Babies tend to have their own schedule from the very start, including when they arrive. But in some cases, they need a little extra help to make that happen. That’s where labor induction comes in.
“Every birth is a unique story, and getting induced doesn’t take away from that,” says Aparna Sridhar, MD, an OB/GYN at UCLA Health and professor of Clinical Obstetrics and Gynecology at the David Geffen School of Medicine at UCLA. “The goal with every labor is a healthy mom and healthy baby. Induction is just another path to get there.”
In this Q&A, Dr. Sridhar explains what to expect with labor induction and addresses common concerns.
Q: What is labor induction?
A: What brings on spontaneous labor is nature’s best-kept secret. But we know there are hormonal changes that cause contractions of the uterus to start. Then the cervix begins to soften, thin out and open. We call that cervical ripening. With induction, we try to bring on this process using medications or other methods.
Q: When might a provider recommend inducing labor?
A: For the most part, inductions are done for medical reasons — when we have concerns that continuation of the pregnancy is either not good for the parent or not good for the fetus.
Some common reasons include:
- Health problems such as hypertensive disorders, preeclampsia, eclampsia, gestational or pre-gestational diabetes
- Problems with the baby’s growth
- Problems with the placenta
- Infection of the uterus
- If your water has broken and some time has passed, but labor hasn’t started naturally
- Pregnancies lasting more than 41 or 42 weeks
- Previous stillbirth
When a patient requests to be induced, we call that an elective induction of labor. But we strongly discourage going that route until 39 weeks.
Q: How is labor induced?
A: There are several ways to induce labor. There is no cookie-cutter approach. It really depends on how ready your cervix is and how your body and fetus respond.
There are certain medications we use:
- Prostaglandins help with cervical ripening. They’re a medication designed to imitate the prostaglandins naturally produced in the body. These are not used if you’ve had a C-section.
- Oxytocin is a hormone made by the body that causes contractions. We can use a manufactured form (Pitocin) given through IV to start or speed up labor.
There are also mechanical ways to induce labor:
- A catheter with an inflatable balloon at the end can be inserted through the vagina into the cervix. Then the balloon expands and helps open the cervix. Pain medications can help with discomfort. But most patients tolerate it well.
- Amniotomy is where we actually break the water bag. This is the fluid-filled sac that is around the baby. We usually do this if the cervix is already ready.
Q: How long will it take?
A: Everything really depends on how someone’s body responds. But it’s rarely a quick process, especially if this is your first pregnancy. Natural labor can take days or weeks. With induction, it could take several hours or two to three days to get to active labor.
I tell my patients to prepare for longer induction times by bringing books or digital entertainment. Unless there is a medical issue, you can continue to have snacks and meals through the initial part of the induction process.
The goal of induction at UCLA Health is to gently help the body start the process, and keep it as slow and steady as possible. That means listening to the patient’s body and taking it one step at a time.
Q: Is there a higher risk of C-section if you induce?
A: Research has shown that inducing labor does not increase the risk of C-section. And in some cases, it may actually lower the risk.
A large high-quality trial in 2018 found that when healthy first-time moms around 39 weeks or more were induced, the C-section rates were similar or lower. These results reassured us that induction doesn’t increase the risk of C-section.
Q: Is labor induction more painful?
A: Labor induction can feel more intense to some women. But that’s not everyone’s experience. Pain tolerance is different for each person. You have access to the same pain management options, including:
- Directed breathing techniques
- Nitrous oxide
- Epidural
It's not a given that just because you’re getting induced, you have to take something for pain. Many of my patients have made it through the entire induction process without an epidural.
Q: What advice do you give patients who are nervous or disappointed about needing an induction?
A: One of the biggest emotional hurdles patients face is feeling like their body “didn’t do what it was supposed to do,” or feeling disappointed because they really wanted to go into labor naturally. It’s important to acknowledge those feelings.
It’s helpful to think of the induction as a decision that you’re making for the safety of you and your baby. You’re doing this for a reason. Preparing for the process with your doctor is also really important. If you have a partner, family member or doula, bring them into the conversation so you can all discuss a plan together.
Induction isn’t one-size-fits-all. Some people are ready and respond quickly. Others need more time. The goal is always a safe, respectful birth experience for you and your baby. Always have a conversation with your provider about the reasons, options and ways you’ll be supported.
To learn more or make an appointment, visit UCLA Obstetrics and Gynecology.
