember your baby was ever late at all!

Reasons, Types, and Risk Factors

Inducing labor, also known as labor induction, is a procedure where a doctor or midwife uses methods to help you go into labor.

In most cases, it’s best to let labor happen on its own, but there are exceptions. Your doctor may decide to induce you for medical reasons or if you’re 2 or more weeks past your due date.

Talk with your doctor about whether labor induction is right for you.

In a perfect world, you’ll go into labor right on cue at 40 weeks. However, sometimes the process doesn’t go as smoothly as expected, and the baby runs late.

Certain medical problems can make an extended pregnancy risky for you and your baby, including:

growth problems in the baby
too little amniotic fluid around the baby
gestational diabetes
high blood pressure
preeclampsia
a uterine infection
placental separation from the uterus
Rh incompatibility

Your doctor may need to induce labor if your water breaks before you start getting contractions. Contractions are a sign that labor has started and your cervix has begun to open. A lack of contractions could mean that your body isn’t preparing for delivery like it should.

You might prefer to induce if you live far from a hospital or have a history of delivering quickly. Inducing labor may also be medically necessary after 42 weeks. At this point, the placenta can no longer provide enough oxygen and nutrients for your baby.

Preeclampsia is another reason for inducing labor. Preeclampsia is when you develop high blood pressure and at least one related symptom. If you have high blood pressure during pregnancy, delivering your baby early could prevent complications.

There are a few ways to speed up the process if your baby is behind schedule. The safest and most effective way is to see your doctor. Medications or medical techniques can bring on labor more quickly.

The other option is to try to induce labor on your own. Before you try anything, talk with your doctor or midwife. Make sure the method you’re attempting is safe and that your pregnancy is at the optimal time to induce.

Two types of medications induce labor. Drugs called prostaglandins soften the cervix to ready it for delivery. You can take these drugs by mouth, or they can be inserted as a suppository into your vagina.

The second type of drug kick-starts contractions. Pitocin is the most common of these medications. You get it through an IV.

Your cervix needs to be ready for labor or the medications won’t work. Learn the pros and cons of using medication to induce labor.

Medication isn’t the only way to get your labor started. Membrane stripping and breaking your water are two other options.

Stripping the membranes involves the amniotic sac. Your doctor uses their fingers to push the amniotic sac away from the cervix.

To break your water, the doctor pops open the amniotic sac with a small plastic hook. Your baby will then move its way to the top of your cervix in preparation for delivery. You could go into labor days or even hours later.

Membrane stripping is generally considered safe, but experts disagree on whether this practice is worth doing.

For a more natural approach without medical intervention, you can try inducing labor on your own. Studies haven’t verified that these methods work, so check with your doctor or midwife before trying any of them.

One of the easiest and safest ways to try inducing labor on your own is to take a walk. The gravity from your movements may help slide your baby down into position. Although a walk may not speed up your pregnancy, it’s good for you in general.

Having sex can also help. Semen contains hormones called prostaglandins, which make your uterus muscles contract. Having an orgasm yourself will also stimulate your uterus.

There’s no evidence that getting more active will help induce labor, but it’s good for your health and pregnancy. Exercise reduces your risk of a C-section and gestational diabetes.

It’s safe for most people to exercise during their pregnancy. Still, it’s a good idea to check with your doctor beforehand. Certain conditions may mean you should avoid exercise completely during pregnancy.

Deep inside the core of a pineapple is an enzyme called bromelain that breaks down proteins. That property makes it a key ingredient in many meat tenderizers.

The theory behind using bromelain for labor induction is that it might break down tissue in your cervix and soften it to prepare for delivery. There’s no scientific evidence that this theory is true, however.

Bromelain might work well on meat, but it’s not very active in the human body. Plus, pineapple could worsen pregnancy heartburn.

While it’s usually best to let nature take its course, inducing labor may be a good idea if there’s a problem with your pregnancy or your baby. If you’re healthy, an induction might help you avoid a C-section.

A 2018 study found that women in their first pregnancy who were induced at 39 weeks were less likely to need a C-section than those who waited. Complication rates didn’t differ between the two groups.

Ask your doctor whether it makes sense to induce at 39 weeks if:

this is your first pregnancy
you’re only carrying one baby
you and your baby are healthy

C-sections can be risky, causing complications like bleeding and infection. While they may be necessary in certain cases, these surgical deliveries can also cause more problems with future pregnancies.

Your labor will be induced in a hospital or birthing center. The process will differ based on which technique your doctor uses to induce labor. Sometimes doctors use a combination of methods.

Depending on the techniques your doctor tries, it can take anywhere from a few hours to several days for your labor to start. Most of the time, induction will lead to vaginal delivery. If this doesn’t work, you might need to try again or have a C-section.

What you can expect depends on the method of induction:

Prostaglandins come as a suppository that goes into your vagina. After a few hours, the medication should trigger labor.
You’ll get Pitocin through an IV. This chemical stimulates contractions and helps speed up the labor process.
During amniotic sac rupture, the doctor will place a plastic hook inside your vagina to open up the sac. You may feel a warm rush of water as the sac breaks. When your water breaks, your body’s prostaglandin production increases, which should start your contractions.

The hospital staff will monitor your contractions to see how your labor is progressing. Your baby’s heartbeat is also monitored.

Health concerns and a long pregnancy are reasons why you might consider labor induction. It’s not a decision to make lightly since inducing labor can have serious risks. These include:

premature birth
slowed heart rate in the baby
uterine rupture
infections in both parent and baby
excessive bleeding in the parent
umbilical cord issues
lung problems in the baby
stronger contractions
vision and hearing problems in the baby
poor lung and brain development

Labor inductions don’t always work. If your induction isn’t successful, you may need a C-section.

The drugs and techniques used to induce labor can cause side effects for both you and your baby. Pitocin and other medications that soften your cervix can intensify contractions, making them come faster and closer together.

More intense contractions may be more painful for you. Those faster contractions can also affect your baby’s heart rate. Your doctor might stop giving you the medication if your contractions are coming too quickly.

Rupturing the amniotic sac may cause the umbilical cord to slip out of your vagina before your baby. This is called prolapse. Pressure on the cord can reduce your baby’s oxygen and nutrient supply.

Labor needs to start within about 6 to 12 hours after rupturing your amniotic sac. Not going into labor within that time frame increases the risk of infection for both you and your baby.

The Bishop score is a system your doctor uses to figure out how soon you’ll deliver and whether to induce labor. It gets its name from obstetrician Edward Bishop, who devised the method in 1964.

Your doctor will calculate your score from the results of a physical exam and ultrasound. The score is based on factors like:

how far your cervix has opened (dilated)
how thin your cervix is (effacement)
how soft your cervix is
where in the birth canal your baby’s head is (fetal station)

A score of 8 or above means you’re close to starting labor and that induction should work well. Your odds of a successful induction go down with a lower score.

Induction uses medication or medical techniques to start your labor. Natural labor happens on its own. The length of labor that happens without medical intervention varies.

Some people deliver within a few hours of their first contractions. Others have to wait several days before they’re ready to deliver.

When you go into labor naturally, the muscles of your uterus start to contract. Your cervix then widens, softens, and thins to prepare for your baby’s delivery.

During active labor, your cramps become stronger and more frequent. Your cervix widens from 6 cm to 10 cm to accommodate your baby’s head. At the end of this stage, your baby is born.

What labor induction feels like depends on how your doctor induces your labor.

Membrane stripping is slightly uncomfortable, and you should expect some cramping afterward. You’ll feel a slight tug when the doctor breaks your amniotic sac. Afterward, there will be a rush of warm fluid.

Using medication to induce labor produces stronger and faster contractions. You’re more likely to need an epidural when you’re induced than if you start labor without induction.

Unless you or your baby’s health is at risk, waiting for labor to come on its own is the best decision. The biggest benefit is that it reduces the risk of complications from induced labor.

Labor induced without good reason before 39 weeks can lead to more complications than benefits. However, if your doctor induces labor for medical reasons, it could improve both your health and the health of your baby.

Weigh all the benefits versus the risks with your doctor before you decide to have an induction. If your doctor is pressuring you because of scheduling issues, get a second opinion.

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.

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. nine0003

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.

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 of the patient, which is assessed using the Bishop scale (when viewed through the vagina, the position of the cervix, the degree of its dilatation, consistency, length, and the position of the presenting part of the fetus in the pelvic area are assessed). Also important is the medical history (medical history) of the patient, for example, a past caesarean section or operations on the uterus.

The following methods are used to induce (stimulate) 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. nine0022
Amniotomy or opening of the fetal bladder - in this case, during a gynecological examination, when the cervix has already dilated sufficiently, 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. nine0022

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. nine0022
Fetal 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. nine0022
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.

The use of a balloon catheter increases the risk of inflammation inside the uterus.

When using oxytocin, the patient may rarely experience a decrease in blood pressure, tachycardia (rapid heartbeat), hyponatremia (lack of sodium in the blood), which may result in headache, loss of appetite, nausea, vomiting, abdominal pain, depression strength and sleepiness. nine0003

Induction of labor, compared with spontaneous labor, increases the risk of prolonged labor, the need for instrumentation

(use of vacuum or forceps), postpartum hemorrhage, uterine rupture, the onset of too frequent uterine contractions and the associated deterioration of the fetus, prolapse umbilical cord, as well as premature detachment of the placenta.

If induction of labor is not successful

The time frame for induction of labor varies from patient to patient, on average labor begins within 24-72 hours. Sometimes more than one method is required. nine0003

The methods used do not always work on different patients in the same way and quickly. If the cervix does not dilate as a result of induction of labor, your doctor will tell you about your next options (which may include inducing labor later, using a different method, or delivering by caesarean section).

ITK833

This informational material was approved by the Women's Clinic on 01/01/2022.

Induction of labor in women with a normal pregnancy of 37 weeks or more

Does an induction policy at 37 weeks' gestation or more reduce the risks for infants and their mothers compared with a policy of waiting until later gestational age or until there is an indication for induction of labor?

This review was originally published in 2006 and subsequently updated in 2012 and 2018.

What is the problem?

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. nine0003

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.