Induced Labor: Indications, Procedure & Natural Options

Induced labor is a medical procedure used to start labor when it does not begin on its own. It uses medications or specific techniques to trigger contractions and help the cervix soften and open.

An OB-GYN or midwife may recommend inducing labor if a pregnancy continues beyond 41 weeks. Induction might also be advised if the water breaks but labor doesn’t start on its own, or when certain conditions are present that increase the risk of complications, such as gestational diabetes, preeclampsia, or fetal growth restriction.

Induced labor is performed in a hospital after the OB provider evaluates the mother and baby and assesses how ready the cervix is for labor. Depending on the situation, induction may involve medications, breaking the amniotic sac ("water"), or gently sweeping the membranes.

Indications for induction

Induced labor may be recommended by your OB provider in the following situations:

• Prolonged pregnancy, when gestation goes beyond 41 weeks, since risks to the baby increase;

• Ruptured membranes, if the water breaks near the end of pregnancy and labor does not start on its own;

• Low amniotic fluid, when the amount of fluid around the baby is low, even after trying hydration;

• Maternal health problems, such as uterine infection, gestational diabetes, high blood pressure, or preeclampsia;

• Fetal growth restriction, when the baby is not growing at the expected rate;

• Stillbirth;

• Certain Rh incompatibility situations, when monitoring suggests the baby may be at risk and earlier delivery is recommended by the obstetrician.

In addition, induction may be considered for practical reasons, such as living far from the hospital or not having a support person available.

However, the pregnant person has the right to clear information about labor induction. After counseling from the medical team, she can choose to accept, postpone, or refuse the procedure.

Is induced labor more painful?

Induced labor can be more painful than spontaneous labor because contractions are often stronger and closer together. The cervix may also take longer to dilate.

Continuous fetal monitoring is usually needed, which can limit certain positions or comfort measures used to manage pain.

Induction procedure

Before beginning an induction, the OB provider assesses the mother’s and baby’s overall condition, explains the available options, and evaluates both the readiness of the cervix and fetal well-being.

Induction is performed in the hospital and may involve more than one method, depending on what is safest and most appropriate. Throughout the process, the goal is constant medical supervision and safety for both mother and baby.

The method used depends on cervical readiness (often assessed by a Bishop score). For an unfavorable cervix, ripening agents like prostaglandins or mechanical methods such as a balloon catheter are commonly used first.

According to the American College of Obstetricians and Gynecologists (ACOG), if the cervix is already favorable or partly dilated, oxytocin (Pitocin) infusion may be started to help bring on contractions. Amniotomy (artificial rupture of membranes) may be done before or after oxytocin to strengthen contractions.

In some cases, the provider may do a gentle membrane sweep to help the body begin labor more naturally.

Induction does not always work on the first try, and another round may be needed. The process can take several hours or last as long as two to three days.

How long does induction take?

Once induction begins, the time until delivery depends on how ready the cervix is, which method is used, and how the woman’s body responds.

Contraindications for induction

Induced labor may not recommended in cases of:

• Signs of fetal distress, when urgent delivery is needed and induction is not the safest option;

• A history of cesarean delivery or other uterine surgery in some cases, because uterine scarring can increase the risk of uterine rupture and changes which methods are appropriate;

• Twin pregnancy or pregnancy with more than two babies in some situations, depending on factors like fetal positions and the maternal/fetal health;

• Breech presentation or when the baby is not head-down, especially if a vaginal birth is not planned;

• Active genital herpes infection at the time of labor;

• Complete or partial placenta previa;

• HIV infection with a high or unknown viral load near delivery, because the delivery plan depends on viral load and treatment status.

In addition, induced labor is not recommended in cases of vasa previa, which occurs when umbilical cord blood vessels are close to the inner opening of the cervix. According to the Society for Maternal-Fetal Medicine (SMFM), planned cesarean delivery for a prenatal diagnosis of vasa previa is recommended to occur before rupture of membranes, to reduce the risk of fetal bleeding.

If your baby is suspected to be larger than average, your OB provider will evaluate this and discuss how it may affect your delivery plan.

Possible complications

Complications can occur during labor induction, including a failed induction, which may lead to a c-section. There can also be a higher risk of infection when the water is broken.

The baby’s heart rate may drop if medications cause contractions that are too frequent or too strong, which can reduce oxygen delivery to the baby.

Although rare, induction can also lead to uterine rupture. This can happen at the site of a prior c-section scar or previous uterine surgery, but it can also occur in women with no history of uterine surgery.

Are inductions dangerous?

Induced labor is not necessarily dangerous, but like any medical procedure, it comes with risks. These can include overly strong contractions, induction that does not work and results in a cesarean delivery, and a longer hospital stay.

This is why induction should be recommended and monitored by an OB provider, with the pregnant woman fully informed about the potential benefits and risks.

How to induce labor naturally

Other ways to help encourage labor to start naturally (always with an OB provider's knowledge and guidance) include:

• Physical activity, such as taking a long walk;

• Nipple stimulation, which may increase oxytocin release and cause the uterus to contract, helping trigger or strengthen contractions;

• Sexual intercourse without a condom, which may help soften the cervix;

• Masturbation, which in late pregnancy may increase oxytocin release and support contractions and labor;

• Positive emotional experiences, such as visiting a favorite place, eating a favorite meal, or using a perfume linked to good memories;

• Acupuncture sessions.

In addition, some people use red raspberry leaf tea late in pregnancy, but evidence is limited. It should only be used if your OB provider says it is safe for you.