It's common for many women, especially first-time mothers, to watch their baby's due date come and go without so much as a contraction. The farther away from the expected delivery date (called the EDD) you get, the more anxious you may become. You may start to feel like a ticking time bomb. You may wonder — is this baby ever going to come?
Late pregnancy can be challenging — you may feel large all over, your feet and back may hurt, you might not have the energy to do much of anything, and you're beyond ready to meet the little one you've nurtured all this time. Which is why waiting a little longer than you'd expected can be particularly hard.
Still, being past your due date doesn't guarantee that your doctor (or other health care provider) will do anything to induce (or artificially start) labor — at least not right away.
What Is It?
Labor induction is what doctors use to try to help labor along using medications or other medical techniques. Years ago, some doctors routinely induced labor. But now it's not usually done unless there's a true medical need for it. Labor is typically allowed to take its natural course, with less medical intervention, in most birthing settings today.
Why Is It Done?
Your doctor may suggest an induction if:
- your water broke
- your baby still hasn't arrived by 2 weeks after the due date (when you're considered post-term — more than 42 weeks into your pregnancy)
- you have an infection in the uterus called chorioamnionitis
- you're having a pregnancy with certain risks (i.e., if you have gestational diabetes or high blood pressure, or your baby has growth problems)
Some doctors will perform "elective inductions" — in other words, they will induce labor if the mother wants it for nonmedical reasons. However, this isn't always the best option because inductions do come with risks.
Doctors try to avoid inducing labor early because the due date may be wrong and/or the woman's cervix may not be ready yet.
How Is It Done?
Some methods of induction are less invasive and carry fewer risks than others. Ways that doctors may try to induce labor by getting contractions started include:
- Stripping the membranes. The doctor puts on a glove and inserts a finger into your vagina and through your cervix (the opening that connects the vagina to the uterus). He or she moves the finger back and forth to separate the thin membrane connecting the amniotic sac (which houses the baby and amniotic fluid) to the wall of your uterus. When the membranes are stripped, the body releases hormones called prostaglandins, which help prepare the cervix for delivery and may bring on contractions. This method works for some women, but not all.
- Breaking your water (also called an amniotomy). The doctor ruptures the amniotic sac. During a vaginal exam, he or she uses a little plastic hook to break the membranes. This usually brings on labor in a matter of hours.
- Giving the hormone prostaglandin to help ripen the cervix. A gel or vaginal insert of prostaglandin (often the drug Cervidil) is inserted into the vagina or a tablet is given by mouth. This is typically done overnight in the hospital to make the cervix "ripe" (soft, thinned out, or dilated) for delivery. Administered alone, prostaglandin may induce labor or may be used before giving oxytocin.
- Giving the hormone oxytocin to stimulate contractions. Given continuously through an IV, the drug (often Pitocin) is started in a small dose and then increased until labor is progressing well. After it's administered, the fetus and uterus need to be closely monitored. Oxytocin is also frequently used to spur labor that's going slowly or has stalled.
What Will It Feel Like?
Stripping the membranes can be a little painful or uncomfortable, although it usually only takes a minute or so. You may also have some intense cramps and spotting for the next day or two.
It may also be a little uncomfortable to have your water broken. You may feel a tug followed by a warm trickle or gush of fluid.
With prostaglandin, you may have some strong cramping as well. With oxytocin, contractions are usually more frequent and regular than in a labor that starts naturally.
What Are the Risks?
Inducing labor is not like turning on a faucet. If the body isn't ready, an induction may fail and, after hours or days of trying, a woman may end up having a cesarean delivery (or C-section). This appears to be more likely if the cervix is not yet ripe.
If rupturing the amniotic sac doesn't work, your doctor may need to induce labor a different way. Why? Because there's a risk of infection to both you and your baby if the membranes are ruptured for a long time before the baby is born.
When prostaglandin and/or oxytocin are used, there is a risk of abnormal contractions developing. In that case, the doctor may remove the vaginal insert and turn the oxytocin dose down. While it is rare, there is an increase in the risk of developing a tear in the uterus (uterine rupture) when these medications are used. Some other complications associated with oxytocin use are low blood pressure and low blood sodium (which can cause problems such as seizures).
Another potential risk of inducing labor is giving birth to a late pre-term baby (born between 34 and 36 weeks). Why? Because the due date (also called the expected delivery date, or EDD) may be wrong. Your due date is 40 weeks from the first day of your last menstrual period (LMP). If you deliver on your due date, your baby is actually only about 38 weeks old — that's because your egg didn't become fertilized until about 2 weeks after the start of your last menstrual period. Women who have irregular periods or first trimester bleeding may be mistaken regarding when their last menstrual period was. Although ultrasounds can help to narrow it down, the estimated date of conception may still be off by a couple of weeks.
Babies born late pre-term are generally healthy but may have temporary problems such as jaundice, trouble feeding, problems with breathing, or difficulty maintaining body temperature.
Even though inductions do come with risks, going beyond 42 weeks of pregnancy can be risky, too. Many babies are born "post-term" without any complications, but concerns include:
- A vaginal delivery may become harder as the baby gets bigger.
- The placenta that helps to provide the baby with nourishment is deteriorating.
- The amniotic fluid can become low or contain meconium — the baby's first feces.
Old wives' tales abound about ways to induce labor. One of the oldest involves the use of castor oil. It is not safe to try to artificially start labor yourself by taking castor oil, which can lead to nausea, diarrhea, and dehydration. Breast stimulation can cause uterine contractions by causing the release of oxytocin. However, the safety of this practice has not been well studied. Earlier studies had suggested that the baby might have abnormal heartbeats after breast stimulation. Several recent studies looked at whether having sex in late pregnancy can induce labor, but there is no conclusion on this yet.
Talk to your doctor before doing anything to try to encourage your little one to come out. Inducing labor is best left to medical professionals — you may cause more harm than good.
As frustrating as it can be waiting for your baby to finally decide to arrive, letting nature take its course is often best, unless your doctor tells you otherwise. Before you know it, you'll be too busy to remember your baby was ever late at all!
Reviewed by: Larissa Hirsch, MD
Date reviewed: July 2006
