The Huddle Up

Induction of Labor: What, When and How ?!?

Jul 18, 2023 | OB/GYN

Written by Dr. Meredith Thomas - One Huddle OB/GYN Expert
Dr. Meredith Thomas – One Huddle OB/GYN Expert

From the minute one finds themselves pregnant, many people anticipate the moment when their birth will begin. Some worry, some await eagerly, some make concrete plans, some blissfully imagine, some relinquish control and feel “whatever happens, happens!” We’re all so different and our births are so different. Whichever end of the spectrum you are on, adding the information that you might have an induction of labor – will likely rock your world for a minute.

Pregnancy generally concludes with the spontaneous onset of labor, indicating the readiness of both the pregnant person and baby for the birthing process. But in certain situations, labor may be medically induced – either for an elective (personal) or medical reason. Induction involves using medical procedures to stimulate the labor hormones and contractions before they naturally commence (read more about those here! ACOG – Labor Induction FAQs). Choosing induction of labor requires understanding the potential benefits and risks. This understanding is gained from collaboration with your providers and having the ability to make informed decisions regarding birth plans. Here at Huddle, our goal is to help you feel well supported, empowered and safe in your pregnancy and one of the ways we do this is to help you understand what questions to ask. 

Induction may be required for a variety of reasons. Prolonged pregnancies that continue significantly beyond the estimated due date could warrant induction to avoid potential complications associated with post-term pregnancies. Some indications for induction of labor could be medical conditions affecting the pregnant person such as gestational diabetes or high blood pressure or conditions affecting the baby such as low amniotic fluid or growth concerns. Additionally, logistical factors like distance from a medical facility or a history of rapid labor might make scheduled induction the safer option.

Elective induction, or decision to induce labor based purely on preferences and not on medical indications, have become more commonplace in the last several years. The New England Journal of Medicine (kind of a big deal in the medical world!) published a research study that showed a decrease in the rate of cesarean sections for first time births in low risk people who were induced at 39 weeks (read the NEJM fine print here). This study is known as the ARRIVE Trial. 

Now, that statistic requires a bit more breakdown. The study is comparing people who were induced at 39 weeks to everyone else. Everyone else includes people who went into labor on their own after 39 weeks as well as the people who were induced later because of a medical indication or they got to 1-2 weeks beyond the due date and chose to be induced. If we looked just at the people who were induced and the people who went into spontaneous labor – spontaneous labor is less likely to result in a cesarean section. However, we have not yet developed a crystal ball to tell us who is going to go into spontaneous labor without developing a medical complication later in their pregnancy. This is especially difficult to predict for people who have not labored before (like the people in this study). So, if you are thoroughly confused and don’t know what to choose – you’ve understood the study! It does not make any clear conclusions and I personally do not recommend induction of labor at 39 weeks based on this. I do, however, have discussions with my patients and if they desire an elective induction, I believe the study supports that this is a safe option. In addition to demonstrating a lower rate of cesarean birth, the study also showed that people who had an induced labor had a lower chance of developing high blood pressure or preeclampsia. Some risks associated with induction in this study were a longer labor course but overall there was not an increase in risks to birthing person or the baby. Not all hospitals can accommodate elective inductions and not all care providers recommend them so definitely discuss with yours! Read the midwifery response to the ARRIVE trial to help understand the multiple perspectives. 

The decision to induce labor must involve dialogue between the pregnant person and the prenatal care provider in a way that centers the needs and desires of the pregnant person. The medical conditions encountered during the pregnancy must be well understood and communicated.  The reasons for induction, potential risks, and involved processes should be thoroughly discussed with the healthcare provider. When used appropriately, labor induction can be a valuable tool for ensuring a safe delivery and the wellbeing of both the mother and baby. As with all aspects of birth, having the right information is key to making the best decisions. In our birth course, you can listen to our very own doula Kathleen – Birth Expert go into more detail about induction of labor and advocating for yourself on the labor floor. 

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