Inducing labor has become a common practice, with over 20% of pregnancies being induced for various medical and non-medical reasons. However, this procedure is not without risks and should be carefully considered by expecting mothers. There are pros and cons to electively inducing labor that women should weigh with guidance from their healthcare provider.
What is labor induction?
Labor induction is the process of artificially starting labor before it begins naturally. This is done by using medications or other methods to stimulate uterine contractions. The goal is to achieve a vaginal delivery by kickstarting the labor process.
There are a few different methods doctors can use to induce labor:
- Oral or vaginal administration of prostaglandin medications which soften the cervix and stimulate contractions
- Artificial rupture of membranes (breaking the water)
- Intravenous oxytocin (Pitocin) to stimulate uterine contractions
- Stripping or sweeping of the membranes by separating the amniotic sac from the cervix
- Insertion of a Foley catheter with an inflatable balloon to help dilate the cervix
The most common method is using intravenous Pitocin along with rupturing the amniotic sac. This combination provides strong uterine stimulation to get labor started and progressing.
Why do doctors recommend induction?
There are both medical and elective reasons why a doctor might recommend inducing labor. Some of the most common reasons include:
- Post-term pregnancy – Allowing a pregnancy to continue past 42 weeks gestation has risks including stillbirth. Induction reduces these risks.
- Pre-eclampsia – This condition of high blood pressure in pregnancy can threaten maternal and fetal health. Delivering the baby is the cure.
- Intrauterine growth restriction – When a fetus is not growing well, earlier delivery may improve the outcome.
- Maternal health conditions – Conditions like diabetes, kidney disease, or autoimmune disorders may warrant induction for optimal outcomes.
- Premature rupture of membranes – If the amniotic sac breaks too early, induction reduces the risk of infection.
- Logistical reasons – Some women opt for induction to schedule delivery for convenience or to ensure their preferred doctor is available.
When there is a clear medical benefit, induction of labor is very reasonable. However, the risks versus benefits must be carefully weighed when considering induction without a strong medical reason.
What are the potential benefits of induction?
There are a few key potential benefits that can make induction an attractive option:
- Control over timing – Scheduling delivery provides control and convenience for families to make arrangements for work, childcare, and support.
- Avoiding complications – Inducing before problems set in can prevent risks like stillbirth in post-term pregnancies.
- Doctor availability – Some women have a strong preference for their own doctor or midwife to deliver the baby.
- Prevention of cesarean section – Going into spontaneous labor after an unfavorable cervix can increase the risk of unplanned C-section. An elective induction can ripen the cervix first.
- Shorter labor – Studies show induced labor may be slightly shorter than spontaneous labor, especially in first pregnancies.
Many women are drawn to the idea of controlling the start of labor. However, there are no guarantees with induction, and going into labor spontaneously has benefits as well.
What are the potential risks of induction?
While the benefits are appealing, there are also important risks and downsides to consider with elective induction of labor:
- Failed induction – The medications and methods do not successfully start labor in up to 30% of inductions, resulting in a C-section.
- Uterine rupture – Pitocin can cause contractions that are longer and stronger than natural labor, increasing the very rare risk of uterine rupture.
- Fetal distress – The intensity of induced contractions may briefly reduce blood flow to the baby, causing fetal heart rate decelerations.
- Infection – More vaginal exams raise the risk of introducing infection.
- Higher cost – More time in the hospital and extra interventions raises the costs.
- Increased pain – Some studies find induced labor results in stronger, more painful contractions compared to spontaneous labor.
A higher C-section rate is one of the biggest concerns. If the body is not quite ready, induction is less likely to be successful.
When is induction recommended?
The American College of Obstetricians and Gynecologists has guidelines on when induction is generally either appropriate or not recommended:
| Recommended for Induction | Not Routinely Recommended |
|---|---|
|
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As a general rule, induction has good evidence behind it when there are clear medical indications. For marginal indications or no medical reason, induction becomes far more controversial.
What are women’s options?
Pregnant women do have options when it comes to induction:
- Accept the doctor’s recommendation for medically indicated induction – This is reasonable with conditions like preeclampsia or significant post-term pregnancy.
- Decline recommendations for marginal or elective induction – Women have the right to decline induction when the indications are less compelling or nonmedical.
- Seek a second opinion – Getting another perspective from a different obstetrician can help weigh the pros and cons.
- Wait for spontaneous labor if no concerning medical issues – Going into natural labor when both mom and baby are doing well is a reasonable choice.
- Try natural induction methods first – Methods like nipple stimulation, acupressure, spicy foods, and walking can be tried before medical inductions.
Having open and shared discussions with your doctor is key to determining the best options for your particular pregnancy.
Pros and cons of elective induction at 39 weeks
Due to some potential benefits, elective induction around 39 weeks gestation has become popular. Many practices now offer the option. Here are some key pros and cons to consider:
Potential Pros:
- Lower risk of requiring a C-section
- 12% lower risk of preeclampsia
- 25% lower risk of fetal demise
- More likely to have vaginal delivery before complications arise
- Can schedule delivery on a preferred date and time
- Higher likelihood of having your delivery provider of choice
Potential Cons:
- Potentially longer labor and more painful contractions
- Risks from induction medications and methods
- Higher chance of interventions like vacuum or forceps delivery
- Higher risk of infection
- Baby more likely to have complications like respiratory distress or low APGAR scores
- Risk of failed induction leading to unplanned C-section
There are good arguments on both sides of routinely inducing otherwise healthy pregnancies at 39 weeks. A lot depends on the woman’s specific risk factors and chances of spontaneous labor progressing favorably.
Is elective induction right for you?
The choice of whether and when to induce is not always a straightforward decision. Here are some questions to help pregnant women decide if elective induction is the right choice:
- What are your personal reasons or motivation for wanting induction?
- Are you well-educated on the risks and benefits specific to your individual scenario?
- Is your cervix ripe and ready to achieve a vaginal delivery?
- Are you hoping to avoid complications or are your chances already low?
- Do you have strong medical indications driving the recommendation?
- Are you willing to accept the increased risks of interventions like C-section?
- Do you have social reasons that make induction significantly more convenient?
Scheduling birth for nonmedical reasons in otherwise low-risk pregnancies remains controversial. Women need to reflect carefully and have in-depth conversations with doctors to determine if elective induction is right for their situation.
Questions to ask your doctor about induction
To help pregnant women make truly informed decisions about induction, here are some key questions to ask during prenatal appointments:
- Why are you recommending induction for me? What risks am I trying to avoid?
- How will you induce my labor? What are the risks of those methods?
- What are my bishop score and chances my induction will be successful? Have you assessed my cervical ripeness?
- If induction fails, at what point will you make the call for a C-section? How urgently will this happen?
- What options do I have other than induction? What are the risks of waiting for spontaneous labor?
- Is induction recommended due to hospital scheduling policies or convenience, or is there a clear medical benefit?
- Can I meet with a doula or patient advocate to discuss my options and preferences regarding induction?
Getting clear data and explanations of the recommendations allows women to truly understand the necessity for induction and make informed decisions.
How to avoid unnecessary induction
Women who hope to avoid medically unnecessary induction do have some options and strategies:
- Learn induction best practices – Be educated on when major medical groups recommend induction versus when it provides little benefit.
- Discuss risks and benefits – Have in-depth, open conversations with your provider weighing pros and cons.
- Request monitoring – Decline elective induction in favor of continued fetal monitoring for reassuring indications.
- Get second opinions – Seek out additional perspectives from other obstetricians before agreeing to induction.
- Try natural induction first – Use methods like nipple stimulation for 1-2 weeks before considering medical induction.
- Avoid elective inductions before 39 weeks – Don’t schedule induction too early without medical need due to risks to baby.
Remember that induction should be recommended based on a specific medical benefit to mom or baby. Declining marginal inductions can lead to healthy vaginal deliveries.
Conclusion
Induction is a common and useful obstetric intervention when there are clear health indications during pregnancy. However, the procedure does carry risks that women should carefully weigh against any potential benefits. Having open, informed discussions with your doctor is key to determining if induction is the right choice for your individual scenario.
Elective induction for nonmedical reasons remains controversial, as spontaneous labor onset has its own advantages. While doctors may favor induction out of convenience, women have every right to understand the indications and decide what is ultimately best for their bodies and babies.