Inducing Labor

When it's a good idea to help nature along and when it isn't


Over the past 10 years, more and more women — for a myriad of reasons —have had some of the unknowns taken out of the labor and delivery process by having labor induced. In fact, the number of induced deliveries has roughly doubled in the past decade. According to the Centers for Disease Control and Prevention in Atlanta, the rate of inductions increased from 9 percent in 1989 to 18 percent in 1997.

Induction of labor is the artificial stimulation of uterine contractions when there have been none that were effective in changing the cervix. It can be a complex matter; there are risks and conditions when women should not be induced.

In about half of all induced labors, pregnant women are given the hormone prostaglandin — either orally or as a vaginal suppository applied directly within the birth canal — to ripen the cervix, notes William F. Rayburn, M.D., professor and chairman of the department of obstetrics and gynecology at the University of New Mexico School of Medicine in Albuquerque. (A ripe cervix is soft enough to begin effacing and dilating.)

Another way doctors can induce labor is to artificially rupture the amniotic membrane, which often will trigger contractions. The doctor guides a sterile tool in through the vagina, carefully making a tiny tear in the sac.

The most common reason for inducing is that a pregnancy has gone long past the due date (usually defined as two weeks past due). By this time, problems with the baby can arise, and the once-ideal uterine environment can begin to deteriorate. Reasons for inducing labor prior to the due date include high blood pressure, gestational diabetes and the baby not thriving, among others. Obstetricians have become better at understanding these risks over the past decade and can better intervene with planned inductions.

Inducing labor creates a greater chance of Cesarean section and a longer labor for some women. But for others, being induced means a brief labor and peace of mind — particularly for women who live far from the hospital and fear a long drive while in labor.