An induction of labor is when medication and other techniques are used to bring on labor. There are various reasons why labor can be induced: going well over your due date is only one of them.

Dr. Monica Lee, herself induced due to preeclampsia, offers insight on all that you need to know about labor induction, including the why, the how, and the million dollar question we all have: is an induction more painful than a birth that starts on its own?

Daniela: Good morning, Dr. Lee; welcome to Dreaming of Baby. As part of our segment on childbirth, we are looking forward to having your insight on induction of labor. Before we start with our discussion, grateful if you could introduce yourself to our readers.

Dr. Monica Lee: I am a UCLA trained obstetrician-gynecologist in southern California. I have been practicing for over nine years and have delivered over 1000 babies. My own pregnancy was induced for severe preeclampsia, so I went through the whole process myself.

What is labor induction?

Daniela: Thank you for this introduction, Dr. Lee, it’s great to have you with us today. With the aim of providing a thorough overview to our readers on this subject, what is ‘induction of labor’?

Dr. Monica Lee: It is the provocation of labor with medication when natural labor is not present. You are stimulating contractions with medication to open the cervix in order to have a vaginal birth.

Dr. Monica Lee: “[Labor induction] is the provocation of labor with medication when natural labor is not present.”

Why would labor be induced?

Daniela: Why would labor be induced? What factors usually lead to this?

Dr. Monica Lee: There are numerous reasons. The pregnancy can be way past the due date, over 41 weeks. The baby could be having issues such as intrauterine growth restriction. The mom could be sick such as preeclampsia. There could be a risk to the baby in certain instances if the pregnancy is prolonged, such as cholestasis of pregnancy, diabetes, and high blood pressure.

Daniela: Thank you for this overview. How early can labor be induced if there are such risks?

Dr. Monica Lee: As early as is necessary to keep baby and mommy healthy. Most of the time you don’t see an induction unless the baby can tolerate the process so usually some of the earliest inductions are around 33 or 34 weeks, but sometimes earlier for severe preeclampsia.

Daniela: You note that an induction is only done if the baby can tolerate the process. What would determine this? Would C-sections be more common in case of risks to the mother?

Dr. Monica Lee: Labor induction usually doesn’t cause more risk to the mother. A cesarean is usually regarded more dangerous for mom since it is a major surgery. A vaginal delivery occurs in an already naturally occurring orifice that enlarges for the process.

Dr. Monica Lee: The baby tolerating the process of labor induction is measured by fetal heart monitoring. There are monitors on the mother’s abdomen during the entire labor to make sure baby’s heart rate doesn’t show stress patterns. If the stress patterns are bad, then the result is a cesarean section to prevent brain damage/death.

How is labor induced?

Daniela: Many thanks for clarifying. Going into the specifics of labor induction, how is labor induced?

Dr. Monica Lee: There are several methods: prostaglandins such as misoprostol (aka Cytotec), Cervidil. There is Pitocin, foley balloon, cooks balloon or rupture of membranes.

Daniela: For the benefit of our readers, can you please elaborate on these procedures?

Dr. Monica Lee:
– Cytotec can be placed in the mouth to dissolve or in the vagina to dissolve every 4-6 hours if contractions permit. They soften the cervix and cause it to open easier, called cervical ripening.
– Pitocin is placed through an IV infusion causing constant contractions to also soften the cervix and open it.
– Foley balloon and cooks balloon are placed through the cervix into the uterus; this causes pressure to open up the cervix mechanically. Balloons are sometimes used with Pitocin to augment the process.
– Rupture of membranes can only be done if the cervix is already open and your nurse, midwife or doctor puts a hook up the vagina and hooks the bag of water to prick it open.

Daniela: To clarify then, once the cervix is open, the rupture of membranes can take place? How dilated must the mom-to-be be before the membranes can be ruptured?

Dr. Monica Lee: Technically, you can rupture the membrane as long as you can get the hook up there, so sometimes at even 1-2 cm dilation. But usually, I try not to rupture the membranes until active labor, 6 cm. But if the patient is on her 3rd baby and she is already 4 cm dilated and she is having regular contractions then I might rupture her, knowing her labor will go quickly. This is where medical experience and judgment kick in.

Daniela: So why is it preferable to wait for further dilation? Would there be risks involved if the membranes are ruptured too early?

Dr. Monica Lee: Yes, if the labor was prolonged and the membranes were ruptured, there is a higher risk of infection, which could cause high fever, fetal distress and thus cesarean section and endometritis.

Daniela: And would the endometritis risk, in this case, be connected to the cesarean section or the early rupture of membranes?

Dr. Monica Lee: Endometritis is an infection of the uterus. It is connected to both processes and is more common if you have rupture of membranes causing an infection called chorioamnionitis and then increases even more after a cesarean section.

Is an induced labor more painful?

Daniela: Thank you for clarifying. We’ve had quite a few questions from expectant moms asking if the procedures for inducing labor are painful – as well as if there’s a difference in pain levels between naturally occurring labor and an induction. Can you offer some insight on this?

Dr. Monica Lee: Labor itself is painful, it requires contractions that cause cervical dilation. But I have not seen many patients complain during the early labor process since the contractions are not super strong at that time, even at the time of induction. Induction does take longer so women are more exhausted by the time active labor rolls around. Tired people are more mentally exhausted and can experience more pain and anxiety. People who get induced are already more anxious since there is a perception that things are not perfect. Anxiety tends to augment pain also.

Dr. Monica Lee: Pain is a subjective feeling and thus can be affected by your mental state. This is where mind-calming methods can help, such as the practice of meditation. You can also always get an epidural to help with the pain. My labor did not hurt until the medicine in my epidural ran out. But then when the anesthesiologist topped it off the pain was gone again.

Dr. Monica Lee: “Pain is a subjective feeling and thus can be affected by your mental state.”

Daniela: Thank you for sharing this very helpful information. Are there any pain relief options that women can avail of in the early stages when labor is being induced? Can an epidural be administered that early?

Dr. Monica Lee: Yes, an epidural can be administered as long as the patient will be admitted and will not leave until a delivery occurs. I had mine placed at 1 cm since the chief of anesthesia was leaving soon, I asked for him before he left. He had it placed in 3 minutes and I didn’t even feel it go in.

Dr. Monica Lee: “An epidural can be administered as long as the patient will be admitted and will not leave until a delivery occurs.”

Daniela: That’s great to know – If a woman has gone past her due date, are there any safe methods she can try at home to get things going?

Dr. Monica Lee: Unfortunately, there are no proven home methods for induction. I usually tell patients to walk and have sex to help things but there is no evidence that works.

Daniela: You noted earlier that when a labor is induced it may last longer – What is the average time until delivery for an induced first-time mom?

Dr. Monica Lee: 24-48 hours, but sometimes can last up to 3-4 days.

Risks of labor induction

Daniela: Ok – that is intensive. It helps to keep in mind what you shared with us before on the importance of mind-calming methods. We’re aware that this may be a cause of concern for many when they receive the news that they will have to be induced: what are the risks – if any, associated with labor induction?

Dr. Monica Lee: There are many risks, but most commonly fetal distress causing cesarean and infection, both of which are risks for any normal labor. If the cervix is not favorable the risk for cesarean is higher. Overall, an induction is not necessarily more dangerous than natural labor if monitored closely and performed correctly.

Dr. Monica Lee: “Overall, an induction is not necessarily more dangerous than natural labor if monitored closely and performed correctly.”

Daniela: Thank you for the insight you have shared with us today, Dr. Lee. It was a pleasure speaking with you on this subject. On a final note, what would be the advice that you’d give to an expectant mom about to undergo labor induction and who may be feeling anxious about the whole process?

Dr. Monica Lee: Best to tell her obstetrician and have a conversation about it. Hopefully she picked the right OB and they have the right chemistry so that the OB can make her feel better.

Daniela: Great, thank you for your time today, Dr. Lee; it’s been enlightening!

Dr. Monica Lee: No problem, have a great day!

Dr. Monica Lee is a contributor to Mommy MD Guides

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