Labor induction is something patients often ask me about, especially as their due date approaches and more often when their due date is near a holiday or coincides with another big life event. The hope is that the majority of inductions are done for medical reasons. Induction that isn’t done for medical reasons is considered elective induction.
The American College of Obstetricians and Gynecologists recommend inducing labor only for medical reasons, specifically when it is more risky for the baby to remain inside the mother’s uterus than to be born. Labor is likely to be induced when a complication develops such as hypertension (high blood pressure), preeclampsia (symptoms include high blood pressure and protein in the urine), gestational diabetes, fetal growth restriction, or for other, less common reasons.
Going past your due date is another very common reason you might need to be induced. Most OB/GYNs like to deliver the baby between the patient’s due date and up to one week past. Going more than a week past the baby’s due date usually requires a conversation between the patient and doctor, and rarely is it recommended to let a patient go more than two weeks past their due date.
Generally, OB/GYNs do not like to induce a patient prior to their due date if there is no medical reason to. This is because inductions can take a long time and, in some cases, end up in a cesarean section (c-section) that might otherwise have been avoided. The risk of a cesarean section is especially increased when you induce a patient who is pregnant with their first child and the patient’s cervix isn’t yet dilated or effaced and the baby hasn’t dropped yet. While there are interventions that can be done to improve these types of situations, those interventions are usually done in the hospital and can often take between six to 18 hours before the patient is ready to proceed with the induction.
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There are multiple ways to initiate the induction process, all dependent on the specific patient and situation. The process is different for every patient depending on how close it appears she is to going into labor naturally and based upon how many children she has had.
The most common ways to start the induction process include:
▪ A foley bulb induction: Your doctor inserts a catheter into your cervix and inflates the balloon with saline solution, which puts pressure on the cervix and encourages dilation.
▪ Medications, including Cervidil, Cytotec or oxytocin: Cervidil is a vaginal insert with a time-released prostaglandin medication that helps your cervix gradually soften, thin and dilate. Cytotec is often used off-label to induce labor, though it has not been approved by the FDA for use in pregnancy. The body naturally produces the hormone oxytocin to stimulate contractions, and medications called Pitocin and Syntocinon are two forms of oxytocin given through an IV at low doses to stimulate contractions.
▪ Artificial rupturing of the membranes: Breaking the amniotic sac can sometimes speed up contractions.
There are advantages and risks to each induction technique and it’s important you go over each one thoroughly with your OB/GYN if you have questions.
Dr. James Whiddon is an obstetrician and gynecologist with Heartland Women’s Group.