Labour is induced when it’s safer for the baby to be delivered than to continue the pregnancy. This happens at different times for different reasons. In a healthy pregnancy, induction happens when you are overdue (41 weeks), or if your water breaks and you do not go into labour on your own. Induction can happen earlier if you have a medical condition or if the baby isn't growing properly.
The way the induction is started depends on your cervix. If your cervix is firm and closed, you may need a step to make it ready for labour, which usually involves placing a medicated gel or insert into your vagina. You get to skip this if your cervix is already soft and slightly open. When the cervix is ready, oxytocin is given in an IV to start contractions. Your waters may be broken if they have not broken on their own.
Induction can take hours to days. It takes longer if it’s your first baby or if you need that extra step to get your cervix ready.
Induction is safe for both you and your baby, but there are some risks. Sometimes the uterus can contract too strongly or too often, which is called hyperstimulation. If it affects the baby’s heart rate, the induction may need to be paused or stopped, or you may even need an emergency C-section. With induction, there is a slightly increased risk of needing forceps, vacuum or a C-section compared with natural labour. If you have had a C-section before, some of the medications used to soften the cervix can increase the risk of uterine rupture, a rare but dangerous complication. Your doctor will talk to you about other options if you find yourself in this position.
Membrane sweeping is a quick procedure that can be done in the medical office. It’s like an intense cervical exam – the membranes are separated from the cervix by sweeping a finger around during the exam. It works by releasing prostaglandins that soften the cervix. Sweeping can reduce the risk of going overdue and can even start contractions, but it can be uncomfortable and cause minor bleeding. Breast stimulation releases your natural oxytocin and can start contractions. Unfortunately there is no agreement yet about what kind of stimulation is best or how long to do it for the best results. Sex has also been suggested as a way to bring on labour because semen contains natural prostaglandins. More research is needed before it can be recommended, but it may help reduce the chances of going overdue. Sex is safe in pregnancy, except if your water has broken, if you are at risk of early labour or if you have a condition called placenta previa. Ask your doctor if you aren’t sure!
The most common herbal remedies used for bringing on labour are red raspberry leaf, blue cohosh and evening primrose oil. Some of these have been used by midwives and traditional healers for a long time, but they have not been well studied by today’s scientists. At this point, there is not enough evidence to say whether or not they work, or even if they are safe to take in pregnancy. The other concern with herbal medicines is that they are not well standardized, so it can be hard to know if you are getting the right dose. There may also be other compounds mixed in that you don’t know about, which may not be safe in pregnancy. When it comes to herbal remedies in pregnancy, I usually tell my patients to avoid them if they can’t be sure what is in them.
Unfortunately, walking has not been shown to bring on labour or to make it progress faster once it has started. However, that doesn’t mean you should hit the couch and wait for labour to start! Being physically active improves your strength, endurance and mood, which will help you cope with the stresses of labour.