Who Needs a Labor Induction?

Most TV shows and movies portray spontaneous labor to add to the drama: within minutes, the water breaks, the contractions start, and the pregnant character is wailing with pain. But in reality, the beginning of labor is often much less dramatic. 

Sometimes, labor doesn’t even start on its own. You may have been induced in the past or know someone who had an induction of labor. Like a lot of things in pregnancy, you’ve probably heard about labor inductions but might not really understand what that means. This article will cover what an induction is and the most common reasons for induction.

What is an induction of labor?

Labor induction is when your provider uses medication or a medical device to start regular labor contractions. Labor inductions are quite common and are increasing in the United States. The number of pregnant people who had their labors induced is between 27% to 41%. 

Some people may have their labor induced for non-medical reasons; these are called 'elective' inductions of labor. For some people, inducing labor is safer than staying pregnant; these are called 'medical' inductions of labor. An elective labor induction before 39 weeks of pregnancy is not recommended. Before 39 weeks, the fetus is still growing and developing.

Medical Reasons for Labor Induction

There are some health conditions where your provider will strongly urge you to have a medical induction of labor. There are many varied reasons for a medical induction. Some reasons are common, and others are extremely rare. You might need an induction if:

Your pregnancy is late-term or post-term

A late-term pregnancy is when you are between 41 weeks 0 days and 41 weeks 6 days. Post-term pregnancy is 42 weeks and 0 days and beyond. If you see a midwife for your pregnancy care, they may not be able to care for you if you are beyond 41 weeks and 6 days of pregnancy. 

You have high blood pressure

Untreated high blood pressure during pregnancy can be a life-threatening emergency. Depending on how severe the high blood pressure is, the provider may recommend an induction between 37 to 39 weeks of pregnancy. These guidelines often change, so it is okay to ask your provider if their recommendations follow the most current guidelines.

You have diabetes

Depending on how controlled your blood sugar is, your provider may recommend a medical induction between 38 to 40 weeks of pregnancy.

The baby is not growing as expected 

Your provider may refer to this as intrauterine growth restriction (IUGR). An ultrasound may show that the fetus is smaller than expected. However, ultrasounds in the third trimester can be unreliable. A single ultrasound may not be a good predictor of fetal size. It is normal to see a perinatologist or maternal-fetal medicine specialist for additional testing. Usually, someone gets two ultrasounds before induction for IUGR is recommended.

Your amniotic fluid is low

Low amniotic fluid is called oligohydramnios. This is when your amniotic fluid index (AFI) is less than or equal to 5 cm, or if the largest vertical pocket is measuring less than or equal to 2 cm. Some people find that rest, hydration, and a bath where your abdomen is submerged can increase the amniotic fluid. 

Your water broke before contractions started

If your water breaks and you are considered full-term (between 37 weeks and 41 weeks), you might need a medical induction of labor. The water breaking is called prelabour rupture of membranes; you might see it abbreviated as PROM. The longer your water is broken, the greater the risk of infection for you or the fetus. This risk is lower with no cervical exams. Some providers may recommend inducing labor immediately if your water breaks before contractions. Other providers may recommend waiting to see if labor starts within a specific timeframe, generally 12 to 24 hours.

You are at least 40 years old

The risk of stillbirth for people who are 40 years old and older increases after 39 weeks of pregnancy. Your provider may recommend labor induction between 39 to 40 weeks of pregnancy to reduce this risk 

You have cholestasis of pregnancy

Cholestasis of pregnancy is a condition caused by your gallbladder that makes you itchy and can increase the risk of sudden fetal death. Depending on the severity, your provider may recommend labor induction between 37 to 39 weeks of pregnancy. 

There is another medical concern or condition that has come up

The human body is amazing – and amazingly complex. There are other, less common reasons why you might need a medical induction of labor. These situations depend on you, your genetic makeup, and your unique pregnancy. If your provider suggests an induction, you can always ask them for more information.

Inductions can be empowering and life-saving

Each pregnant person is different. Labor induction should be individualized and discussed with you before it is started. Your provider should share the benefits, risks, and alternatives for the methods of induction they recommend so you can be a part of the decision-making process. You should be able to give consent or say no to procedures and medications before they begin.

Remember that needing or wanting an induction is not a “failure” on your part. When used with care, inductions should help ensure your and baby’s safety. Inductions simply help jump-start what your body is already capable of doing: giving birth.