Tips & Tools: Induction of Labor



How can I lower my chance of being induced unnecessarily?

How can I increase my chance of having a vaginal birth if my labor is induced?

How can I protect my baby's health and safety if my labor is induced?



How can I lower my chance of being induced unnecessarily?

You can:
  • Find a doctor or midwife with low induction rate. Some caregivers have much lower induction rates than others. Although there are many exceptions, family physicians tend to have lower rates than obstetricians, and midwives generally have the lowest rates of all. Styles of practice can also vary widely within each of these groups even when the women being cared for are at similar risk. (Choosing a Caregiver will give you detailed information.)
  • Choose a birth setting with a low induction rate. Some hospitals have far lower rates of induction than others. Some hospitals have quality improvement programs to reduce their induction rates, including programs to avoid scheduling births before the 39th week of pregnancy whenever possible. In general, rates of intervention are much lower for out-of-hospital birth centers and at home births, compared with hospitals. (Choosing a Birth Setting will give you detailed information.)
  • Discuss your preferences with your caregivers. Find out how they will work with you to meet your goals and preferences. If their response does not satisfy you and you have other options, seek a better match.
  • Educate yourself about the different reasons women are induced, and the evidence (or, in many cases, the lack of evidence) supporting these reasons. The Best Evidence: Induction of Labor page will give you more detailed information. You may also want to review your rights to informed refusal, in case you choose to exercise this right.
  • Do your best to make sure your estimated due date (EDD) is accurate. Caregivers often recommend an induction of labor based on how far along the pregnancy is. Having an accurate EDD may lower the chance that your labor will be induced based on an incorrect due date. An ultrasound in early pregnancy is the most accurate way to estimate your due date unless you know the exact day of your last period and exactly when you were expecting your next period, and have not recently been pregnant or used hormonal birth control like the Pill. If you track your menstrual cycles and have regular periods, you may not need an ultrasound to find out your EDD, but your caregiver may still recommend one for confirmation. Bring as much information as possible to your first prenatal appointment to increase the chance of having an accurate due date. This information might include the date of your last several periods, dates you might have conceived, and the date and results of any pregnancy tests you took. Use this worksheet (PDF) to find out your most accurate due date.

How can I increase my chance of having a vaginal birth if my labor is induced?

You can:
  • Find a doctor or midwife with a low c-section rate. The c-section rate in induced labors varies significantly by the individual caregiver attending the birth. Those with a low overall c-section rate may be less likely to perform c-sections in women having labor induced.
  • Prepare for labor to take a long time to kick in and progress. Inducing labor is, by definition, forcing your body to go into labor before it is ready. Changes and processes that normally occur over days or weeks are condensed into a matter of hours. If mother and baby are doing well, the process of reaching "active" labor (dilation of the cervix to 6 or more cm) through induction can take 24 hours or longer. Once in active labor, your cervix may continue to dilate more slowly than is typical in labors that start on their own.
  • Plan for excellent labor support. Because labor may be longer and more difficult, women experiencing induced labor may benefit significantly from having a skilled labor support companion. Benefits of continuous labor support include increased chance of vaginal birth, lower need for pain medication, and higher satisfaction. (Labor Support will give you more detailed information.)
  • If your caregiver recommends a cesarean section and it is not an emergency, ask specific questions about why she/he is making that recommendation. Ask what your chance of having a vaginal birth might be if you continue to labor longer, and what risks would be involved with waiting. (The Cesarean Section pages of this site will give you more information about the risks and benefits of c-section.)

How can I protect my baby's health and safety if my labor is induced?

You can:
  • Choose to be induced only for a medical reason. Induction without a medical reason exposes your baby to procedures and drugs that can be risky, without counter-balancing benefits. The Best Evidence: Induction of Labor page in this section can help you sort this out.
  • Be as certain as possible that the baby's lungs are fully developed. Babies born before the lungs are fully developed may have serious breathing problems that require respiratory support in an intensive care setting. If you are certain about your estimated due date, waiting until 39 completed weeks of pregnancy is a reliable way to help ensure that the baby's lungs will be developed. If you are not sure of your estimated due date, or your caregiver is recommending medically necessary induction before 39 completed weeks, an amniocentesis (using a needle to remove a small amount of amniotic fluid) and testing the fluid for certain substances may be used to estimate whether the lungs are developed enough to successfully breathe outside the womb. If an induction is needed before the lungs are developed, your caregiver can provide a medication to speed up lung development. Some babies may still experience respiratory distress or other poor health outcomes despite these precautions.
  • Tell your caregiver if your contractions seem to be lasting more than a minute and a half or are coming more often than every 2-3 minutes in labor. These are signs that your uterus may be overstimulated by the medications used to induce labor, a situation that can decrease the amount of oxygen available for your baby. Your nurse can adjust the dose of your medication and try other techniques to allow more oxygen to your baby.



References

Bates E, Rouse DJ, Mann ML, Chapman V, Carlo WA, Tita AT. Neonatal outcomes after demonstrated fetal lung maturity before 39 weeks of gestation. Obstet Gynecol. 2010;116(6):1288-1295.

Luthy DA, Malmgren JA, Zingheim RW. Cesarean delivery after elective induction in nulliparous women: The physician effect. Am J Obstet Gynecol. 2004;191(5):1511-1515.




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Resources: Induction of Labor

Most recent page update: 6/9/2014


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