Labor induction is the process of starting labor using medical methods before it begins on its own. 

If you’re facing an induction, understanding what to expect can help ease your concerns and prepare you for the experience ahead.

Reasons for induction

Medical reasons can prompt induction before 39 weeks of pregnancy. These can include, but are not limited to:

• High blood pressure disorders: These are among the most common reasons for induction. Depending on how severe the condition is, induction might happen between 34 and 37 weeks of pregnancy.
• Diabetes: Whether you have gestational diabetes, Type 1 or Type 2 diabetes, your doctor will consider how well controlled your blood sugar is when deciding on timing. This could mean inducing labor between 36 and 39 weeks.
• Concerns about baby’s health: This may include conditions such as low amniotic fluid or small size.
• Going past 40 weeks: There are risks associated with going past your due date.

Some women choose to induce labor at 39 weeks even without medical problems. If it is safe for mother and baby, waiting until 39 weeks gives babies more time to grow 

“Elective induction of labor at 39 weeks in low-risk patients has been found to reduce cesarean delivery rates and has improved outcomes for mom and baby compared to waiting for labor to occur on its own,” says Logan Schroeder, DO, MPH, an OB/GYN resident. “Therefore, all major OBGYN societies endorse offering to patients the option.”

How doctors decide when induction is needed

“It’s always a risk-benefit discussion about whether the baby is safer outside or inside the uterus,” Dr. Schroeder says. “We try to keep them inside as long as possible until that balance flips, and then they are safer on the outside.”

Doctors base these recommendations on research. For example, if you have certain high blood pressure disorders during pregnancy, studies show there are greater risks to you and your baby after 37 weeks compared to the benefits of waiting longer.

Methods used to induce labor

Every induction is different. The approach depends on how dilated the cervix is and how far along the pregnancy is. Doctors have several tools they can use:

Misoprostol

This pill, also known as Cytotec, can be placed in the vagina or under the tongue. It dissolves and works over four hours to soften the cervix and usually starts mild contractions. Doctors often begin with this method.

Cervical ripening balloon

A thin catheter with two inflatable balloons is passed through the vagina into the cervix. One balloon inflates inside the uterus near the baby’s head, and the other inflates in the vagina. Together, they put pressure on the cervix to help it dilate.

Breaking the water

Using a small hook, the provider gently breaks the amniotic sac (also called the bag of water). This is called artificial rupture of membranes (AROM) and can help labor progress. The bag of water does not have any nerves, so you do not feel any pain—just a gush of warm fluid. 

Pitocin 

This medication, also known as oxytocin, is given through an IV. It helps initiate contractions or intensifies them, making them stronger and closer together. The dose is increased slowly to make sure both you and your baby tolerate it well. If necessary, it can be stopped at any time.

Understanding cervical ripening

Getting the cervix ready for labor is called cervical ripening. This is an important part of induction, especially for first-time mothers.

“We can use different tools to get your cervix to be more dilated or into active labor without just using Pitocin,” Dr. Schroeder says.

This matters because the uterus is a muscle that can get tired. Using the pill and balloon first helps save the effectiveness of Pitocin for later in labor and after delivery, if needed.

Timeline and experience

Induction can take time, especially for first-time mothers. Many women come in during the evening so they can receive the pill and have the balloon placed overnight. 

“It’s not uncommon to come in for cervical ripening as a first-time mom at 39 weeks, and it takes 36 hours to get to 6 cm,” Dr. Schroeder says. “That doesn’t mean things aren’t going well. It just means that it can be a long process.”

If a woman has had previous vaginal deliveries, induction often moves more quickly.

Mothers are encouraged to move around and change positions during labor induction. This can help labor progress and reduce pain.

“People can walk around the halls or get in the bathtub, as long as they don’t have an epidural,” Dr. Schroeder says. “We encourage that, because the more you can move around, the more that head can wiggle into the right spot in your pelvis.”

Scheduling your induction

If you’re having an elective induction at 39 weeks, there’s often flexibility with timing. If a specific day works better for your schedule, doctors can often accommodate that.

However, when induction is recommended for medical reasons like high blood pressure, there’s less flexibility in timing because of safety concerns.

When induction becomes necessary

After 40 weeks, the risk of stillbirth begins to rise. Once pregnancy goes past 41 weeks, this risk increases significantly.

“Placentas don’t last forever,” Dr. Schroeder says. “They don’t work as well after 41 weeks, which increases risks for both mom and baby.”

Babies born after 41 weeks often don’t tolerate contractions as well during labor. The risk of meconium (the baby’s first stool while still inside) also increases, which can cause breathing problems if the baby happens to inhale it.

Talk to your provider

Understanding what to expect can help you feel more in control during labor.  Your doctors and nurses are there to guide you through each step and ensure the safest possible outcome for you and your baby.​​​​​​​​​​​​​​​​

“Induction can be a long process, and there can be a lot of different moving parts,” Dr. Schroeder says. “If there’s anything that we can do to make that better and more comfortable for you, we’re happy to chat with you about it.”