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When Waiting for Baby Isn’t Safe: Inducing Labor

Waiting to go into labor can be exciting. But for some moms the waiting can be harmful, even dangerous. That’s when labor induction may be necessary instead.

Nationwide, about 22 percent of all pregnancies involve induction of labor. “Induction,” says David McKenna, MD, a maternal fetal medicine specialist, “is basically an option to end the pregnancy prior to spontaneous labor occurring or pre-labor rupture of membranes.”

Why Induce?

Medical need usually drives the decision to induce labor. Reasons may include:

• There are medical complications during pregnancy, including hypertension (high blood pressure), preeclampsia (a condition that includes hypertension as well as other risk factors, like high protein levels in the blood), heart disease, gestational diabetes, or bleeding during pregnancy.
• The baby is at risk of not getting enough nutrients and oxygen from the placenta.
• The baby isn’t growing the way he or she should.
• The amniotic sac has ruptured, but labor hasn’t started within 24 to 48 hours.
• Pregnancy lasts longer than 42 weeks. This poses a risk to the baby because the supply of nutrients from the placenta begins to decrease at this point.

“A suspected large baby is not considered a valid reason for induction,” says Dr. McKenna. “That’s a common misconception.”

How Is Labor Induced?

During your pregnancy your cervix is firm and rigid. This holds the baby inside you. Once labor begins, your cervix becomes soft and begins to open or dilate to allow the baby to be born. “We call this cervical ripening,” says Dr. McKenna. The ripening process can take several weeks when left to occur on its own.

When labor is induced, cervical ripening takes place much more quickly. “You might hear your doctor refer to the Bishop Score,” says Dr. McKenna. “It’s a way we indicate how ripe your cervix is throughout the process of birth.”

Your cervix can be ripened, and labor induced, in several ways:

• Medication. Your doctor encourages your body to begin labor by administering the hormone prostaglandin (either by mouth or as a suppository in the vagina), or a synthetic form of the hormone oxytocin (provided through an IV). 
• Amniotomy. If you were to carry your baby to full term (39 weeks), typically your water breaks (amniotic sac ruptures) naturally, and labor begins. But if your water doesn’t break on its own, and there is a need to start labor, your physician can puncture the amniotic sac. As the water gushes out, the baby’s head moves closer to the cervix, making contractions stronger. Most women go into labor within hours after the sac breaks.
• Stripping the membranes. Your doctor gently sweeps a gloved finger over the thin membranes that connect the amniotic sac to the wall of your uterus. This can cause your body to release hormones that soften the cervix and cause contractions.

In first pregnancies, inducing labor can be a longer process than in subsequent pregnancies. On average, inducing labor may take anywhere from a few hours to two to three days. “The ideal is for mom to have contractions every three to four minutes,” Dr. McKenna explains.

Does Inducing Labor Increase the Risk Of Cesarean Section?

“That’s what we used to believe,” says Dr. McKenna. “But the ARRIVE Trial showed us otherwise.” The ARRIVE Trial  was a 2017 study of more than 3,000 low risk first-time mothers who carried their babies' full term. Miami Valley Hospital was one of the research sites for the study. “This important study showed that inducing labor in women who were 39 weeks along with their first baby did not increase the risk for cesarean birth,” Dr. McKenna reports. “As a result of that study, as long as the cervix is ripe, we don’t worry about increasing the chances of cesarean birth by inducing labor.” The study also found that the babies of the women who were induced at 39 weeks had fewer complications, and the mothers were less likely to develop hypertension 

A secondary analysis of the women in the ARRIVE Trial found that those who were induced actually had decreased utilization of health care resources. Dr. McKenna explains this was due to fewer doctor visits, fewer complications, and shorter hospital stays for mom and baby.

Risks of Inducing

With labor induction, you may be at greater risk for:

• An infection
• A longer hospital stay
• Complications with the baby due to prematurity if the pregnancy is less than 39 weeks, and especially if less than 37 weeks
• Uterine rupture (rare)

If your doctor wants to induce you, and you’re not comfortable with it, Dr. McKenna recommends asking:

• What’s the reason for inducing?
• What’s the risk to me and my baby if I don’t get induced?
• What are the benefits if I do get induced?
• What’s the alternative to inducing?

“If your doctor says you need to be induced for medical reasons, I would generally recommend taking that advice,” says Dr. McKenna. “Getting a second opinion is also an option.”

What If It Doesn’t Work?

If your body still doesn’t go into labor after induction, there are two options, says Dr. McKenna. “One is to do a cesarean delivery. Two is to delay the induction. But if there is an urgent medical reason for inducing labor, we would move forward with cesarean delivery.”

Can I Be Induced for Convenience?

Traditionally, elective (not medically necessary) induction was not deemed an acceptable medical practice. However, considering the results of the ARRIVE study, delivery at 39 weeks may actually offer health benefits and in the future may no longer be considered purely elective.   

If you and your baby are healthy, you may prefer to allow your pregnancy (and labor) to progress naturally, and that is absolutely OK. On the other hand, some women may prefer the convenience of labor induction at 39 weeks. If your doctor or midwife agrees, this is a viable option that is supported by the American College of Obstetrics and Gynecology.

To learn more about inducing labor, talk to your doctor or health care provider or search for a provider.

Source: American College of Obstetrics and Gynecology; Office of Women’s Health, U.S. Department of Health and Human Services; American Pregnancy Association; American Academy of Family Physicians; March of Dimes; David McKenna, MD, Perinatal Partners