It's common for many pregnant 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 might become.
You may start to wonder — is this baby ever going to come?
Late pregnancy can be challenging — you may feel large all over, your feet
and back might 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 usually
allowed to take its natural course. However, in some situations, a health care provider
may recommend induction.
Why It's Done
Your doctor might suggest an induction if:
your water broke but you are not having contractions
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)
Induction also can be appropriate under certain circumstances, as with a mother
who is full term and has a history of rapid deliveries or lives far from a hospital.
Some mothers request elective inductions for convenience, but these do come with
risks. Doctors try to avoid inducing labor early because the due date may be wrong
and/or the woman's cervix might not be ready yet.
How It's 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 the vagina and through the 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 the 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 using a little plastic hook to break the membranes.
If the cervix is ready for labor, amniotomy usually brings on labor in a matter of
Giving the hormone prostaglandin to help ripen the cervix. A
gel or vaginal insert of prostaglandin 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) 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 (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 can 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 might have some strong cramping as well. With oxytocin,
contractions are usually more frequent and regular than in a labor that starts naturally.
Risks and Precautions
Inducing labor is not like turning on a faucet. If the body isn't ready, an induction
might fail and, after hours or days of trying, a woman may end up having a cesarean
delivery (C-section). This appears to be more likely if the cervix is not yet ripe.
If the doctor ruptures the amniotic sac and labor doesn't begin, another method
of inducing labor also might be necessary because there's a risk of infection to both
mother and baby if the membranes are ruptured for a long time before the baby is born.
When prostaglandin or oxytocin is used, there is a risk of abnormal contractions
developing. In that case, the doctor may remove the vaginal insert or 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. 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 after 34 and before 37 weeks). Why? Because the due date (EDD) may be wrong.
Your due date is 40 weeks from the first day of your last menstrual period (LMP).
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. They may also be more likely than full term babies to have developmental
or school problems later on.
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
A vaginal delivery may become harder as the baby gets bigger. As babies get bigger,
the chance of an injury during delivery, such as a broken bone, increases.
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. If the baby breathes in meconium,
it can cause breathing problems.
Old wives' tales abound about ways to induce labor, such as 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. And herbs and herbal supplements meant
to induce labor can be harmful. Breast stimulation can cause uterine contractions
by causing the release of oxytocin. However, some studies have suggested that
the baby might have abnormal heartbeats after breast stimulation. Some women feel
that having sex in late pregnancy can induce labor, but there is no conclusion on
Talk to your doctor before doing anything to try to encourage your little one's
arrival. 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!