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It has been decided to induce your labor. In reaching this decision your physician or midwife has considered several factors including your current health, your baby’s health and how far along you are in your pregnancy. In many cases you have been directly involved in these discussions.

Between 20 to 25 percent of patients who receive their care at Care New England hospitals have their labor induced. This information has been developed to help you and your family understand how labor induction works and what to expect. We also hope that it will answer many of the questions that you may have regarding labor induction. More specific questions that may not be answered here should be addressed with your health care provider.

Reasons for Induction

Labor can be induced for many medical indications, but these indications generally fall into three categories:

  1. Inductions for medical or obstetrical conditions that are currently impacting your health or your baby’s health.
  2. Inductions for medical or obstetrical conditions that are not causing current problems, but have the potential to impact your health or your baby’s health.
  3. Inductions for convenience.

In addition to prioritizing these indications, your physician or midwife has considered how far along you are in your pregnancy – your gestational age.

In some cases, the impact of these medical or obstetrical conditions is serious enough that your health care provider has decided that your baby should be delivered several weeks before your due date and your induction should be scheduled right away. But in most cases, induction is performed much closer to the time that your baby is due and scheduling is more flexible. These decisions are always made in an effort to provide the best possible outcome for you and your baby.

Because Care New England hospitals may have several requests for labor inductions every day, the decision as to which patients should be admitted on any given day is determined by the category of induction described above. The patients with the most serious medical or obstetrical conditions are prioritized for hospital admission and induction. For other patients with a less serious indication, the need for delivery is not as urgent and more time can be taken to adequately prepare for induction.

The Process

As labor induction is often unexpected and may be performed at an earlier point in your pregnancy than anticipated, your body may not be quite ready for labor.

In these cases it is usually best to take additional time to prepare your body for labor by a process called cervical ripening. The goal of cervical ripening is to soften, dilate and efface (shorten) your cervix (the area of the uterus that the baby will pass through). By taking additional time to ripen the cervix, your labor is usually shorter and safer for you and your baby. Because everyone’s starting point and the response of their body is different, the time required for adequate cervical ripening is difficult to predict and can extend for more than one day.

Cervical ripening can be performed using medications called prostaglandins or by placing a balloon-like device inside the vagina (birth canal) to dilate your cervix. For some patients both options are used. Prostaglandins can either be taken by mouth or placed in the vagina.

Many patients may start to experience mild contractions during the cervical ripening phase. This is normal and helps to better prepare the cervix for the actual induction. Occasionally patients will start labor with cervical ripening.

When cervical ripening is needed, it can take place in the hospital after admission or in the emergency department as an outpatient. When outpatient cervical ripening is performed, it is usually with the intention to induce labor within the next few days.

Once the cervix has reached the point where adequate ripening (dilation, effacement and shortening) of your cervix has taken place, you will be admitted or transferred to the labor room for induction. As with admission and cervical ripening, individual patients will be brought to the labor room based on the seriousness of their indication.

Your induction will be started by using oxytocin (an intravenous medication) or performing a pelvic examination to break your water. When oxytocin is used, it is started at a very low dose and gradually increased until you are having regular labor contractions.

As with cervical ripening, the starting point for induction and the response of each patient is different and, as a result, the time required for your induction is difficult to predict.

Occasionally during an induction, the decision is made to allow the patient to rest and the induction will be stopped. When that occurs, the patient will often be transferred from the labor room to the Antenatal Care Unit. In those cases the patient usually returns to the labor room the following day to continue the induction.

Outcomes

The decision to induce labor is also influenced by the potential outcomes. Women who undergo labor induction typically have longer labors and are also more likely to be delivered by cesarean section. The most common reasons for cesarean section are poor progress in labor and difficulty tolerating labor for the baby. Patients who are delivered by cesarean section usually have longer hospital stays after delivery and a slower recovery. There is also a greater chance of complications such as infection and heavier blood loss with cesarean section.