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If your baby needs a nudge after 40 weeks, you may be induced. Here’s what to expect

By Paula Ford-Martin

You’re a week past your due date and anxious to get baby out. It turns out your healthcare provider is, too. Though providers hope to keep all babies “on the inside” through 39 weeks, being overdue (beyond 40 weeks) has the potential to jeopardize baby’s health — or your health as a mom-to-be. So, providers have a procedure called induction to help safely jump-start the labor and delivery process. Here’s a little more on why they do it and what happens:

Why Is Labor Induced?

While, for the most part, inductions are reserved for women who have passed their due dates, they may also be scheduled for medical reasons. These include diabetes, gestational hypertension, preeclampsia (a serious blood pressure disorder in pregnancy), multiple gestations, problems with the placenta or amount of amniotic fluid, or a nonstress test that indicates baby may not be well, according to Linda Burke-Galloway, MD, FACOG, author of The Smart Mother’s Guide to a Better Pregnancy. Basically, if mom or baby is at risk, and delivery is the cure, induction will be recommended.

Because the amniotic sac (also known as your “bag of waters”) provides a barrier that protects your baby from germs entering the womb, if it ruptures before labor has started, the hospital may start the induction process at some point to prevent the potential of infection for your baby.

While induction is generally safe, there are risks involved, including an increased risk of C-section. Your provider will always weigh the risks of induction against the benefits of delivery.

How Does Labor Induction Happen?

When your provider plans your induction, they’re trying to simulate natural labor. “Induction basically entails administering medications — either vaginally, orally, or via an intravenous line — that will cause a woman to have uterine contractions,” explains Angela Jones, MD, FACOG, an ob/gyn at Healthy Woman OB/GYN, a practice in Freehold, NJ.

• Step 1: Ripen the Cervix. Your provider’s first step will be to examine your cervix to see if it’s ready for labor (what doctors call “favorable”). A favorable cervix is soft, effaced (thinned out), and dilated (open). If your cervix is favorable, you may be able to skip ahead to the second step. If your cervix is unfavorable, you may need a little extra help. 
  
  This can be done with the hormone prostaglandin, which your body naturally makes, in the form of tablets, gels or medicated inserts containing synthetic prostaglandin, or catheters that are placed through your cervix and stimulate natural prostaglandin to be released. All these methods aim to ripen your cervix and improve your chances of going into labor and having a vaginal delivery.
   
• Step 2: Stimulate Contractions. Once your cervix is favorable, you’ll receive Pitocin (synthetic oxytocin) through an intravenous (IV) line. The amount is carefully measured and monitored. At this point, your baby and your contractions (via the uterus) will also be carefully monitored — your provider doesn’t want you to have super-strong or frequent contractions. They aim for normal contractions, lasting 60 seconds and coming every 2 to 3 minutes. In some cases, the Pitocin can be decreased or turned off if your body is in labor on its own.
  
  Amniotomy (when your provider breaks your water with a tiny, long sterile hook) is often done to increase the strength and frequency of contractions. It may also be used to induce labor (since it stimulates prostanglandin), especially for women who’ve had a vaginal birth before. However, amniotomy most often happens after your labor is active — meaning your cervix has dilated to 4 centimenters or more and your contractions are regular — and only in the hospital, due to concern of infection.
  
  Some providers may also perform a membrane sweep, a procedure to start labor in women whose cervix is starting to dilate or open. They use a gloved finger to separate the amniotic membrane, or bag of waters, from the cervix. Also called “having your membranes stripped,” this can be done in the provider’s office. Some women find it painful, and experts aren’t certain it’s effective.

Can I Plan My Induction with My Provider?

Just as every woman, pregnancy and provider are different, so is every induction. For example, one woman may be induced with several doses of prostaglandins followed by Pitocin followed by an amniotomy, while others may only need their water broken. Also, some providers prefer certain medications and procedures. Generally, if you’ve had a vaginal delivery before, your induction may progress more quickly. If this is your first baby, it may take a long time. 

Learn more about how to navigate labor induction.

Published on December 30, 2015.

Paula Ford-Martin has authored more than a dozen consumer health and parenting books, including the bestselling Everything Pregnancy Book, 4^th edition, and The Only Pregnancy Book You’ll Ever Need.