Induction of Labor

For most pregnant women, labor starts spontaneously and there is no need to interfere with the natural progression of events, from the first contraction to birth. If labor doesn’t start on it’s own naturally and you and your doctor or midwife decide it’s not a good idea to wait any longer, they may use certain interventions (techniques and/or medications) to “induce” your labor to start artificially. These interventions cause uterine contractions to begin or your cervix to ripen and dilate, so you can deliver your baby vaginally.

When induction of labor is being considered, your doctor or midwife should fully discuss your options with you before any decision is reached. This should include explaining the procedures and care that will be involved and whether there are any risks to you or your baby. During the induction of labor, your contractions, your blood pressure, how well your cervix is dilating, as well as your baby’s heart rate will be monitored carefully.

Labor induction is an increasingly common procedure, with over 20% of births being induced (or about 1 in 5). This is a large increase from 1989, when only about 8% of all live births were induced (or close to 1 in 10). Inductions for non-medical (often convenience) purposes are the main reason for this rate increase. The pressure to schedule births for reasons of convenience (women, as well as their doctors) has resulted in growing numbers of “elective inductions”. Ideally, labor is induced when the risks of prolonging the pregnancy are more serious than the risks of delivering the baby right away.

The most common reason for induction is when a pregnancy has gone 2 or more weeks past the estimated due date, which is often called “post-term gestation” or “post-date pregnancy”. Most studies have shown that it’s safer, in these instances, to deliver the baby at this time instead of waiting for labor to begin on its own, due to increased risks including possible uterine infection, decreasing amniotic fluid, stillbirth, aspiration of meconium, ossification of baby’s skull (making molding of the head during birth difficult or impossible) a very large baby (called “macrosomia”) and heightened chances of needing a cesarean.

Your doctor or midwife may also recommend induction if your pregnancy is complicated by a health condition that presents a risk to you or your baby, including high blood pressure, diabetes, severe preeclampsia, kidney or lung disease and serious infection.

There are a number of other reasons that induction may be offered or recommended: if you have placenta abruption, the placenta is not functioning properly, you have a small pelvis (and delivering a large baby vaginally may be impossible), your baby isn’t growing properly (IUGR), your baby’s heart rate has abnormal patterns, there’s too little fluid around your baby, your water breaks and your labor doesn’t start (often called “PROM”, which poses a risk of infection), you develop a uterine infection (“chorioamnionitis”) or you’ve had a previous full-term stillbirth. Induction under these circumstances may be your best option.

Other possible (non-medical) reasons for labor induction include: prior history of rapid labor (which heightens risk of an unplanned home birth), living a long distance from a hospital, your doctor or midwife will be unavailable for an extended period of time; possibly on vacation near your due date and you’d rather not take the chance of getting the on-call doctor, as well as special family circumstances (such as partner going on military leave, etc).

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