Are you thinking about asking for an elective induction? Or has your healthcare provider suggested you have one?
Either way it’s important to know the pros and cons of induction of labor and the risks and benefits for you and your baby.
Here we go through the research to give you a balanced and evidence based overview of when induction may or may not be necessary.
WHAT IS A MEDICAL INDUCTION AND SHOULD YOU HAVE ONE?
Medical inductions are a big thing to get your head around. There’s a lot of information out there on the Internet about having an induction to get you into labor.
If you’re considering whether or not to be induced you’ve probably started to read all kinds of articles and watch all kinds of YouTube videos and…it’s confusing.
Our intention is to give you a simple and balanced view of the pros and cons of medical induction. We don’t want to push you into having an induction if you don’t want one. And we certainly don’t want to discourage you from having one if you and your physician have discussed your options and you’ve decided that an induction is right for you.
Our promise is to tell you the facts, bust a few myths, and empower you to make this decision for yourself.
WHAT IS A MEDICAL INDUCTION?
A medical induction is a procedure which happens in hospital. Medicines are used to induce (start) labor before it happens naturally.
There are a few different medicines that can be involved in an induction. Some women will only have one of these and other women will need a combination of them to start labor:
1. Cervical Ripeners
Medicines called synthetic prostaglandins are inserted into the vagina. The hormones these medicines release start to thin and soften the cervix, which is known as ‘ripening’. This stimulates the start of labor.
2. Cervical Pipening Balloons
Sometimes a small tube called a catheter is inserted through the vagina into the cervix, with a an inflatable balloon attached to the end of it. Once inside, the balloon is slowly filled with saline (salt water solution) to expand it as it rests against the cervix. This creates pressure which can help to ripen the cervix.
3. Intravenous Medication
Your healthcare provider may insert a cannula into a vein, usually in your arm or hand. This is a thin needle with a tube attached which allows medication to be given intravenously (directly into your blood). They will then give you a synthetic version of the hormone oxytocin, which stimulates contractions. This synthetic hormone is called Pitocin.
If your cervix is already slightly dilated (opened) your healthcare provider may induce labor by breaking your water. This is called Artificial Rupture of Membranes (AROM/ARM), rupturing the amniotic sac, or an ‘amniotomy’.
It’s done by inserting a small plastic hook through the vagina to break the membranes that hold the amniotic fluid around your baby. If you have this procedure you may feel a gush or a trickle of water.
Rupturing the amniotic sac can stimulate contractions to start so that you go into labor. Sometimes this doesn’t work and your healthcare provider will then offer cervical ripening medication or intravenous medication to strengthen contractions.
All of these inductions methods take place in hospital and your baby’s heart rate will be monitored before, during and after.
IS HAVING AN INDUCTION SAFE?
Although medical inductions are extremely common, they are still a serious medical intervention in pregnancy. It has a number of important effects on you and your baby and the earlier you are induced, the higher the risk of complications.
Induction shortens the length of time that your baby has to develop in the womb. This is called shortening the gestational age. It also interrupts your body’s natural preparations for labor.
In 2014 data showed that 23% of pregnant women in the US had a medically induced labor, but studies show that induction is under-reported by healthcare providers and the actual figure is closer to 41%.
The reasons for induction reported in a research study by Childbirth Connection included:
- Medical reasons which meant that induction was the safest option for baby and/or mother
- Medical reasons which were not backed up by solid research, so it was unclear whether induction was the safest option. These included the physician suspecting that the baby was too big (there is no current evidence that induction is safer when the baby is large) and the physician suspecting that the baby was too small
- Non-medical reasons, including induction being the most convenient option for the healthcare provider or the parents
Research shows that the induction of labor is safest after 39 weeks gestation. Babies born before 39 weeks are more likely to have serious medical and development problems. And evidence suggests that a medical induction before 41 weeks also carries more risk than induction after 41 weeks.
Different methods of induction have different potential side-effects and unwanted outcomes. We will look at some of those side effects below.
Induction of labor is a serious procedure and should not be taken lightly. If there is a well-researched medical reason why induction is necessary then it can be safer than waiting for labor to begin naturally.
But without a well-researched medical reason, induction is not safer and could lead to more interventions or complications.
WHEN WILL MY HEALTHCARE PROVIDER TALK TO ME ABOUT HAVING AN INDUCTION?
If your doctor or midwife thinks that you should consider an induction they will discuss this with you as soon as they can. Normally this is in the last weeks of pregnancy as your estimated due date (EDD) approaches.
Reasons with good, research-based evidence that support the need for induction include:
- Pregnancy complications which could threaten your baby’s health or yours, including hypertension, preeclampsia, heart disease, gestational diabetes or bleeding in pregnancy
- Baby not getting enough oxygen and nutrients from the placenta
- The amniotic sac has ruptured (your water has broken) but labor hasn’t started; this becomes a concern between 24-48 after the sac is ruptured
- You are 42 weeks pregnant or more, which sometimes means that the placenta becomes less effective at supplying your baby with nutrients and can increase the chance of stillbirth
- There is an infection inside your uterus. This is called ‘chorioamnionitis’
When your physician brings up the topic of an induction it’s important that you understand why they think you should have one. Ask as many questions as you need to, and if you’re unsure, ask them to share the evidence that suggests an induction is the safest option for you.
Remember that asking for clarification and evidence is not confrontational or rude. This is your body and your baby, and it is your right to understand exactly why this intervention is being recommended to you.
PROS OF MEDICAL INDUCTION OF LABOR
Benefits of a well-timed induction include:
- Safer labor and birth for both Mom and baby if there is a good, evidence-based reason for the induction
- Less uncertainty as an induction date means that you know when you will go into labor (unless you go into labor naturally before your induction date); this can be reassuring for some Moms
- Lower risk of cesarean delivery (C-section) but only in inductions that take place after 41 weeks gestation; and the risk of cesarean delivery is higher in inductions before 39 weeks
CONS OF INDUCTION OF LABOR
Potential problems include:
1. Increased need for other medical interventions
Induction in itself is a medical intervention, and research shows that it can lead to more interventions being needed during labor. This is sometimes called a ‘cascade of interventions’.
Usually, your body begins natural processes to prepare for labor a few weeks before labor actually starts. Being induced means that those processes all have to take place in just a few hours because your body simply isn’t ready to go into labor.
As a result, other interventions that become more likely during an induced labor include: pain medications such as an epidural; forceps delivery or vacuum extraction, where your physician uses tools to help move your baby down the birth canal and out of the vagina; and episiotomy, where your physician makes a cut at the opening of the vagina.
2. Baby having medical and developmental problems
If labor is induced before your baby has reached important developmental milestones there is an increased chance that your newborn will have to spend time in ICU after delivery. Some babies may have longer-term health problems as a result of early delivery.
The last 5 weeks of pregnancy are crucial for a baby’s brain development, and their lungs are still developing too.
3. Slow induction
Although some women who are induced go into labor and deliver their babies very quickly, this is not always the case.
Induction can take just a few hours or it can take days to actually reach the point when you’re officially in labor.
An induction is more likely to be slow if you haven’t reached full term and if your body isn’t already showing signs of getting ready for labor.
4. Failed induction
Around 25% of first time Moms who are induced will not go into labor, or will not progress in labor. This can mean that you have to have a C-section.
5. Negative effects on yours or your baby’s wellbeing during labor
- Prostaglandins and Pitocin, the medications that are used to start labor, can both cause abnormal contractions or too many contractions. This can reduce the oxygen supply to your baby and lower their heart rate. Pitocin induction has a number of risks attached to it.
- Methods of induction that involve touching or interfering with the amniotic sac, such as breaking your water, can increase the risk of infection for baby and Mom. If labor doesn’t start and progress within 24-48 hours after the membranes have been ruptured the chance of infection increases.
- Bleeding after delivery. Being induced increases the chance that the muscles of your uterus won’t contract normally after you’ve given birth. This is called ‘uterine atony’ and can cause serious bleeding.
HOW CAN I MAKE SURE I’M NOT INDUCED UNNECESSARILY?
Many women share the common experience of feeling under pressure to have an induction. This is an unfortunate aspect of a very medicalized birth culture; hospitals and doctors take a clinical approach to birth.
Sometimes, clinical intervention is absolutely necessary and it’s a really good thing that medical support is available to pregnant and laboring women, and babies.
Clinical interventions in labor save lives.
But they’re not always necessary. And when they’re not necessary, research shows that interventions, including the induction of labor, can cause harm.
There are several things you can do to help lower the chance that you will be induced unless it really is necessary.
- Learn about labor and inductions. You’re doing it already by reading this article. Learn about the common reasons why your doctor might encourage you to have an induction, and whether or not those reasons are backed up by research evidence. For example, many doctors advise induction because they think a baby is too small or too big. But there’s no evidence that induction improves outcomes for those babies. If you can talk confidently with your doctor about why you don’t want to have an induction it will be easier to work out a plan that you are a comfortable with.
- If possible, find a doctor or healthcare team with a low induction rate. Midwives tend to have lower induction rates than doctors, so if a midwife-led birth is an option in your area it’s worth considering. Some doctors and hospitals induce much more often than others. Ask the hospital for this information or look online, as some statistics from recent years should be available.
- Choose to give birth in a setting with a low induction rate. As mentioned, some hospitals induce far less than others, and some have improvement programs with concrete aims to reduce their induction rates. If you can choose to give birth in a birth center rather than a hospital, or at home, then your chances of induction are lowered even more.
- If you’re not yet pregnant, you can start reducing your chance of induction when you are pregnant right now. By tracking your menstrual cycle! When you get pregnant you will be given an estimated due date (EDD) by your healthcare provider. This is calculated from the first day of your last menstrual period.Knowing when that first day was is important, but so is knowing how long or how irregular your menstrual cycle is. The EDD is usually calculated based on a menstrual cycle of 28 days long. But lots of women have longer or shorter cycles, or cycles which are a different length every month. If you know this about your cycle you can tell your healthcare provider, making it less likely that they will miscalculate your due date.That can make all the difference in late pregnancy because it changes when you are considered full term and it changes the post-term date (between 41-42 weeks) when your doctor will recommend an induction.
I WANT TO BE INDUCED — CAN I ASK FOR AN INDUCTION?
Some pregnant women want to be induced. If that’s you and you’re wondering whether you can ask for an induction, the simple answer is yes.
You can discuss induction with your healthcare provider if it’s something you want. Choosing to have an induction yourself is called an ‘elective induction’.
However, unless there’s a specific medical reason for wanting an induction, it might be worth thinking more about why you want it and whether there’s a different way to manage that.
Many healthcare providers will not provide an elective induction without any clear medical need for it.
Research shows that for a healthy pregnant woman carrying a healthy baby, going into labor naturally gives you the best chance of a smooth labor and delivery with as few interventions as possible.
All of your reasons for wanting an induction are valid. None of them are silly. Having a baby is a huge deal and it’s normal to have intense or overwhelming emotions. But before you commit yourself to the medical route, consider whether you could find another way to have the birth you want.
COMMON REASONS WOMEN WANT TO BE INDUCED
1. Feeling scared that something’s going to go wrong.
Almost all women feel scared of labor. Whether it’s your first baby or your fifth, labor and delivery are always a bit unknown. You can’t predict what will happen.
Even if you’re not worried about labor itself you might be worried about your baby; anxiety about a baby’s health can be exhausting, and sometimes a Mom-to-be just wants to get their baby out so they can see, hold and care for their child.
These fears make lots of women want to just get labor over and done with. The waiting and worrying feels like too much and they want to move on and get on with their lives.
This is understandable. It really is. But if this is true for you, remember that induction might not be the safest or easiest option.
Instead of asking for an elective induction, could you find ways to ease your fear or anxiety and prepare for a healthy and positive natural birth?
Hypnobirthing can be incredibly useful to help you prepare your mind for the challenges of labor. And it also helps you to relax and find a sense of confidence and calm while you’re still pregnant.
Other options might be counseling with a women’s health or pregnancy specialist to talk through your concerns and find a new way of looking at them; getting out and about for walks or going to a prenatal yoga class; or taking the time to absorb yourself in activities that make you feel happy and relaxed.
You can do this and it’s OK to believe that everything is going to be fine.
2. Being very uncomfortable, emotional, or being in pain during late pregnancy
Yes — pregnancy can be really uncomfortable. Especially in those final few weeks.
You are full of baby.
You’re big, achey, and leaking all kinds of fluids when you’re least expecting it (just so you know, leaking fluids is a theme that continues for a little while after giving birth, too!).
We don’t mean to make light of it though. Discomfort or pain in pregnancy can cause genuine exhaustion and low mood. The intense physical and emotional feelings you’re experiencing can make you want to get labor started as soon as possible.
Please do talk through any discomfort or pain you’re feeling with your doctor. See if they can help. And equally, chat with your doctor or with a trusted friend or relative about the emotions you’re going through too. It’s all important.
But see if you can find ways to ease those discomforts and stay relaxed so that you can stay pregnant until your body is ready for labor. Exercise does help, as much as you don’t want to do it.
Swimming is a wonderful way to take the weight off and soothe your muscles and you can do it safely right up until the end of pregnancy.
Stretch, move, and treat yourself to little things that make you feel good.
3. Wanting to know when labor is going to start
Some new Moms just want to know when they’re going to go into labor. This might be related to the first reason on this list.
If you feel scared then knowing when to expect labor might help you to feel prepared.
Or it might be a matter of planning; you’re an organized person and you want to be able to plan the days leading up to and after your labor.
Neither of those reasons are bad. But do ask yourself if they’re strong enough reasons not to try for a spontaneous labor.
Research shows that going into labor naturally is better for you and your baby as long as there isn’t a medical reason why you should be induced.
If you can, embrace the unknowns of these last few weeks of pregnancy and spend the time bonding with your bump. We know it’s easier said than done but it will be worth it.
INDUCTION OF LABOR IS A BIG DECISION
Ultimately, remember that your body is your body whether you are pregnant or not. We encourage you to listen to the advice that your healthcare providers give you.
Ask as many questions as you need to and ask those questions again if you don’t fully understand the answers you’re given.
Sometimes an induction is necessary, or significantly safer than waiting to go into labor naturally. If that’s the case your physician will tell you.
If your doctor recommends an induction, ask them to tell you why they want you to have an induction and discuss any doubts you have with them. Unless it’s an emergency situation and your baby is in danger or your own health is at risk, the decision of whether or not to have a medical induction is yours.
It’s your body, your pregnancy and your baby.
Amis, Debby. 2014. Healthy Birth Practice #1: Let Labor Begin on Its Own in the Journal of Perinatal Education. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4235056/
Eisenberg Center at Oregon Health & Science University. 2009. Thinking About Having Your Labor Induced?A Guide for Pregnant Women. https://www.ncbi.nlm.nih.gov/books/NBK51222/
Labor Induction by the Mayo Clinic. https://www.mayoclinic.org/tests-procedures/labor-induction/about/pac-20385141
Childbirth Connection. 2016. Quick Facts About Labor Induction. http://www.nationalpartnership.org/our-work/resources/health-care/maternity/quick-facts-about-labor-induction.pdf
Inducing Labor by the American Pregnancy Association. https://americanpregnancy.org/labor-and-birth/inducing-labor/
The Possible Benefits of Inducing Labor by Health Women. https://www.healthywomen.org/content/article/possible-benefit-inducing-labor
Lothian, Judith. 2006. ‘Saying No to Induction’ in the Journal of Perinatal Education. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1595289/