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Pregnancy and Childbirth

Induced Labor: When is it Necessary?

For most pregnant women who are coming to term, labor starts spontaneously and there is no need to interfere with the natural progression of events, from the first contraction to birth. But for some women, labor needs to be induced using special medications. Below, two OBGYN's discuss some of the reasons why labor induction might be necessary.

What are some of the reasons why you would need to induce labor?
ADRIANNE MOORE, MD: There are several reasons to induce labor. If the baby is not growing well and would be better off outside the mother than in, then we will induce. Another common reason for inducing labor is when the pregnancy goes past the due date. Some physicians will induce the labor at 41 weeks, and others will wait until 42 weeks.

What are some of the medical approaches used to induce labor?
STEVEN HOCKSTEIN, MD: There are several medications that are commonly used to induce labor. If the cervix is already dilated somewhat-or "ripe", as we call it-you can just begin oxytocin, which is a medication given through an IV. And that brings on contractions.

If the cervix is still not dilated at all when you've reached the end of the pregnancy, medications can be applied directly to the cervix and the vagina. There are prostaglandin tablets that are placed in the vagina, and prostaglandin gels that are applied to the cervix. And they help soften and change the cervix chemically so that 12 hours later, when oxytocin is started, the cervix can dilate more easily.

So if you were describing the pros and cons of induced labor to a mother, what would you say?
STEVEN HOCKSTEIN, MD: I try to avoid induced labor in my practice. It is associated with an increased risk for cesarean section, which is also something I try to avoid. There are certainly many times when induction of labor is appropriate. It's a balance between risks - the risk of continuing the pregnancy versus the risk of inducing labor and cesarean section. And when a pregnancy has gone beyond its date, perhaps 41 to 42 weeks, and there may be complications with the baby - the amniotic fluid is low, for example - then induction is perfectly indicated. And despite the increased risk of cesarean section, it is more important to deliver the baby.