When Is It Time To Induce Labor?

In a perfect world, your pregnancy would end on – or at least close to – the date you circled on the calendar when you learned you were expecting. But what happens when your baby decides to linger past that due date? Or if a complication arises? 

This is the point at which your OB-GYN may suggest induction, essentially a “jumpstart” to the delivery process to bring on labor. 

Reasons To Induce 

A good birth plan is one that prepares for the unexpected. And while the goal is to safely deliver your baby in the manner you prefer, there are reasons why inducing might be required, including: 

• Late-term pregnancy - The most common reason is simply that your baby is staying put. Should pregnancy extend beyond 41 weeks, induction can lower the risk of delivery complications.

• Premature rupture of membranes (PROM) – This is a breach of the amniotic sac before 37 weeks and before labor begins.

• Multiple birth - Twins or other multiples can come with delivery or health complications. Inducement provides a controlled setting and potential emergency medical attention.

• Hypertension disorders – These can cause elevated or irregular blood pressure levels, such as preeclampsia, which can lead to death of the mother or baby.

• Diabetes, or gestational diabetes - The reduction of insulin production puts infants at risk.

• Fetal growth restrictions – There are scenarios where the baby may not be growing appropriately.

• Abruptio placentae - Also known as premature separation of the placenta, this condition limits oxygen and nutrients to the womb and causes significant blood loss.

• Blood disorders – These include blood-related issues such as RH Factor — an incompatibility of blood types between mother and fetus. 

How It Works 

In most non-emergency deliveries, the earliest your doctor will induce labor is at 39 weeks. This gives your baby’s body and lungs time to fully develop. The first step is a cervical exam to establish your Bishop score, an indicator of the readiness of the cervix for labor, based on four parameters:

• Dilation (gradual opening of the cervix)

• Effacement (thinning of the cervix)

•  Consistency (level of firmness)

• Position (where the baby’s head is relative to the maternal pelvis) 

If you and your doctor opt for induction, what happens next depends on how to achieve the best outcomes for you and your child: 

• Stripping (or sweeping) the membrane - This manual maneuver by your doctor’s finger is usually done at 39 weeks and initiates production of prostaglandin, a natural chemical in your body that triggers muscles in the uterus to contract. This procedure can be done at your doctor’s office, depending on your pregnancy status. 

If your cervix isn’t ready, your doctor may suggest ripening the cervix in the hospital first. Options includes: 

• Ripening the cervix - To assist with softening and thinning the cervix, you may be prescribed an oral or vaginally inserted prostaglandin

• Foley bulb - Your doctor might insert a balloon-like device that is slowly inflated to widen and dilate the cervix. 

After the cervix is deemed favorable for induction — either from one of the above procedures or your body’s natural processes — the following procedures take place at the hospital: 

• Breaking your water - Your doctor manually punctures the amniotic sac, which often brings on labor.

• Oxytocin injection - Usually delivered intravenously, oxytocin is a hormone naturally produced during labor that lowers stress and can get contractions started. 

Risks with Inducing Labor 

As with all deliveries, there are risks to consider when inducing labor. The most common is that your body won’t respond and a C-section delivery is required. 

Additionally, inducing labor can cause contractions to come too close together, lowering your baby’s heart rate. Called tachysystole, it’s defined by the American College of Obstetricians and Gynecologists (ACOG) as having more than five contractions in 10 minutes and lasting more than 30 minutes. 

Once the amniotic sac is broken, there’s increased risk for infection or umbilical cord prolapse, a condition where the cord becomes compressed and limits oxygen to the baby. 

Finally, remember, the goal of your medical team is to ensure you and your baby start your new life together healthy and strong. While there are risks involved in any childbirth scenario, the rewards are far greater.