Inducing labor: When to wait, when to induce

Nature controls most aspects of labor, but sometimes nature needs help. Healthcare professionals might decide it's better for some people to deliver before labor starts on its own. At that time, they might suggest inducing labor.

Labor induction, also called inducing labor, means getting the uterus to contract before labor begins on its own. It's sometimes used for a vaginal birth. The main reason to induce labor is when there's concern for your health or your baby's health.

Your care team may suggest labor induction if you have:

• Diabetes. This can be diabetes that came on during pregnancy, called gestational diabetes, or diabetes that was present before pregnancy. Having diabetes that's treated with medicine is a strong reason to consider delivery by 39 weeks.
• High blood pressure.
• A medical condition such as kidney disease, heart disease or obesity.
• An infection in the uterus.
• A body mass index of 30 or greater.

Other reasons for labor induction include:

• Labor that hasn't started on its own one or two weeks after a baby's due date. At 42 weeks from the day of the last period, this is called a postterm pregnancy.
• Labor that doesn't begin after the water breaks. This is called premature rupture of membranes.
• Problems with the baby, such as poor growth. This is called fetal growth restriction.
• Too little amniotic fluid around the baby. This is called oligohydramnios.
• Problems with the placenta, such as the placenta peeling away from the inner wall of the uterus before delivery. This is called placental abruption.

Sometimes inducing labor is the best choice. That's true when there's concern about your health or your baby's health. It's also true if the pregnancy goes two weeks past the due date.

Why the concern after two weeks? When a pregnancy lasts longer than 42 weeks, there might be less amniotic fluid around the baby. And there's more risk of having a baby who is larger than average. This is called fetal macrosomia. It can lead to trauma to the baby during delivery.

There also is an increased risk of C-section, stillbirth and the baby breathing in its own waste, called meconium aspiration.

Asking for labor induction when there isn't a medical need for it is called elective induction. People who live far from a hospital or a birthing center might want this type of induction. So might those who have a history of fast deliveries. For them, scheduling an elective induction might help avoid giving birth without medical help.

Before an elective induction, a healthcare professional makes sure that the baby's gestational age is at least 39 weeks or older. This lowers the risk of health problems for the baby.

Women with low-risk pregnancies may choose labor induction at 39 to 40 weeks. Research shows that inducing labor during this time lowers several risks. Risks include having a stillbirth, having a large baby and getting high blood pressure during pregnancy. It's important that you and your healthcare professional share in the decision to induce labor at 39 to 40 weeks.

It's not likely.

There's no evidence that there's anything you can do to start labor. Neither exercising nor having sex induces labor. Don't use herbal supplements. They can harm the baby.

Labor induction isn't for everyone. It might not be an option if you've had a C-section with a vertical cut or major surgery on your uterus. It also might not be an option if the placenta blocks the cervix, called placenta previa, or if the umbilical cord drops down the vagina ahead of the baby, called prolapsed umbilical cord.

Another reason not to be induced is if the baby is in certain positions in the uterus. These include lying buttocks first, called breech, or lying sideways.

Inducing labor carries risks, including:

• Failed induction. An induction might fail if proper ways to induce don't result in a vaginal delivery after 24 or more hours. Then a C-section might be needed.
• Low fetal heart rate. Medicines used to induce labor might cause too many contractions or contractions that are out of the ordinary. This can lower the baby's oxygen supply and lower or change the baby's heart rate.
• Infection. Some methods of labor induction, such as rupturing the membranes, might raise the risk of infection for both you and your baby.
• Uterine rupture. This is a rare but serious complication. The uterus tears along the scar line from an earlier C-section or major surgery on the uterus. If uterine rupture happens, an emergency C-section is needed to prevent life-threatening complications. The uterus might need to be removed.
• Bleeding after delivery. Labor induction raises the risk that the uterine muscles won't contract the way they should after giving birth. This condition, called uterine atony, can lead to serious bleeding after a baby is born.

Inducing labor is a serious choice. Work with your healthcare professional to decide what's best for you and your baby.