Induction of Labor

Today, we are joined by Dr. Lisa Levine, a Maternal Fetal Medicine specialist, who talks to us about induction of labor. 

We answer the following questions: 

1. What is an induction of labor?
   • So first, of all, remember: labor is when a pregnant person has contractions of their uterus, or womb, and their cervix starts to open. If everything goes well, at the very end, the person is able to push and deliver their baby (or babies) vaginally. Labor induction, is very simply put, getting someone into labor who is not yet in labor. I often say it is like “jump-starting” labor. And the goal is for that person to give birth vaginally.
2. Why do we perform an induction of labor?

   • We absolutely would love if every pregnant person could go into labor on their own. That would make our jobs easier! However, there are some people who, because of medical problems they had before pregnancy, or medical problems they develop during pregnancy, need to be delivered earlier so that they and their babies can stay healthy. After a certain point, staying pregnant may not be the healthiest option for that person or for their baby. Some people may also choose induction after a certain point for their own reasons, such as help with childcare or needing to go back to work, but that does not usually happen before 39 weeks. There are many reasons to be induced, and you should talk to your doctor about when it is safest for both you and your baby to undergo an induction.

   • Most people will be given a due date for their pregnancy the first time that they see a doctor. This is done by using the first day of your last period (if you have regular periods) and an early ultrasound. The “due date” simply means that that is the day that you will be forty weeks pregnant. That’s it. It is not a magic day that your body will suddenly go into labor, or a day that you HAVE to be delivered by, unless you are told by your pregnancy provider.

   • We call a “term” pregnancy, meaning a fully developed pregnancy, anywhere between 37 and 42 weeks. And usually, that is when pregnant people will go into labor. So, most people are not considered “early” or “preterm” if they go into labor, say… when they are 38 weeks and 2 days-which is just 12 days before their due date. And for most people who don’t have medical problems before or during pregnancy, it is totally fine for them to go into labor sometime between 37 and 42 weeks.

3. When do we perform an induction of labor?

   • That depends on the patient’s medical condition, how the baby is doing inside, and a lot of other factors. This would have to be a discussion with your doctor. Most of the time, that date will be in the 39-40 week range, but if you develop high blood pressure of pregnancy, have a more serious medical condition or we think that baby is not doing well, we may recommend earlier.

     Also, for patients and babies that are healthy overall, if they go past their due date, we would also monitor them and their babies very closely because of that tiny increased risk of stillbirth. Therefore, your doctor may talk to you about induction of labor at 41 weeks or bring you in for monitoring of the baby if you are past 41 weeks and want to try to go into labor on your own. We usually do not recommend going past 42 weeks, because of that increasing stillbirth risk.

4. What do we do for induction of labor, and what can patients expect on the labor floor?

   • The first thing to expect is that we have to do a lot of stuff upfront to make sure that we are giving you the correct medicine to put you into labor and caring for you in a safe way. This will include bloodwork to see what your blood counts are and what blood type you have, testing you for some sexually transmitted infections, like HIV and syphilis, as well as an ultrasound to determine that the baby is head down. We don’t recommend induction if the baby is in any other position. We will also put in an IV so that we can give you medicines through it to help with your induction.

     We also put two monitors on your belly: one is to listen to the baby’s heartbeat, and the other is to monitor your contractions. Finally, we also have to do an internal vaginal exam to see how dilated and thin your cervix is.

   • If your cervix is not very dilated or not thin (we mean anything under 3 or 4 centimeters), we would recommend first starting with some medicine that you take by mouth or that we place in the vagina. This medicine is called misoprostol, which is a medicine that can help soften and thin the cervix and get it to open up a little bit more. The second thing we may recommend is something called a “Foley” balloon, which is a thin tube that has a small, inflatable balloon at the very tip. Your doctor will place the foley balloon into the cervix through the vagina, and then inflate the balloon with some wate