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Understanding Induction: Pros and Cons of Inducing Labor

Getting induced is common. But it’s not well understood by most women, especially first-time moms. In this blog post learn what induction is, how it’s done, why it’s done, and the pros and cons of inducing labor.

woman with IV needle in her hand, in a hospital bed

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Most women know about “getting induced” even before they start having their own kids. But even women who have given birth before often don’t know all the implications of induction. 

Unfortunately, when it comes to induction, the benefits are often overstated and the risks unexplained. But that needs to change. So come with me and let’s learn about inducing labor – why it’s done, how it’s done, the pros and cons, and the reasons some women still choose it.

Ready? Let’s go.

What is an Induction?

So what does it really mean when a pregnant woman gets induced? Induction is when a woman or her care provider does something to try to get labor to start. In other words, the opposite of induction is waiting for labor to start on its own.

How is Induction Done?

Inducing labor can be done in many different ways. I’ll go over the more medical ways doctors may induce labor then briefly cover some “natural” ways to induce labor.

Inducing Labor: Artificial Rupture of Membranes

I’m sure you’ve heard about a woman’s “water breaking.” They portray it in movies (usually incorrectly) and it can be a dramatic way for labor to begin. This breaking of waters refers to the moment when the amniotic sac breaks open and the amniotic fluid begins to spill out.

A woman’s water will always break at some point during labor and birth. But sometimes, a care provider will go in and put a small tear in the amniotic sac manually, in hopes that the tear will encourage labor to begin.

This process is referred to as artificial rupturing of membranes (AROM, for short) or amniotomy. 

The idea is that rupturing the amniotic sac will encourage your body to release the hormones needed to start (or speed up) labor.

Inducing Labor: Membrane Sweeping

Before your care provider performs an amniotomy, they will likely try what is sometimes called a “stretch and sweep.” This membrane sweeping (another name for the same procedure) separates the amniotic sac from your uterus.

Like AROM, the hope is that the procedure will trigger the release of labor-stimulating hormones.

You can learn about the research behind membrane sweeping and the reasoning for and against the procedure in Membrane Sweeping: The Research and the Risks.

Inducing Labor: Prostaglandins

Prostaglandins are hormone-like substances that are found naturally in the human body. They help to control inflammation, blood flow, and blood clotting.

In pregnant women, prostaglandins are one of the main hormones that start spontaneous labor. Working with oxytocin, prostaglandins soften your cervix so it can begin to dilate. This will happen naturally when your body and baby are ready for labor to begin.

If you get induced, you will likely first be given synthetic prostaglandins, directly into your vagina, to help get your cervix ready for labor. Prostaglandins are sometimes given in gel form and sometimes in a tablet. Usually, prostaglandins will be followed by another form of induction, such as Pitocin.

Fun fact: Prostaglandins are the reason some people say that sex can trigger labor because semen contains high amounts of prostaglandins.

Inducing Labor: Synthetic Oxytocin

Perhaps the most common form of induction is an IV drip of synthetic oxytocin – usually Pitocin. Pitocin and Syntocinon are both forms of synthetic oxytocin. They are chemically identical to natural oxytocin, which a woman’s body produces in large amounts before and during labor.

Oxytocin plays a role in triggering the start of labor. During labor oxytocin controls the rhythm and strength of contractions. Pitocin mimics the role of oxytocin in labor but does not perform all the same functions. We’ll talk more about Pitocin later.

Inducing Labor: Foley Balloon 

Another common form of induction is the foley balloon, also called a foley catheter. In this method of induction, a doctor inserts a catheter (a thin plastic tube) into a woman’s vagina and up to her cervix.

The end of the catheter then inflates like a balloon, putting pressure on the opening of the cervix to encourage it to begin to dilate.

Inducing Labor: “Natural” Methods

While the methods I’m about to list are usually called “natural,” the reality of it is that anything you do to get labor to start before your body begins spontaneously is induction. And though these more natural methods are generally less risky, any form of induction carries risks. (We’ll talk about those risks in a moment.)

I also want to point out that natural methods of induction are typically less effective (and certainly less proven) than medical or mechanical means of induction, like those above. That said, some women have great success with inducing labor on their own through these methods.

Natural methods of induction include:

  • Nipple stimulation
  • Sex
  • Drinking castor oil or “midwives’ brew”
  • Acupuncture
  • Walking
  • Eating spicy food
  • Drinking special teas or taking herbal supplements
  • Massage
  • Eating dates
  • and more.

Most of these methods are safe to try, though you may want to get approval from your care provider before attempting any of them.

Why is Induction Done?

Now that you know how induction is done, you’re probably wondering why. Sometimes women choose to be induced before labor begins, even without a medical reason for doing so. This is called “elective induction.”

Often, a woman is induced because a doctor recommended it.

But the reasons for recommending induction aren’t all straightforward. Some are more beneficial and valid than others.

A doctor might recommend an induction for 6 general reasons:

  • the baby’s due date has come and gone, 
  • the mother is older than average, 
  • the mother is overweight,
  • the mother has gestational diabetes, 
  • the mother has other medical conditions, or
  • the mother’s water has broken but labor hasn’t started.

Let’s talk about each briefly. 

“Overdue” Baby

Pregnancy is defined as being 40 weeks long. Due dates are calculated based on this definition. But not all women are the same and not all babies are ready to be born at exactly 40 weeks. I talk about that in Is Your Due Date Wrong? Here’s How to Make it More Accurate.

What you need to know for the purposes of this blog post is simply that if you go past 40 weeks and 6 days you will be considered “late term,” and if you go past 42 weeks you will be considered “post term.”

Some doctors will recommend an induction solely because you are past your due date.

There are risks of being “post term,” but the risks are often overstated and misunderstood. The risks of post term pregnancy are:

  • Stillbirth
  • Macrosomia (very large baby)
  • Postmaturity syndrome (related to deterioration of the placenta)
  • Meconium aspiration
  • Decreased amniotic fluid

The thing is, the risk of all of these is actually pretty small, even if you go past 42 weeks. The reason doctors get nervous is because the risk does increase as the pregnancy continues.

I have a blog post coming soon all about these risks and how to understand your actual risk, so keep an eye out!

Advanced Maternal Age

As women get older, the risks of childbirth increase, generally. The official term for a woman who gets pregnant and is 35 or older is “advanced maternal age.” These slightly older mothers generally have an increased risk of:

  • Miscarriage, 
  • Preterm labor, 
  • Gestational diabetes, 
  • Preeclampsia,
  • Stillbirth, and 
  • C-section.

And their babies may be at higher risk of being small for gestational age, having low Apgar scores, being born with chromosomal abnormalities, and requiring admission to the NICU.

BUT, like with post term pregnancies, these risks are fairly low. Plus, every woman is different. It’s very possible that a 40-year-old woman is in better shape and will have a healthier pregnancy and baby than a 20-year-old who does not eat well or exercise, among other things.

Plus-size Pregnancies, Gestational Diabetes, and Other Medical Conditions

When a woman starts a pregnancy with a BMI classified as overweight or obese, she is more likely to experience complications such as gestational diabetes, preeclampsia, macrosomia, and stillbirth. Each of those factors alone may lead a doctor to suggest labor induction. 

For more details on the risks of macrosomia and stillbirth, check out my blog post on those and other risks common in post term pregnancies (coming soon).

Diabetes and preeclampsia, if uncontrolled or unmonitored, can cause problems with other organs or lead to seizures or strokes. Because of these possible dangers, care providers may want you to have your baby sooner rather than later.

Note: Both diabetes and preeclampsia are affected by your diet. It may even be possible to reverse or control some negative effects of either through changes in your diet. To learn more, I highly recommend Lily Nichols’ book Real Food for Pregnancy.

Premature Rupture of Membranes

When your amniotic sac breaks (i.e. your “water breaks”) without labor beginning shortly thereafter, that is called premature rupture of membranes (PROM). Most of the time, PROM isn’t a reason for worry (as long as it doesn’t happen earlier than 37 weeks).

Your body knows what it’s doing and labor is likely coming soon.

If you call the hospital after experiencing PROM, they will probably tell you that you and your baby are at risk for infection and that you need to be induced. If you go to the hospital, you will likely be given an IV with antibiotics just in case.

Alternatively, many women have chosen to wait for labor to begin on its own, at home, and both they and their baby have been just fine.

The thing is, infection requires bacteria to get into the vagina. That is far more likely to happen if you go into the hospital and doctors start to do regular cervical checks. So if your membranes have ruptured, it may be wise to simply stay home and say no to cervical checks!

Pros and Cons of Inducing Labor

With all the knowledge you’ve just gained, it’s time to talk about the pros and cons of getting induced.

Pros of Inducing Labor

Induction isn’t inherently bad. Sometimes induction can protect a mother or baby and be a good thing. So let’s go over a few positives of getting induced.

Convenience and Cost

For most women, the main benefit of induction is convenience. If you get induced you know when labor is going to start (for the most part). Sometimes induction fails, but the majority of women will go into labor within a few days – if not hours or minutes – of an attempted induction.

For some women, this ability to plan their birth is quite valuable, even when weighed against the benefits of waiting for labor to begin spontaneously.

Closely related to convenience is cost, which is often influenced by insurance. I know women who have chosen to be induced for this reason alone.

Unfortunately, money does affect our decisions, even those related to the birth of our children. And in some cases, giving birth before the end of the month or the end of the year can greatly reduce your childbirth costs.

Lower Chance of Stillbirth and Other Negative Outcomes

Stepping away from logistics, getting induced can reduce risks for some mothers and babies. 

One study found that induction at 41 weeks can reduce the chance of stillbirth.

The risk of stillbirth without induction was about 4 babies per 1,000. Comparatively, mothers who were induced at 41 weeks had a risk of stillbirth of 1.7 out of 1,000.

(It’s important to note that studies have shown that inducing at 39 weeks does not significantly lower your risk of stillbirth or other negative outcomes.)

Another study showed that babies of women who were induced at 41 weeks had fewer negative outcomes, including low Apgar scores, meconium aspiration, nerve injury, and admission to the NICU. That said, risk was low in both the experimental and the control group.

Women who choose to be induced may also avoid the complications mentioned in the “Why is Induction Done?” section above (such as macrosomia, infection, etc).

Less Chance of C-section

Finally, for first-time mothers, induction may reduce the chance of getting a c-section. A large study found that inducing low-risk first-time moms reduced the chance of c-section from 22% to 19%.

Caveat: Induction Isn’t the Only Option

I want to point out that while studies have found a reduction in c-section rates when first-time mothers are induced, induction is not the only (or, often, the best) option for avoiding c-sections. Other options include changing where and with whom you give birth.

For example, midwives consistently achieve very low rates of c-sections, even without using induction. Also, c-section rates vary hugely from hospital to hospital, with some locations making it as much as nine times more likely that you’ll have a c-section.

Cons of Inducing Labor

So induction isn’t always bad. But it’s not always good either. Now let’s look at some of the downsides of getting induced.

Accidental Prematurity

The biggest risk of induction is the possibility of accidental prematurity. If you have an induction before (or sometimes even on or after) your due date, it’s possible that your baby won’t be as developed as you and your care provider thought.

As I mentioned earlier, due dates aren’t always accurate and that means even if you think you are past 40 weeks your baby could only be 37 weeks (for example) in terms of development. 

Prematurity is one of the leading causes of newborn death. It also presents many other risks, including:

  • Breathing problems because of underdeveloped lungs
  • Long NICU stays
  • Increased risk for hospital readmittance
  • Weakened immune system
  • Higher likelihood of severe jaundice
  • Temperature instability
  • Low blood sugar
  • Low heart rate
  • Sucking and feeding problems

I want to point out that it’s also quite hard to tell how big or developed your baby is through a third trimester ultrasound. They can be inaccurate. So don’t rely too heavily on ultrasound measurements from late pregnancy to decide how ready your baby is to be born.

Possibility of a Failed Induction

While induction is successful most of the time, sometimes an induction will fail and a woman’s body just won’t go into labor at that time. Depending on other factors (such as if your amniotic sac has broken) and hospital policy, you may be sent home to wait for labor to start or to try induction again later.

But sometimes a failed induction means a c-section. Unfortunately, this is common but often unnecessary.

One study compared rates of induction leading to a c-section across several hospitals and found lots of variation in how often it happened. That may suggest that some doctors’ preferences for induced labor and c-section deliveries influences this occurrence.

Another group of researchers pointed out that no standard criteria for a “failed induction” exists and that also leads to unnecessary c-sections.

At its simplest, just because a woman’s body doesn’t go into labor when given synthetic hormones doesn’t mean her body is incapable of normal labor. It just means it’s not the right time.

The Cascade of Interventions

I explained earlier that some researchers have found a small reduction in the likelihood of c-section for some first-time mothers when they are induced at 41 weeks. That is true. But there’s something else at play here too.

It’s often called the cascade of interventions.

This “cascade” describes the effect that utilizing one intervention can have on the rest of your labor. Often, accepting one intervention (like getting an IV or being induced) leads to another…and another…and another.

And the more interventions that happen, the more the natural process of labor is inhibited. 

Sometimes, this cascade of interventions leads to a c-section that could have been avoided. And it often starts with getting induced.

You can learn more about this phenomenon in The Cascade of Interventions [Explained].

Discomfort, Pain, and Infection

Another downside of induction is that it often leads to a labor that is more painful and uncomfortable than spontaneous labor would have been. 

For one thing, induction doesn’t always mean productive labor starts right away. It’s not uncommon for women to be induced and have contractions start but to make no progress for hours or even days. That happened to a friend of mine just a few months before this writing.

Those contractions are still uncomfortable, even if they aren’t helping you get closer to birth. And the longer you have to cope with contractions, the more likely it is you’ll get worn out before it’s over.

Second, contractions brought on by induction are often more painful than natural contractions. 

Cervical ripening (the term used when prostaglandins are given vaginally to help get the cervix ready) can cause sharp pains. And Pitocin (which I’ll talk about in a moment) makes contractions longer, stronger, and closer together.

In addition to the increased pain, synthetic hormones interrupt natural production of beta-endorphins, a hormone that helps relieve pain naturally. Beyond that, the intensity of induced contractions means your body has less time to get used to labor, which often makes it harder to cope.

And finally, if you are induced, your doctor will want to closely monitor your labor. That will likely include frequent cervical checks which can be uncomfortable at best and quite painful at worst.

Those frequent cervical checks, plus any use of internal monitors and other factors like long or slow labor can lead to an increased risk of infection

Frequent Use of Pitocin

Finally, some of the risks of induction are tied up in a specific method of induction: using Pitocin. Receiving Pitocin through an IV is a common way to get induced. While it can be effective, it has many of its own risks.

I have a full blog post dedicated to Pitocin coming soon, but I’ll list a few risks for reference here. Downsides to using Pitocin include:

  • More painful labor
  • Higher likelihood of fetal distress
  • Increased chance of c-section
  • Higher risk of postpartum hemorrhaging
  • Increased risk of uterine rupture (especially during VBAC)

For these reasons, getting induced in a way other than using Pitocin may be safer.

Conclusion: Induction Is Individual

To begin as we started, you’d probably heard of getting induced long before you read this blog post. But hopefully you now understand much more about it, the pros and cons of inducing labor, and why or why not it might be a good choice for you.

While I would like to say induction is something to avoid, that’s not always true. Part of the reason being truly informed is important is so that women can set themselves up for the kind of happy, calm birth experience they want. And that won’t look the same for everyone!

To get induced or not needs to be a personal decision for many reasons. For example, while the risk of stillbirth is still low even at 42 weeks, a mother who has had miscarriages or stillbirths in the past may prefer to be induced to avoid the risk of stillbirth as much as possible. 

On the other hand, a woman trying for a VBAC may do everything she can to avoid induction because it can increase the risk of uterine rupture.

So, armed with truth, you can now make a truly informed choice for you and your baby.

I recommend you think about induction and make your decision long before your doctor brings it up. If you know what you want, you’ll be better able to communicate your choice and to do what needs to be done to make your plan a reality. 

Until next time,

Allison

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