When To Induce Labor, According To Experts
Anyone nearing their due date can tell you that when the end of your pregnancy is just on the horizon, it's typical to wonder when to induce labor. But when, if, and how to induce labor will vary from person to person, and will depend on a variety of factors.
Labor induction is recommended when there are concerns for the fetus or pregnant person, or when someone has gone past their due date with no signs of labor starting on its own, according to the American College of Obstetrics and Gynecology. Dr. Caitlin Szabo, an OB-GYN at Taylor, Suarez, Cook, and Khan (Division of Atlanta Women’s Healthcare Specialists), tells Romper that there are "a variety of reasons to consider induction." Some of those reasons, according to Szabo, include pre-existing conditions, like high blood pressure or diabetes, being an older pregnant person (over age 35), carrying twins, or if there are concerns for the growth of the fetus and/or the amount of amniotic fluid.
Dr. Melissa R. Peskin-Stolze, an OB-GYN at Montefiore Health System, tells Romper that a pregnant person presenting with hypertension, or showing signs that they will develop preeclampsia, might also be induced.
“This disease is a special condition related to pregnancy and there is a spectrum of disease severity. It is generally marked by high blood pressure and protein in the urine," she says. "It can also be further complicated by abnormality in blood work and may present with concerning symptoms like headache or visual changes or abdominal pain."
Additional reasons for inducing labor early include placental abruption, preterm premature rupture of the membranes, and hemolytic anemia. The best thing to do if you’re concerned about whether or not you may need to be induced is to have an honest conversation with your care provider. The risks of induction include lowering your baby’s heart rate or oxygen supply, uterine rupture, and infection, according to the Mayo Clinic. There’s also the chance that the induction will fail, which can lead to a Caesarean section.
When Should Labor Be Induced?
When it comes to labor induction, there are few instances where you’ll want to induce early. For healthy individuals experiencing their first pregnancy, ACOG suggest inducing at 39 weeks in order to reduce the need for a C-section. It's also recommended that labor not be induced before 39 weeks, in order to ensure the best outcome for the fetus. Induction should only be performed sooner due to serious health reasons.
“If a [pregnant person] has elevated blood pressure, [they] may need to be induced as early as 34 weeks," Peskin-Stolze says. "That being said, if she sees her provider every two weeks after 28 weeks and weekly after 36 weeks, this condition should be detected and/or precautions should be reviewed with the expectant [parent]."
If you prefer to wait for labor to happen "naturally," and you have no health reasons preventing you from doing so, both Peskin-Stolze and Szabo say it's OK to do so, just as long as you don't go past 42 weeks gestation.
“The rate of stillbirth increases exponentially after 41 weeks, so typically your OB-GYN will recommend induction at least by that point in pregnancy,” Szabo says.
Janet King, a midwife in Cwmbran, Wales, agrees, telling Romper, “If I am caring for a low-risk [pregnant person,] I will offer induction at 41 weeks, as per the National Institute for Health and Care Excellence (NICE) guidelines."
What Are Some Medical Methods Of Labor Induction?
The most common way caregivers induce labor is by way of membrane stripping. “Membrane stripping, performed by the prenatal provider, can speed up the onset of labor,” Peskin-Stolze says. This type of induction is generally more effective if the cervix is already soft or partially dilated when performed, and involves a practitioner inserting their fingers through the cervix, between the membranes and wall of the uterus, in order to release prostaglandins. Stripping the membranes can be an uncomfortable procedure, Peskin-Stolze says, and has an "associated risk of breaking the water bag or causing light bleeding."
Other methods of induction include the insertion of laminaria (a type of seaweed kelp) to expand the cervix, and the insertion of a catheter with an inflatable balloon to widen the cervix, according to ACOG. Amniotomy, in which a hook is used to rupture the amniotic sac, and the use of oxytocin (brand name Pitocin), are also induction methods that can be utilized.
What Are Some Ways To Induce Labor At Home?
No one should attempt to induce on their own without first consulting with their care provider. But if your health care provider does give you the go-ahead, "there are a lot of at-home methods to try to trigger your body to start having spontaneous contractions, but there is not a lot of evidence that they work,” Szabo says.
Chief among them is sex, which Szabo says works by triggering the release of the body’s natural oxytocin (as does nipple stimulation), potentially triggering contractions. But when it comes to the effectiveness of this method, a 2001 study published in Cochrane Library concluded that data is limited and no serious conclusions can be made.
Still, King says that she always suggests sex to try and kick off labor. “Sperm contains natural prostaglandins, and you produce oxytocin when you orgasm. I say that it may not work, but you’ll have fun trying,” she says. Szabo says that pregnant people should first speak with their provider prior to having sex, just to make sure it's safe to do so.
While castor oil and spicy food are often recommended by laypersons, Peskin-Stolze says both can cause unpleasant digestive side effects, like upset stomach, diarrhea, and possible dehydration. Neither have been shown to reliably induce labor, either.
“Dates, which have a lot of fiber (and you have to eat a lot of them), may reduce the likelihood your labor needs to be helped along or augmented, but does not necessarily induce labor,” Peskin-Stolze says, adding that it, too, has unwanted side effects.
Acupressure, massage, acupuncture, meditation, and general relaxation can all potentially make a pregnant person feel good, but according to Peskin-Stolze, they also don’t have enough evidence in Western literature to prove they are effective at inducing labor. “Walking can be helpful to draw the baby into the pelvis, but don’t expend too much energy, as one will need it for labor,” she says. And every pregnant person should be weary of methods like sipping wine or taking black cohosh.
“Any alcohol ingestion during pregnancy is officially not recommended," Peskin-Stolze says. "Herbal medicine has a rich history, but can be dangerous as naturopathic remedies are not monitored by the FDA…(and) something like black cohosh can be teratogenic." Teratogens are substances that can cause defects in embryos, hence the strong warning against such methods.
“Evening primrose oil has (also) been described as being able to ripen the cervix, but should not be used in certain circumstances,” Peskin-Stolze adds.
Overall, you should speak with your care provider to weigh the risks versus the benefits of induction. If there’s no specific need to induce your labor early, you may want to consider letting your body do the work when it’s ready. But if you do have a medical need, especially if you’ve gone postdates or have any health issues, work with your provider to come up with the best plan for you and your baby-to-be.