5 Important Questions to Ask About Labor Induction

The rate of labor induction in the United States has doubled in the last thirty years. Approximately 1 in 4 women are induced. 

You’ve probably heard mentions of induction from family and friends. And you may be questioning if induction will be necessary for you. 

So, here’s the most important thing to remember about induction: 

The more you know, the more you are in control. 

Educating yourself on induction methods, and when induction is necessary will help you make well-informed decisions concerning your birth. 

Sometimes, induction is necessary…

While at other times it may be avoided altogether.

When it comes to birth, we can’t control everything. But we can educate ourselves.

Knowledge is power! 

So, let’s talk more about labor induction. 

What is The Bishop Score?

Towards the end of your pregnancy your care provider may start talking to you about induction. If so, you can ask them about your Bishop score. The Bishop score can be a helpful tool you can use to advocate for yourself.

Developed by and named after Dr. Edward Bishop in the 1960s, your Bishop score indicates whether or not you are a good candidate for labor induction. 

Your score will range anywhere from 0 to 13. A higher score generally suggests that your cervix is more favorable for labor, meaning that induction is more likely to proceed smoothly. A lower score might indicate that your body isn’t quite ready yet, potentially leading to a more challenging induction process.

Your care provider uses the following factors to calculate your score: 

• Cervical dilation. Measured in centimeters, this tells you how much your cervix has opened. 
• Cervix position. Your cervix will move forward as your baby travels farther down. 
• Cervix consistency. Is your cervix soft or firm? (The softer the cervix, the closer you are to labor). 
• Cervical effacement. How thin is your cervix? A thinning effect happens as labor continues.  
• Baby’s station. How far has your baby moved down into your pelvis? Station is measured from -5 to +5. At -5, your baby is still high up and hasn’t engaged in your pelvis yet. At 0, your baby’s head is engaged, and at +5, your baby is at the vaginal opening and almost ready to be born!

Keeping each of these factors in mind, your doctor will determine your Bishop score.

Here’s how the Bishop scoring works:

5 or below: induction is likely not a good idea yet. Your labor hasn’t progressed enough. 

6 to 7: induction may or may not be right for you. 

8 or above: labor will most likely start on its own soon, and induction is more likely to succeed. 

In order to obtain this information, you would need to be okay with having a cervical check. So keep this in mind as your pregnancy progresses.

Understanding your Bishop score can be empowering when discussing induction options with your healthcare provider. If your healthcare provider recommends induction, knowing your score can help you advocate for your preferences. For example, if your Bishop score is low, you might discuss the possibility of waiting a little longer, if it’s safe to do so, or exploring alternative methods to help your body prepare for labor. On the other hand, a higher score might give you more confidence in proceeding with an induction. 

By being informed about your Bishop score, you can engage in a more collaborative conversation with your healthcare provider, ensuring that your voice is heard and your choices are respected as you navigate this important phase of your pregnancy journey.

If your labor doesn’t start spontaneously before 42 weeks, then there are risks involved in both waiting for labor to start and in having your labor medically induced. Your healthcare provider should be able to provide you with all the evidence you need to weigh the risks and benefits and make an informed decision about what is right for you and your baby.

What Labor Induction method should be used? 

Different circumstances may require different techniques. 

There are several reasons why your doctor may recommend induction: 

• Labor isn’t advancing and you may need or want assistance to augment progress
• Preeclampsia 
• Gestational diabetes
• Hypertension
• Heart disease
• Placenta complications
• Your water breaks, but your body does not go into labor with contractions. 
• You are well past your due date (past 41 weeks of pregnancy) 
• Your amniotic fluid is low 
• You have an infection in the uterus
• You have a history of stillbirth or other childbirth risks in your past 
• You request an “elective induction,” which means you plan your induction ahead of time with approval and in coordination with your care provider. 

Sometimes, you may only need one intervention to get labor started and progressing. 

Other times there is a combination of methods used. 

It depends on how far your labor has progressed, what your body is doing, and how you personally feel about it. 

Here are a few methods your doctor may try: 

• Membrane Sweep. With a gloved hand, your care provider will attempt to separate your membranes from your uterus. This may allow the release of natural prostaglandins, causing the cervix to soften. 
• Prostaglandins. These hormones already exist naturally in the body to ripen the cervix. Your doctor may give you synthetic prostaglandins to encourage the cervix to soften. These are typically provided in vaginal tablets, gels, or suppositories. The two most common prostaglandins used for labor induction are: Cytotec and Cervidil.  
• Balloon catheter. A balloon catheter, also known as a Foley balloon, is used for induction by gently inserting it into the cervix and then inflating the balloon with sterile saline. The pressure from the inflated balloon helps the cervix to dilate and encourages the release of natural prostaglandins. This method is often used when the cervix is not yet favorable for labor but needs a little help to get things started.
• Pitocin. Your body naturally produces oxytocin which helps to start and keep labor going. The synthetic equivalent, Pitocin, can be given to you through an IV to either augment your contractions or to help get them started. 
• Amniotomy. With a plastic hook or other surgical instrument, your doctor will break your water (amniotic sac.) This is usually done to help augment your labor when it has already started, but it can also be done to get labor started. 

What Happens During an Induction, Step by Step?

Understanding the methods is one thing. Knowing what the actual experience looks like, in order, is another.

Here’s how a typical induction unfolds:

1. IV fluids. Once you’re settled in, your nurse will start an IV and begin giving you fluids.

2. Electronic fetal monitoring. Monitors are placed on your belly to track your baby’s heartbeat and your contractions throughout the process.

3. Cervix ripening. If your cervix isn’t effaced yet, you may receive a ripening agent, or a balloon catheter may be used instead. Once the cervix dilates to around 3 cm, a balloon catheter will fall out on its own. This step can take a couple of hours or happen overnight while you sleep. Sometimes, this alone is enough to start labor with no further interventions needed.

4. Pitocin. If your cervix is already ripe, Pitocin may be started right away through your IV. It begins at a low dose and is adjusted based on how your body responds, bringing on regular, increasingly strong contractions.

5. Vaginal exams. Your care provider will check your dilation and effacement periodically and adjust your care plan accordingly.

6. Rupture of membranes. If it hasn’t happened on its own, your provider may break your amniotic sac using a small hooked instrument.

7. Internal fetal monitoring, if needed. If your care team is having a difficult time monitoring your baby with the external monitor, or if you’re high-risk, your team may suggest using internal monitoring instead. This requires ruptured membranes: a small electrode attaches to your baby’s scalp to track their heart rate, and sometimes a catheter is placed in the uterus to measure contraction strength.

8. Coping with labor pain. Many people find induced contractions more intense than spontaneous ones, in part due to reduced mobility. Epidurals are common at this stage, though some choose not to have an epidural and instead lean on breathing techniques, hypnobirthing, nitrous oxide, and the support of their birth team instead.

9. Birth. Once your contractions are steady and effective, you’ll continue laboring until you’re fully dilated and ready to begin pushing. Once you are fully dilated, your provider will help you determine when it’s time to begin pushing. In some situations, you may spend some time laboring down first.

What Are the Risks of Induction? 

With any birth intervention there is always an element of risk. Your body has a learning curve ahead of it while undergoing any induction method. Your body may react in a variety of ways to a foreign object or external medication.

So, let’s break down a few risks you could encounter when being induced for labor: 

• Infection. Any outside object inserted inside your body increases the risk of introducing bacteria. 
• Increased likelihood of C-section. Any intervention increases the likelihood of more interventions (like C-sections). Sometimes, it can be a domino effect.  
• Uterine rupture. Lengthy exposure to oxytocin (Pitocin) may cause too much stress on the uterine wall. This is very rare but serious. 
• It won’t work. Sometimes, induction doesn’t work and your body does not make progress. When that happens your care provider will usually recommend a c-section after a period of time. 
• Uterine atony. Sometimes inducing labor causes your uterus to not contract after giving birth which is necessary to bring it back down to normal size and heal. While rare, this can cause a postpartum hemorrhage.

Keeping these risks in mind will help you make decisions about your birth going forward. 

Sometimes induction is necessary, but not always. 

5 Natural Ways to Encourage Labor to Start

Some people might happily welcome the idea of inducing labor, especially when they’re feeling overwhelmed and tired of being pregnant. On the other hand, others might prefer to avoid it.

If you’re hoping to avoid induction, taking good care of yourself and your baby is a great place to start. Eating nutritious foods, staying hydrated, staying active, and keeping up with your prenatal care are all important for a healthy pregnancy. Of course, even the healthiest pregnancies sometimes require medical induction.

But what about those natural methods you’ve probably heard about? Can eating dates, having sex, or going for a walk really help get things moving?

Let’s walk through a few things that may help encourage labor to begin on its own, along with what the research tells us.

Tip #1 – Nipple Stimulation. Nipple stimulation helps your body release oxytocin, the hormone that causes contractions during labor. And there’s actually some promising research behind this one! A review of several small studies found that women who used nipple stimulation were more likely to go into labor within 72 hours than those who didn’t. However, more research is needed to better understand how safe and effective it is. Because nipple stimulation can cause strong contractions, check with your care provider before trying it. It’s especially important to avoid this method without medical guidance if you have a high-risk pregnancy.

Tip #2 – Eat a Few Dates. Here’s an excuse to enjoy something sweet! Some research suggests that eating dates during the final weeks of pregnancy may help soften your cervix and get it ready for labor. A few studies have also found that women who ate dates were less likely to need certain medical interventions during labor. The research is still limited, but the findings are encouraging. Many studies have looked at eating about six small dates a day, starting around 36–37 weeks. Dates are also packed with fiber and nutrients, making them a great pregnancy snack. If you have gestational diabetes, check with your care provider about how many are appropriate for you.

Tip #3 – Acupuncture. Some research suggests that acupuncture may help your cervix soften and prepare for labor. However, studies haven’t consistently shown that acupuncture actually starts labor or helps people avoid medical induction. Still, some expectant parents find it relaxing and helpful for easing those everyday pregnancy aches and pains. If you’d like to give it a try, find a licensed acupuncturist who has experience working with pregnant clients.

Tip #4 – Do the Deed. Yes, we’re talking about sex! There’s a reason this one has been passed around as a labor-starting trick for generations. Orgasms can cause your uterus to contract, and semen contains substances called prostaglandins that can help soften the cervix. Sounds promising, right? Unfortunately, studies haven’t found convincing evidence that having sex actually brings on labor. But if you’re feeling up to it, intimacy can still be a lovely way to connect with your partner before your baby arrives. For most people with uncomplicated pregnancies, sex is safe. Just avoid intercourse if your water has broken, you have placenta previa, or your care provider has advised against it.

Tip #5 – Get Moving! Go for a walk, gently rock your hips on a birth ball, or enjoy some prenatal yoga. Staying active can help ease pregnancy discomfort, improve circulation, and keep you feeling good as you prepare for birth. And here’s something interesting! Some research suggests that regular walking during the final weeks of pregnancy may actually help reduce the chances of needing an induction. One study found that women who walked for 30 minutes, three times a week, starting at 38 weeks were less likely to need an induction than those who didn’t follow the walking program. Of course, this doesn’t mean a walk around the neighborhood will send you straight into labor! And there’s no need to exhaust yourself with miles of walking or endless squats. Listen to your body and save some of that energy for the big day.

A Little Reminder: We know those final days and weeks of pregnancy can feel like they’re dragging on forever. It’s completely understandable to be eager to meet your baby. While some of these methods show promise, none can guarantee that labor will begin. It’s best not to try to start labor before 39 weeks unless your care provider recommends it. Always check with your care provider before trying anything intended to bring on contractions. And remember, sometimes induction is the safest choice for you and your baby.

Read more about going past your due date and ways to kick-start labor on our blog Past Your Due Date? 7 Things to Know.

How Can a Doula Help You? 

In the delivery room, it’s helpful to have someone in your corner who is also a knowledgeable professional. 

Hiring a birth doula can put your mind at ease and allows for a more satisfying birth experience.  

Our doulas will…

• Discuss your options with you 
• Know your birth plan 
• Offer emotional and physical support 
• Reduce fear, stress, and anxiety 
• Instill strength 

Allow us to take this journey with you…

We’ve traveled it many times… and we’re prepared to take on the hills and valleys with you every step of the way. 

Schedule a call with us here. 

We can’t wait to hear from you!

Further Reading

Want to dig deeper into the evidence behind induction? These resources from Evidence Based Birth are a great place to start:

• Induction for Big Baby
• Induction for Going Past Your Due Date
• Failed Inductions
• Induction for Low Amniotic Fluid
• Induction for Ruptured Membranes

Also check out our Complete Labor & Birth Prep Guide.