What to Know if you're having Labor Induced

This is another in our series of interviews with Labor and Delivery nurse Kim Petrella, who is an advisor to Parent’s Guide to Cord Blood Foundation. After decades of experience delivering thousands of babies and educating other labor and delivery staff, Kim is our go-to resource for questions about childbirth.

Today’s topic is what you need to know if your doctor or midwife wants to discuss inducing labor, and how to prepare if you are having labor induced.

The first thing to ask is why does your healthcare provider want to induce labor? There should always be a medical justification for an induction. Just a few examples of reasons for an induction may be: mom’s blood pressure is getting too high above her baseline, mom’s blood test results are trending in the wrong direction, the baby’s growth rate is slowing or behind where it should be, or the baby is getting too big for a vaginal delivery given mom’s history, or mom is past her due date, and many more. The two main types of reasons for induction are either: that waiting to go into natural labor could decrease your chances of a vaginal birth, or that waiting may allow an existing medical condition to get worse and create problems. As Kim says, “Your doctor wants to allow for the safest possible delivery for mom and baby, and your doctor may feel it is safer to try to deliver the baby a little early.”

If you are seeking an elective induction, then you need to have a discussion with your healthcare provider about the risks versus benefits of inducing labor for your case. There are circumstances where an elective induction makes sense, and together with your provider you can make an informed decision about the best way to proceed.

When she is not delivering babies, Kim loves to teach

A mom who has planned for a natural labor and delivery may be disappointed to be scheduled for an induction. Being induced does not make you a failure at childbirth before you even got started. It just means that, all things considered about your pregnancy, it would be best to encourage the baby to leave the womb a little sooner for everyone’s safety. It is still possible to try to manage labor with natural methods, despite having labor induced. Kim advises moms to keep their mindset open and flexible.

A quarter of a century ago, inductions tended to dramatically speed up deliveries, to the point of triggering fetal distress¹. If you are pregnant today and have heard horror stories from your mother or older friends about their induction, rest assured that induction is done more gently in 2025. In fact, the process is so slow that it may take you up to three days to deliver the baby, so you need to be prepared that you may have a long stay in the hospital.

Before any drugs are given to induce labor, the cervix needs to be ready. In a natural labor, the cervix “ripens” before going into labor, which means it becomes thinner, more flexible, and starts to dilate². When delivery is induced, the first step is a cervical exam to assess the best method of preparing the cervix. There are several methods to encourage the cervix to ripen: mechanical, or medication, or a combination of both³. The most popular mechanical method is to insert a cervical ripening balloon (sometimes called a Foley balloon) and inflate it. Another method is called “stripping” or “sweeping” the membranes, where a healthcare provider uses their fingers during a vaginal exam to gently separate the amniotic sac from the edge of the cervix. The medication method is to give a natural hormone called prostaglandin that encourages the cervix to ripen. This can be done with a topical gel that is rubbed on the cervix, or mom can take an oral version of the hormone and tuck it into the cheek of her mouth. Oftentimes, when inducing a mom that is not showing any signs of beginning labor, providers will use a combination of mechanical and medication methods to try to get labor started.

Once the cervix is more ready, labor can be induced with an intravenous drug that has the brand name Pitocin (the generic name is synthetic oxytocin). Commonly nowadays, the protocol for delivering Pitocin is to start at a very low rate and increase by small steps roughly every 15-30 minutes. After a while, the healthcare team will stop to evaluate the situation. If it seems safe to continue, they will again gradually increase the Pitocin in small steps, stop to evaluate, and so forth and so on. It may take hours before mom goes into labor. The goal of increasing the Pitocin very slowly is to gradually increase the strength of the contractions and the frequency of the contractions in a way that is safe for the mother and the baby. There are even times when the Pitocin may be kept at the same rate, turned off for a while, or backed down, as the effect of the induction on the baby and mother is always the deciding factor of how to continue bringing on the labor. There are also times when a mother who has been in natural labor needs Pitocin to “augment” the labor, which is a way of helping to increase the strength and frequency of the contractions in a labor that has slowed down or stalled.

There has been some past debate in the medical literature about whether the C-section rate is higher after induced labor, and what is the nature of the connection. A 2017 publication that followed 2,851 pregnant women having their first birth found a higher C-section rate after induction, and attributed it mainly to insufficient cervical dilation⁴. But a year later, the ARRIVE clinical trial was published and it followed 6,000 pregnant women having their first birth and being induced at 39 weeks gestation. The outcome showed a 16% reduction in relative risk of C-section thanks to induced labor!⁵ This was confirmed by the 2023 publication of a meta-analysis of 1.6 million pregnant women that were induced at 39 weeks⁶. The results showed there was a “substantial reduction in the likelihood of emergency cesarean section”. Additional studies have also shown than inductions do not increase the rate of C-sections among mothers over age 35 or babies over 41 weeks gestation^7,8. At this time, the prevailing view in the obstetrics field is that inductions help to prevent C-sections.

There are many do-it-yourself home remedies that allegedly will induce labor, but none of them has been conclusively proven to work. For example, one home remedy claims that having sex will induce labor. There have even been medical studies testing this claim⁹. However, the studies found that the number of women going into labor after sex was not significantly greater than the number of women in the matched control group who went into labor anyway.

Knowing that you are having labor induced, how should you change your preparation for the hospital? The main thing is to prepare yourself, and your support people, that you may have a longer stay in the hospital than a mom who arrives already in active labor. Make sure that you have lined up family and friends to take care of your kids, your pets, and anything else at your home that needs attention.

In addition to things that you would pack for the hospital anyway, consider extra toiletries and comfort items. You should bring your own pillow, with a colorful pillowcase so that it won’t be confused with white hospital pillows. Extra toiletries may include deodorant, dry shampoo, and a personal fan. You may be on a clears diet if your doctors are considering a C-section, so bring snacks that will be allowed, like Ensure clear, clear protein drinks, and hard candy. If you are diabetic with this pregnancy, remember to avoid snacks that contain sugar. Your support person should pack a bag that contains a change of clothes, their daily medications, and any as-needed medications like painkillers or allergy pills. They will need their own snacks and distractions. Don’t forget your cord blood banking kit, if you plan on a collection! You can leave your infant car seat in the car and get it later, once you are ready to be discharged from the postpartum floor.

Inducing labor involves a lot of waiting at the beginning. Try to get up and move around for as long as you can. Bring your favorite music and dance! As a labor and delivery nurse, Kim likes to dance to “vacation music“, upbeat songs about beaches and travel, with her patients. Be sure to label any electronic devices with your name. Remember to bring charging cables for your devices and label those too. Hospital wards are full of forgotten charging cables.

Inducing labor or augmenting labor may be a slower launch to get things rolling, but the goal is ALWAYS to be safe. Remember that your goals are a healthy mommy and a healthy baby, and be proud of yourself for however it happens!

Kim Petrella, MSN, RNC-OB, has been a Labor & Delivery Nurse for over 35 years, and is a member of the Association of Women's Health, Obstetric, and Neonatal Nurses (AWHONN). Kim specializes in leading workshops to educate healthcare providers about the importance of saving cord blood and the best practice techniques for cord blood collections. She has spoken at medical conferences and she has conducted workshops for medical professionals, medical students, nursing students, and high school students. Most of all, she focuses her energies on empowering parents to save their baby's cord blood versus throwing it away. Her passion for taking care of expectant families has been recognized by numerous awards.

References

1. Tillett J. "Pit to Distress:" Is This an Evidence-Based Strategy? Journal of Perinatal and Neonatal Nursing. 2011; 25(4):302-304.
2. Cleveland Clinic. Cervical Ripening. Last updated 2024-12-18
3. Sanchez-Ramos L, Levine LD, Sciscione AC, Mozurkewich EL, Ramsey PS, Adair CD, Kaunitz AM, McKinney JA. Methods for the induction of labor: efficacy and safety. Am J Obstet. Gynecol. 2024; 230(3S):S669-S695.
4. Kjerulff KH, Attanasio LB, Edmonds JK, Kozhimannil KB, Repke JT. Labor Induction and Cesarean Delivery: A Prospective Cohort Study of First Births in Pennsylvania, USA. Birth. 2017; 44(3):252–261.
5. Grobman WA, et al., for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal–Fetal Medicine Units Network. Labor Induction versus Expectant Management in Low-Risk Nulliparous Women. NEJM 2018; 379:513-523
6. Hong J, Atkinson J, Mitchell AR, et al. Comparison of Maternal Labor-Related Complications and Neonatal Outcomes Following Elective Induction of Labor at 39 Weeks of Gestation vs Expectant Management. A Systematic Review and Meta-analysis. JAMA Network Open. 2023; 6(5):e2313162.
7. Fonseca MJ, Santos F, Afreixo V, Silva IS, Almeida MdC. Does induction of labor at term increase the risk of cesarean section in advanced maternal age? A systematic review and meta-analysis. EU J Ob. Gyn. Repro. Biol. 2020; 253:213-219.
8. Sanchez-Ramos L, Olivier F, Delke I, Kaunitz AM. Labor induction versus expectant management for postterm pregnancies: a systematic review with meta-analysis. Obstetrics & Gynecology. 2003; 101(6):1312-1318.
9. Carbone L, De Vivo V, Saccone G, D’Antonio F, Mercorio A, Raffone A, et al. Sexual Intercourse for Induction of Spontaneous Onset of Labor: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Journal of Sexual Medicine. 2019; 16(11):1787–1795.