Labor Induction


Megan Freedman

What is labor induction?

Labor induction includes several methods to start labor contractions. Labor induction is performed when continuing a pregnancy threatens the health of the mother or baby. Labor induction may be necessary when a pregnancy has lasted too long; the baby has a growth problem; or the mother has diabetes, Rh disease, preeclampsia, or separation of the placenta from the uterus. 

There are several methods of labor induction that your doctor or midwife may use alone or in combination with one another. They include breaking your water, stripping your membranes, applying mechanical devices that soften and prepare your cervix for birth, and giving you intravenous medication that signals your uterus to begin contractions. 

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Labor induction is a common procedure, but it does have risks and potential complications. Risks include injury to the baby, infection, and increase risk of cesarean section. Discuss all of your options to induce labor with your healthcare provider to understand which options are right for you.  

Why is labor induction performed?

Your doctor or midwife may recommend labor induction to start labor contractions in order to preserve the health of you or your baby. Labor induction is used in the following situations: 

  • There is not enough amniotic fluid around your baby.

  • There is a placental abruption (separation of the placenta from your uterus).

  • You have health problems including Rh disease, cancer, preeclampsia, chronic hypertension (high blood pressure), and diabetes.

  • You have a uterine infection or other type of infection.

  • Your amniotic sac (bag of water) breaks but labor contractions do not start or are not strong enough.

  • Your baby is not growing or has grown too big to be sustained in the womb.

  • Your pregnancy lasts more than 41 or 42 weeks. A normal pregnancy is 40 weeks.

In some cases, labor induction is an alternative to a cesarean section, in which a baby is surgically removed through a woman’s lower abdomen through an incision (cut). 

Who performs labor induction?

Obstetrician-gynecologists (Ob/Gyns) and midwifes perform labor induction. An Ob/Gyn is a doctor who specializes in women’s health and pregnancy. Midwives deliver babies, provide initial newborn care, and may serve as a woman’s primary healthcare and gynecologic care provider. 

How is labor induction performed?

Your doctor or midwife will perform your labor induction in an office or in the labor and delivery room of a hospital or birthing center, depending on the method of induction. Your provider may combine different labor induction methods that include:

  • Artificial rupture of membranes (amniotomy or “breaking your water”) involves inserting a small surgical hook through your vagina and cervix into your uterus. Your provider will scratch the surface of your amniotic sac to break your water. You will feel the amniotic fluid flow out of your vagina. It may be a trickle, a small stream, or a gush.

  • Cervical ripening techniques help your cervix soften and dilate (open) in preparation for delivery through the vagina. There are medications and mechanical devices that do this. The medications, called prostaglandins, include pills you take orally and vaginal suppositories that are placed directly on your cervix. Your provider may also use a soft catheter with a small saline-filled balloon at the end to place gentle pressure on your cervix to dilate it. Laminaria is another form of mechanical dilation. It is a type of seaweed that may be applied directly to the cervix to dilate it. The seaweed absorbs tissue fluids and expands, dilating the cervix in the process.

  • Oxytocin (Pitocin) is an intravenous (IV) medication that starts contractions to induce labor. It is also used to make contractions stronger.

  • Stripping the membranes typically occurs in a medical office. Your provider inserts a finger into your vagina and through the cervix. Your provider then gently separates the bag of water (amniotic sac) from the uterus. This causes your body to release hormones. This can help prepare your cervix for labor and start contractions within a few hours to a couple of days.

Will I feel pain?

Different labor induction techniques involve different sensations and levels of discomfort. Their effects vary from one woman to the next. 

Amniotomy, or artificial rupture of membranes, is painless for you and your baby. Stripping the membranes may cause menstrual-like cramps. Prostaglandins used to ripen the cervix may cause nausea, vomiting and diarrhea. Intravenous (IV) medications, such as Pitocin, may cause sudden, strong labor contractions. 

If you are using Lamaze or other prepared childbirth techniques, follow your breathing exercises to stay focused and relaxed. Ask your provider about your options for pain control if you planned a natural childbirth but change your mind as your contractions get stronger. 

What are the risks and potential complications of labor induction?

Any medical procedure involves risks and potential complications. Complications may become serious in some cases. Risks and potential complications of labor induction include:

  • Decrease in your baby’s heart rate

  • Heavy vaginal bleeding during or after the birth

  • Increased likelihood of needing a cesarean section

  • Infection in the baby or mother

  • Injury to the baby

  • Premature birth if labor is induced too early

  • Umbilical cord prolapse, in which the umbilical cord comes out of the uterus before the baby. This can compress the umbilical cord between the baby and the mother and cut off blood supply to the baby. Umbilical cord prolapse may require an emergency cesarean section (C-section).

  • Uterine rupture, in which the uterus tears and causes serious bleeding (hemorrhage)

Some women should not have a labor induction. This includes women with the following conditions:

  • You have a current or recent infection of your genitals such as genital herpes.

  • You have had a classical cesarean section (C-section).

  • You have not yet reached 39 weeks of pregnancy.

  • You have problems with your placenta. Problems include placenta previa in which the placenta is blocking the cervical opening.

Reducing your risk of complications

You can reduce the risk of certain complications by:

  • Getting all recommended prenatal care

  • Following activity, dietary and lifestyle restrictions and recommendations during your pregnancy and before your labor induction

  • Notifying your doctor, midwife, or care team immediately of any concerns such as increase in pain or bleeding

  • Taking any medications exactly as directed

  • Telling all members of your care team about the contractions you already feel

How do I prepare for my labor induction?

You are an important member of your own healthcare team. The steps you take before labor induction can improve your comfort and outcome. 

You can prepare for a scheduled labor induction by:

  • Answering all questions about your medical history and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.

  • Taking or stopping medications exactly as directed

  • Telling your doctor or midwife if you have had recent cramps, contractions, vaginal discharge or bleeding, or if there is any decrease in the baby’s movement

Questions to ask your doctor or midwife

Having labor induction and the birth of your baby can be stressful. It is common for patients to forget some of their questions during an office visit. You may also think of other questions after your appointment. Contact your doctor or midwife with concerns and questions before your procedure and between appointments. 

It is also a good idea to bring a list of questions to your prenatal appointments. Questions can include:

  • Why is labor induction needed? What are other options to start my labor or help it to progress more quickly?

  • What methods will you use to induce my labor? What are their risks?

  • How long will the induction take? How soon afterwards will labor begin?

  • What medications will I need before and after the procedure?

  • How will you treat my pain?

  • What happens if labor induction does not work?

  • What are the risks for my baby and me If I chose not to have labor induction?

What can I expect after my labor induction?

Knowing what to expect can help you proceed with your baby’s birth with more confidence.