The week before my due date with my first child, I went to my midwife appointment and asked about induction. I knew pregnant women sometimes got induced toward the end, but I didn’t exactly know the details of when, why, or how. (And to limit anxiety, I chose to refrain from Googling all the things.) She said, “Think of induction as a last resort — since everything looks good with you and baby, there’s technically no reason for us to induce right now.” Oh, okay.
I ended up having my son a few days later without needing to be induced, but as I’ve chatted with other new moms, it seems induction is one of those things you don’t think much about…until you’re going through it. For the vast majority of women, induction occurs when there’s a medical reason to kickstart labor, but it can also result in a whole lot of complicated feelings and unexpected delivery experiences.
Here are nine things you should know about being induced — reasons to take that route in the first place, potential risks, and questions to keep in mind.
1. It will likely happen when you’re past your due date.
Those stories you may have heard about women requesting an induction, so they can deliver on a certain day or be done with pregnancy? Not the norm, nor recommended. Dr. Colleen Wittenberg, a California-based OBGYN with Kaiser Permanente, says it’s best for babies to go full-term, and inducing labor should only happen when medically necessary.
“One reason [for induction] is if you are significantly past your due date,” she explains. “We don’t want people to continue with a pregnancy too much past their due date, especially if the mother is older because problems begin to arise. For instance, when the pregnancy goes on too long, the placenta doesn’t do as good of a job of feeding your baby, and this increases the risk of delivering a stillborn or having other problems with the newborn. It usually happens before labor, if your water breaks or your membranes have ruptured because mom and baby are then at risk of having an infection. We also induce if the placenta is failing or the amniotic fluid is too low.”
Dr. Sherry Ross, an OB/GYN and women’s health expert at Providence Saint John’s Health Center, looks for medical complications that could negatively affect the health of the baby or baby before moving forward with an induction. This might include maternal high blood pressure, diabetes, or poor growth of the baby.
In her opinion, inductions shouldn’t happen before 34 weeks, and only then if it’s a matter of life and death for mom and/or baby. For the most part, it occurs between 39 weeks, when the baby’s lungs are completely developed, and 42 weeks at the latest.
“If you are a normal risk delivery and it’s your first pregnancy, we typically won’t discuss induction until you get to one week past your due date,” notes Dr. G. Thomas Ruiz, OB/GYN at MemorialCare Orange Coast Medical Center. “The reason for that is because if your cervix is not ready, induction is associated with a 50% higher risk of cesarean section. If you’ve had a previous vaginal delivery, we will consider inducing labor at 39 weeks; however, we prefer to let you go into labor spontaneously. Once you get to 42 weeks, we typically recommend delivery.”
2. Induction typically includes medication, but you might need a device, too.
To start labor through induction, most women receive an IV for fluids as well as medication. Depending on how dilated (open) or effaced (thin) your cervix is, you might get something called Pitocin. Or, before that step, you may first need a type of medication called Cervidil, which can also help (FYI: that one is vaginally inserted).
“The intent of induction is to soften the cervix to allow the uterine contraction process to begin on its own, or to use an IV medication to create regular uterine contractions,” notes Dr. Ruiz. “These are referred to as cervical ripening agents and can be either medication, which contains prostaglandins, or a mechanical device such as a balloon. The amount of time it takes to do an induction can be hours or a couple of days, depending on what the cervical exam was at the time of the initiation of the induction.”
Melinda Wyman, a Chicago-based mom, was induced at 38 weeks with her first baby and started with Pitocin — however, when she didn’t progress over the next 24 hours, ended up experiencing the balloon option. “One of my OBs came in and checked me,” she shares. “I reluctantly asked, ‘Am I dilated to anything yet?!’ She was the sweetest little thing and said, ‘Maybe the tip of my pinky…we need to do something else to try and speed this up.’ So she came in with a balloon contraption. I don’t remember specifics, but it was like the jaws of life met a balloon to try and open me up more. Ew, and ouch, but it worked.”
3. Be prepared to wait, because induction can make labor last longer.
“How long the entire process may take can be surprising — and frustrating — if parents are not prepared or weren’t expecting it to take so long,” says Dr. Wittenberg. “An induced labor can be a longer labor, especially if your cervix was not ready, and you may not deliver for more than 24 hours.”
Wyman learned this the hard way. After hearing she needed to be induced, she asked what time she should come back to check into the hospital. Her doctor’s response: “Oh honey, you aren’t going anywhere.” Lexie Reiling, a mom of one, also didn’t expect the induction process to take forever. “Things just generally progressed very slowly — for the first several hours I was mostly just bored,” Reiling says. “Also, and this feels like a weird thing to be upset about, my plan had been to labor at home for as long as possible and not tell the rest of our family that I was in labor until we were at the hospital. But since I was at the hospital to get induced, I felt obligated to tell our families, and then they all showed up to wait for the duration of my labor. It was incredibly sweet, but I felt terrible knowing that they were all sitting in a waiting room for 18 hours.”
4. It might hurt more.
Darby Morris, owner and founder of Sweetbay Doula, says women don’t always realize that induction can make labor more painful, and sometimes choose that route to avoid the assumed pain involved with a natural birth. From her viewpoint, it’s hard to compare the two, since pain is a part of labor whether you get induced or not.
“One misconception is that an induced labor hurts more than a spontaneous labor,” says Dr. Wittenberg. “There is some truth to this, because a few of the medications (oxytocin or Pitocin and prostaglandins) may cause contractions that come too frequently or are longer and stronger than they would normally be. But not all methods of induction will cause labor to be more painful.”
5. C-sections are a common outcome.
According to Dr. Ross, if your cervix isn’t quite ready at the beginning of induction, then you may end up having a cesarean section. And despite your best intentions alongside being induced, other factors can also contribute to a c-section, like size and position of baby or amount of time you push during labor.
For example, Deidre B. got induced at 39 weeks because her baby was measuring large. Even though she was trying to avoid a c-section, she ended up getting one after 36 hours of labor, due to the fact that the baby was breech. Another mom, Amy C., was induced at 40 weeks for the same reason — but after 24 hours of Cervidil and Pitocin, got a c-section because her son wouldn’t fit into the birth canal.
Andrea T., a mom of two in Iowa, had the opposite experience: her first child was measuring too small, but after she got induced and progressed fully, the baby turned its head and got stuck. “I pushed for the max they allowed, three hours, and then went for a c-section,” she says. “My induction experience was not bad at all. The process was started at 11 p.m. and I was wheeled into the operating room around 9 p.m. the next night. My c-section was not what I would consider an emergency, as neither my daughter nor I were in distress; she just wasn’t able to come out. Would the outcome have been different if we waited another week, at 41 weeks, to see if she came on her own? No idea.”
6. There’s risk to induction, but it’s also dangerous to avoid being induced if that’s best for mom and baby.
“All forms of induction have risks associated with them,” says Morris. “In general, one of the biggest risks for induction is greater cesarean birth outcomes. Pitocin, which is the most widely used form of induction, is used in about half of all births in the U.S., and risks of this particular drug include: nausea, vomiting, headache, increased chance of retained placenta or elevated blood pressure, fetal distress, longer labor and possibly greater pain than with spontaneous labor, excessive fluid retention, increased chances of cesarean and prematurity, cardiac arrest, pulmonary edema, and postpartum eclampsia.”
Because an induced labor requires the use of medications and could prolong labor, says Dr. Wittenberg, the baby might also get stressed, which can cause oxygen issues or changes in heart rate. On the other hand, literally all medications and medical procedure involve risk or potential side effects, and the goal of induction is to minimize the potential risks of remaining pregnant, too.
“If a medically indicated induction does not occur, there can be potential health dangers to both the mother and baby,” warns Dr. Ross. “The most concerning health hazard could be death to the mother and baby. Other complications include infection, maternal seizures, stroke, emergency hysterectomy, and significant blood loss.”
7. You might feel relieved…
“I hate surprises, so it was killing me that I had no idea when I was going to go into labor,” says Reiling. “So when my doctor told me at my appointment that she wanted to induce me right then, I was a little bummed — but also really relieved, because I wouldn’t have to sit around wondering when it was going to happen anymore. I’m also a big worrier, so if I had gone into labor at home, I would have been wondering how he was doing and if everything was progressing okay the whole time, whereas since I was induced, they had me hooked up to a bunch of monitors and I had a better idea of how the little guy was doing.”
“All in all, my experience was a long but special one,” says Wyman. “ I didn’t really have a choice to get induced or not. I didn’t want to endanger my daughter in any way due to my low fluids, so I rolled with it and embraced every single moment.”
8. …Or you may feel an odd combination of regret and guilt.
Elyssa Appleton’s second child was head down and ready to go at 36 weeks — and then abruptly turned late in pregnancy, which led to a last-minute decision to induce at 39 weeks. “She was all over the place, and I would feel big movements that woke me up in the middle of the night,” Appleton says. “There was no medical urgency for me to induce. My family was in town for the holidays and I was a miserable pregnant person at that point. The doctor made it sound like I’d have her in six hours tops, and it would be easy based on my first labor, which was easy. So I chose to do it; I pushed for over three hours and ended up with a grade 4 tear. I do regret my choice. I wonder if I would have waited if she would have turned again, and labor wouldn’t have been so traumatizing. I felt like I brought it all on myself. I also felt really guilty about telling my family I was going to induce. My friends all had positive experiences after elective induction, though. Just goes to show you can’t depend on your labor being like someone else’s.”
For Andrea T., even though labor and delivery didn’t necessarily go as planned for either of her two children, she ultimately just wanted to make it through delivery safely. Since that happened in both situations, she views her induction experience as an overall success.
9. You’re allowed to ask questions.
Since labor involves a lot of choices, Morris says it’s important to ask about the benefits, risks, and alternatives in every decision, plus listen to your gut. “If, for example, a doctor tells you that you need Pitocin to get labor going more quickly, you should ask: what are the benefits of Pitocin? What are the risks? What are my alternatives? What is my intuition telling me that I should do right now? What happens if I say, ‘No thanks,’ or decide to wait a little longer? If a very important decision is being made, get a second opinion, just like you would if heart surgery was suggested.”