Inducing Labor

What if women could schedule childbirth just as they'd schedule a root canal? In fact, more and more pregnant women in the U.S. are opting for induced labor — and not necessarily for medical reasons.

In the last decade, the number of labor inductions has doubled — from 9 percent of live births in 1989 to 18 percent in 1997 (the latest year for which statistics are available), according to the American College of Obstetricians and Gynecologists (ACOG). No one knows how much of the rise is due to elective inductions versus those that are medically indicated. But it's unlikely that the reason for the increase is strictly medical.


There are a variety of medical reasons for which women are typically induced. Being overdue, carrying a large baby, pregnancy-induced hypertension, and preeclampsia are but a few reasons. But lately more women and their doctors have imposed some predictability on Mother Nature by hastening delivery for nonmedical reasons, such as wanting to schedule a maternity leave or coordinating care for older children. And this trend is sparking its share of controversy.

Inducing Labor: A Matter of Convenience?

Anecdotally, many experts say the reason for the upswing in inductions is that women are demanding them. ACOG recognizes some nonmedical reasons as legitimate, such as a history of quick labor combined with a long distance to travel to the hospital. However, this is open to interpretation, as there are no specifics on what is too far or too fast.

Some women ask to be induced for reasons that have little to do with safety or health. Some want to schedule their baby's birth for personal convenience, because they are uncomfortable in late-stage pregnancy, or to accommodate a work schedule.

Some doctors give in to nonmedical patient requests for induction. One reason for giving in, according to Valerie Schulz, MD, an ob-gyn at Long Island Jewish Medical Center in New Hyde Park, New York, is that managed care has forced practices to become bigger. "There used to be many more solo practitioners, where it was very likely that a patient's own doctor was going to deliver," she says. "Now, in order to deliver their own patients, doctors might induce on a night they're on call."

How you get induced depends on how "ripe" the cervix is. If your cervix shows no signs that it's ready for labor, your doctor may give you a drug containing prostaglandins (a key labor trigger), administered in a pill, cream, or gel. The administration of prostaglandins softens the cervix substantially. Often the drug works on its own to stimulate labor, but if it doesn't, you'll probably be given Pitocin to bring on contractions.

But many doctors will not do an elective induction using the prostaglandin preparation unless you've begun having irregular contractions or showing signs of softening. If your cervix is thin and soft (as opposed to hard, thick, and closed), the doctor can induce labor with Pitocin. Another option, if your cervix is ripe, is breaking the bag of waters to see if that triggers contractions. If it doesn't, Pitocin is usually administered. But no matter how an induction is started, there are risks that you should be aware of in advance.

Inducing Labor: A Risky Venture

Inducing birth doesn't always work. If your water breaks but your cervix fails to dilate despite receiving the drug containing prostaglandins, you'll probably need a c-section due to the risk of infection (which could harm the baby). And elective inductions generally have a higher c-section rate.

Many women who've been induced complain that childbirth hurts more than if labor is spontaneous. The likely cause for this is that induced labor begins suddenly and possibly quite forcefully. You'll launch right into regular contractions without the "building up" process experienced in the natural progression of labor.

Plus, in most settings, if Pitocin is administered, continuous electronic fetal monitoring is required. The drawback to having continuous monitoring is that it limits your mobility. You'll want to avoid it if you plan on walking or taking a warm shower while laboring.

According to the American College of Obstetricians and Gynecologists, a doctor or midwife should only induce a woman for nonmedical reasons if she is at least 39 weeks pregnant, the baby's head has dropped down into her pelvis, and her cervix has thinned out and is favorable for giving birth.

Inducing Labor: Considering a Deadline

For many women, other concerns outweigh the risks associated with induction. For instance, if you have to move to a new home within a strict timeframe, your spouse has unavoidable travel around the time of your delivery, you live in a remote area far from the hospital, and so forth, you may feel you have to ask your doctor about the possibility of induction.

Of course it's best to try to schedule things around your labor, and not the other way around. But in the event that's not possible, discuss your options carefully with your physician.

Related Articles


Marilyn Kennedy Melia is a freelance writer in Northbrook, Illinois.

The information on this Web site is designed for educational purposes only. It is not intended to be a substitute for informed medical advice or care. You should not use this information to diagnose or treat any health problems or illnesses without consulting your pediatrician or family doctor. Please consult a doctor with any questions or concerns you might have regarding your or your child's condition.

Content courtesy of American Baby