View source for Labor induction

{{Short description|Artificial stimulation of childbirth}}
{{redirect|Medically induced|the type of coma|Induced coma}}
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{{Infobox medical intervention |
  Name        = Labor induction |
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  ICD9        = {{ICD9proc|73.0}}-{{ICD9proc|73.1}} |
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|alt=|Synonym=induction of labor, labour induction}}
'''Labor induction''' is the procedure where a medical professional starts the process of labor ([[Childbirth|giving birth]]) instead of letting it start on its own. Labor may be induced (started) if the health of the mother or the baby is at risk. Induction of labor can be accomplished with pharmaceutical or non-pharmaceutical methods.<ref name=":5">{{Cite web |title=Labor Induction |url=https://www.acog.org/womens-health/faqs/labor-induction |access-date=2025-02-10 |website=American College of Obstetricians and Gynecologists |language=en}}</ref>

In [[Western countries]], it is estimated that one-quarter of [[Pregnancy|pregnant women]] have their labor medically induced with drug treatment.<ref name=":0" /> Inductions are most often performed either with [[prostaglandin]] drug treatment alone, or with a combination of prostaglandin and intravenous [[oxytocin]] treatment.<ref name=":0" />

==Causes==
{{Women's health sidebar}}
Commonly accepted medical reasons for induction include:
* [[Postterm pregnancy]], i.e. if the pregnancy has gone past the end of the 42nd week.
* [[Intrauterine growth restriction|Intrauterine fetal growth restriction]].
* There are health risks to the woman in continuing the pregnancy (e.g. [[pre-eclampsia]]).
* [[Prelabor rupture of membranes|Premature rupture of the membranes]]; this is when the membranes have ruptured, but labor does not start within a specific amount of time.<ref>Allahyar, J. & Galan, H. "Premature Rupture of the Membranes."; also American College of Obstetrics and Gynecologists.</ref>
* Premature termination of the pregnancy ([[abortion]]).
* [[Perinatal mortality|Fetal death]] in utero and previous history of [[stillbirth]].
* [[Twin]] pregnancy continuing beyond 38 weeks.
* Previous health conditions that puts risk on the woman and/or her child such as [[Diabetes mellitus|diabetes]], [[Hypertension|high blood pressure]].
* High [[body mass index]].
* [[Macrosomia]].<ref>{{cite journal | doi=10.1056/NEJMoa1800566 | title=Labor Induction versus Expectant Management in Low-Risk Nulliparous Women | date=2018 | last1=Grobman | first1=William A. | last2=Rice | first2=Madeline M. | last3=Reddy | first3=Uma M. | last4=Tita | first4=Alan T.N. | last5=Silver | first5=Robert M. | last6=Mallett | first6=Gail | last7=Hill | first7=Kim | last8=Thom | first8=Elizabeth A. | last9=El-Sayed | first9=Yasser Y. | last10=Perez-Delboy | first10=Annette | last11=Rouse | first11=Dwight J. | last12=Saade | first12=George R. | last13=Boggess | first13=Kim A. | last14=Chauhan | first14=Suneet P. | last15=Iams | first15=Jay D. | last16=Chien | first16=Edward K. | last17=Casey | first17=Brian M. | last18=Gibbs | first18=Ronald S. | last19=Srinivas | first19=Sindhu K. | last20=Swamy | first20=Geeta K. | last21=Simhan | first21=Hyagriv N. | last22=MacOnes | first22=George A. | journal=New England Journal of Medicine | volume=379 | issue=6 | pages=513–523 | pmid=30089070 | pmc=6186292 }}</ref>

Induction of labor in those who are either at or after term improves outcomes for newborns and decreases the number of [[Caesarean section|C-sections]] performed.<ref>{{cite journal|last1=Mishanina|first1=E|last2=Rogozinska|first2=E|last3=Thatthi|first3=T|last4=Uddin-Khan|first4=R|last5=Khan|first5=KS|last6=Meads|first6=C|title=Use of labour induction and risk of cesarean delivery: a systematic review and meta-analysis.|journal=Canadian Medical Association Journal |date=Jun 10, 2014|volume=186|issue=9|pages=665–73|pmid=24778358|doi=10.1503/cmaj.130925|pmc=4049989}}</ref>

== Methods ==
{{Redirect|Labor inducer|the hamburger|Labor Inducer (hamburger)}}
Methods of inducing labor include both pharmacological medication and mechanical or physical approaches.<ref name=":5" />

Mechanical and physical approaches can include [[artificial rupture of membranes]] or membrane sweeping. Membrane sweeping may lead to more women spontaneously going into labor (and fewer women having labor induction) but it may make little difference to the risk of maternal or neonatal death, or to the number of women having [[c-sections]] or spontaneous vaginal births. There are also risks associated with membrane sweeping. The risks include irregular contractions, [[Obstetrical bleeding|bleeding]], and in 1 out of every 10 women an [[amniotic sac]] rupture, which can lead to a formal induction within 24 hours of the rupture if labor hasn't been induced.<ref name=":4">{{cite journal |last1=Finucane |first1=EM |last2=Murphy |first2=DJ |last3=Biesty |first3=LM |last4=Gyte |first4=GM |last5=Cotter |first5=AM |last6=Ryan |first6=EM |last7=Boulvain |first7=M |last8=Devane |first8=D |title=Membrane sweeping for induction of labour. |journal=The Cochrane Database of Systematic Reviews |date=27 February 2020 |volume=2 |issue=2 |article-number=CD000451 |doi=10.1002/14651858.CD000451.pub3 |pmid=32103497|pmc=7044809 }}</ref>

The use of intrauterine catheters are also indicated. These work by compressing the [[cervix]] mechanically to generate release on [[Prostaglandin|prostaglandins]] in local tissues. There is no direct effect on the [[uterus]]. Results from a 2021 systematic review found no differences in [[Caesarean section|cesarean delivery]] nor [[neonatal]] outcomes in women with low-risk pregnancies between inpatient nor outpatient cervical ripening.<ref>{{Cite book |last1=McDonagh |first1=Marian |url=https://www.ncbi.nlm.nih.gov/books/NBK569292/ |title=Cervical Ripening in the Outpatient Setting |last2=Skelly |first2=Andrea C. |last3=Hermesch |first3=Amy |last4=Tilden |first4=Ellen |last5=Brodt |first5=Erika D. |last6=Dana |first6=Tracy |last7=Ramirez |first7=Shaun |last8=Fu |first8=Rochelle |last9=Kantner |first9=Shelby N. |date=2021 |publisher=Agency for Healthcare Research and Quality (US) |series=AHRQ Comparative Effectiveness Reviews |location=Rockville (MD) |pmid=33818996}}</ref>

===Medication===
* [[Intravaginal administration|Intravaginal]], endocervical or [[extra-amniotic administration]] of [[prostaglandin]], such as [[Prostaglandin E2|dinoprostone]] or [[misoprostol]].<ref name="pmid15043790">{{cite journal |vauthors=Li XM, Wan J, Xu CF, Zhang Y, Fang L, Shi ZJ, Li K |title=Misoprostol in labor induction of term pregnancy: a meta-analysis|journal=Chin Med J (Engl)|volume=117 |issue=3 |pages=449–52 |date=March 2004 |pmid=15043790 }}</ref> [[Prostaglandin E2]] is the most studied compound and with most evidence behind it.{{Citation needed|date=August 2018}} A range of different dosage forms are available with a variety of routes possible. The use of misoprostol has been extensively studied but normally in small, poorly defined studies. Only a very few countries have approved [[misoprostol]] for use in induction of labor.{{Citation needed|date=August 2018}}
* [[Intravenous therapy|Intravenous]] (IV) administration of synthetic [[oxytocin]] preparations is used to artificially induce labor if it is deemed medically necessary.<ref name=":0" /> A high dose of oxytocin does not seem to have greater benefits than a standard dose.<ref>{{cite journal|last1=Budden|first1=A|last2=Chen|first2=LJ|last3=Henry|first3=A|title=High-dose versus low-dose oxytocin infusion regimens for induction of labour at term.|journal=The Cochrane Database of Systematic Reviews|date=Oct 9, 2014|volume=10|issue=10|article-number=CD009701|pmid=25300173|doi=10.1002/14651858.CD009701.pub2|pmc=8932234|s2cid=205201341}}</ref> There are risks associated with IV oxytocin induced labor. Risks include the women having induced contractions that are too vigorous, too close together (frequent), or that last too long, which may lead to added stress on the baby (changes in baby's heart rate) and may require the mother to have an emergency [[caesarean section]].<ref name=":0" /> There is no high quality evidence to indicate if IV oxytocin should be stopped once a woman reaches active labor in order to reduce the incidence of women requiring caesarean sections.<ref name=":0">{{Cite journal|last1=Boie|first1=Sidsel|last2=Glavind|first2=Julie|last3=Velu|first3=Adeline V.|last4=Mol|first4=Ben Willem J.|last5=Uldbjerg|first5=Niels|last6=de Graaf|first6=Irene|last7=Thornton|first7=Jim G.|last8=Bor|first8=Pinar|last9=Bakker|first9=Jannet Jh|date=2018-08-20|title=Discontinuation of intravenous oxytocin in the active phase of induced labour|journal=The Cochrane Database of Systematic Reviews|volume=2018|issue=8|article-number=CD012274|doi=10.1002/14651858.CD012274.pub2 |pmid=30125998|pmc=6513418}}</ref>
* Use of [[mifepristone]] has been described but is rarely used in practice.<ref name="pmid16647925">{{cite journal |vauthors=Clark K, Ji H, Feltovich H, Janowski J, Carroll C, Chien EK |title=Mifepristone-induced cervical ripening: structural, biomechanical, and molecular events |journal=Am. J. Obstet. Gynecol. |volume=194 |issue=5 |pages=1391–8 |date=May 2006 |pmid=16647925 |doi=10.1016/j.ajog.2005.11.026 }}</ref>
* [[Relaxin]] has been investigated,<ref name="pmid11406079">{{cite journal |vauthors=Kelly AJ, Kavanagh J, Thomas J |title=Relaxin for cervical ripening and induction of labor |journal=Cochrane Database Syst Rev |issue=2 |article-number=CD003103 |year=2001 |volume=2010 |pmid=11406079 |doi=10.1002/14651858.CD003103 |pmc=8693181 }}</ref> but is not currently commonly used.
* mnemonic; ARNOP: [[Antiprogestogen|Antiprogesterone]], relaxin, [[nitric oxide]] donors, oxytocin, prostaglandins

===Non-pharmaceutical===
* Membrane sweep, also known as membrane stripping, Hamilton maneuver, or "stretch and sweep". The procedure is carried out by a [[midwife]] or doctor as part of an internal vaginal examination. The midwife or doctor inserts lubricated, gloved fingers into the vagina and inserts their index finger into the opening of the cervix or neck of the womb. They then use a circular movement to try to separate the membranes of the amniotic sac, containing the baby, from the cervix. This action, which releases hormones called prostaglandins, may prepare the cervix for birth and may initiate labour.<ref>{{cite web |title=Stretch and sweep |url=https://www.pregnancybirthbaby.org.au/stretch-and-sweep |website=www.pregnancybirthbaby.org.au|date=24 March 2021 }}</ref> While this process can cause discomfort, bleeding, and irregular contractions and carries the risk of breaking the amniotic sack,<ref>{{Cite journal |last1=Boulvain |first1=Michel |last2=Stan |first2=Catalin M |last3=Irion |first3=Olivier |date=2005-01-24 |editor-last=Cochrane Pregnancy and Childbirth Group |title=Membrane sweeping for induction of labour |journal=Cochrane Database of Systematic Reviews |volume=2005 |issue=1 |article-number=CD000451 |language=en |doi=10.1002/14651858.CD000451.pub2 |pmc=7032890 |pmid=15674873}}</ref> many would still choose to have membrane sweeping carried out for their next birth.<ref name=":4" /> 
* [[Artificial rupture of membranes|Artificial rupture of the membranes]] (AROM or ARM) ("breaking the waters")
* Extra-amniotic saline infusion (EASI),<ref name=Guinn2004>{{Cite journal | last1 = Guinn | first1 = D. A. | last2 = Davies | first2 = J. K. | last3 = Jones | first3 = R. O. | last4 = Sullivan | first4 = L. | last5 = Wolf | first5 = D. | title = Labor induction in women with an unfavorable Bishop score: Randomized controlled trial of intrauterine Foley catheter with concurrent oxytocin infusion versus Foley catheter with extra-amniotic saline infusion with concurrent oxytocin infusion | doi = 10.1016/j.ajog.2003.12.039 | journal = American Journal of Obstetrics and Gynecology | volume = 191 | issue = 1 | pages = 225–229 | year = 2004 | pmid = 15295370 }}</ref> in which a [[Foley catheter]] is inserted into the [[cervix]] and the distal portion expanded to dilate it and to release prostaglandins.
* Cook Medical Double Balloon known as the Cervical Ripening Balloon with Stylet for assisted placement is approved by the [[Food and Drug Administration|FDA]] in the United States. The Double balloon provides one balloon to be inflated with [[Saline (medicine)|saline]] on one side of the uterine side of the cervix and the second balloon to be inflated with saline on the vaginal side of the cervix.

== Timing and risks ==
{{See also|Gestational age|Postterm pregnancy}}
Labor induction before 39 weeks of pregnancy is not recommended unless there the mother or her child would be at risk otherwise.<ref>{{Cite journal |last=Grobman |first=William A. |date=2022-09-06 |title=The role of labor induction in modern obstetrics |url=https://linkinghub.elsevier.com/retrieve/pii/S0002937822001909 |journal=American Journal of Obstetrics and Gynecology |language=en |volume=230 |issue=3 |pages=S662–S668 |doi=10.1016/j.ajog.2022.03.019|pmid=38299461 |url-access=subscription }}</ref><ref>{{Cite web |title=Induction of Labor at 39 Weeks |url=https://www.acog.org/womens-health/faqs/induction-of-labor-at-39-weeks |access-date=2025-02-11 |website=American College of Obstetricians and Gynecologists |language=en}}</ref> Some [[Medical guideline|medical guidelines]] recommend waiting until 41 weeks with low-risk pregnancies before induction.<ref>{{Cite web |date=4 November 2021 |title=Inducing labour. NICE guideline |url=https://www.nice.org.uk/guidance/ng207/ |access-date=2025-02-11 |website=National Institute for Health and Care Excellence}}</ref><ref name=":6">{{Cite book |url=https://iris.who.int/bitstream/handle/10665/363138/9789240052796-eng.pdf |title=WHO Recommendations on Induction of Labour, at or Beyond Term |date=2022 |publisher=World Health Organization |isbn=978-92-4-005279-6 |edition= |location=Geneva}}</ref> Doctors and pregnant women should have a discussion of risks and benefits when considering an induction of labor in the absence of an accepted medical indication.<ref name="ACOGfive">{{Citation |author1=American Congress of Obstetricians and Gynecologists |title=Five Things Physicians and Patients Should Question |work=[[Choosing Wisely]]: an initiative of the [[ABIM Foundation]] |url=http://www.choosingwisely.org/doctor-patient-lists/american-college-of-obstetricians-and-gynecologists/ |access-date=August 1, 2013 |archive-url=https://web.archive.org/web/20130901094916/http://www.choosingwisely.org/doctor-patient-lists/american-college-of-obstetricians-and-gynecologists/ |archive-date=September 1, 2013 |publisher=[[American Congress of Obstetricians and Gynecologists]] |author1-link=American Congress of Obstetricians and Gynecologists}}, which cites

* {{cite book |author1=American Academy of Pediatrics |author-link1=American Academy of Pediatrics |title=Guidelines for perinatal care |author2=American College of Obstetricians and Gynecologists |author-link2=American College of Obstetricians and Gynecologists |publisher=American Academy of Pediatrics |year=2012 |isbn=978-1-58110-734-0 |edition=7th |location=Elk Grove Village, IL}}
* {{Cite journal |author=ACOG Committee on Practice Bulletins |year=2009 |title=ACOG Practice Bulletin No. 107: Induction of Labor |journal=Obstetrics & Gynecology |volume=114 |issue=2, Part 1 |pages=386–397 |doi=10.1097/AOG.0b013e3181b48ef5 |pmid=19623003}}</ref>

Inducing labor before 39 weeks in the absence of a medical indication (such as [[Hypertensive disease of pregnancy|hypertension]], [[intrauterine growth restriction]], or [[pre-eclampsia]]) increases the risk of complications of [[Preterm birth|prematurity]] including difficulties with respiration, infection, feeding, [[jaundice]], [[neonatal intensive care unit]] admissions, and perinatal death.<ref>{{cite web |date=2011-07-18 |title=Doctors To Pregnant Women: Wait At Least 39 Weeks |url=https://www.npr.org/templates/transcript/transcript.php?storyId=138473097 |access-date=2011-08-20 |website=[[NPR]]}}</ref> Inducing labor after 34 weeks and before 37 weeks in women with [[Hypertensive disease of pregnancy|pregnancy-related hypertensive disorders]] (pre-eclampsia, [[eclampsia]], [[Gestational Hypertension|gestational hypertension]]) may lead to better outcomes for the woman but does not improve or worsen outcomes for the baby.<ref name=":2">{{Cite journal |last1=Cluver |first1=Catherine |last2=Novikova |first2=Natalia |last3=Koopmans |first3=Corine M. |last4=West |first4=Helen M. |date=2017 |title=Planned early delivery versus expectant management for hypertensive disorders from 34 weeks gestation to term |journal=The Cochrane Database of Systematic Reviews |volume=1 |issue=1 |article-number=CD009273 |doi=10.1002/14651858.CD009273.pub2 |pmc=6465052 |pmid=28106904}}</ref> 

[[Postterm pregnancy|Postterm pregnancies]] lasting beyond 41–42 weeks are associated with increased risks of [[stillbirth]], [[Perinatal mortality|neonatal death]] and [[caesarean section]] which can be reduced by inducing labor.<ref>{{Cite journal |last1=Borovac-Pinheiro |first1=Anderson |last2=Inversetti |first2=Annalisa |last3=Di Simone |first3=Nicoletta |last4=Barnea |first4=Eytan R. |last5=the FIGO Childbirth and Postpartum Hemorrhage Committee |date=8 October 2023 |title=FIGO good practice recommendations for induced or spontaneous labor at term: Prep-for-Labor triage to minimize risks and maximize favorable outcomes |url=https://obgyn.onlinelibrary.wiley.com/doi/10.1002/ijgo.15114 |journal=International Journal of Gynecology & Obstetrics |language=en |volume=163 |issue=S2 |pages=51–56 |doi=10.1002/ijgo.15114 |pmid=37807591 |issn=0020-7292|url-access=subscription }}</ref><ref>{{Cite web |title=Labor Induction |url=https://www.acog.org/womens-health/faqs/labor-induction |access-date=2025-02-11 |website=American College of Obstetricians and Gynecologists |language=en}}</ref><ref name=":6" /><ref>{{cite journal |last1=Middleton |first1=P |last2=Shepherd |first2=E |last3=Morris |first3=J |last4=Crowther |first4=CA |last5=Gomersall |first5=JC |date=15 July 2020 |title=Induction of labour at or beyond 37 weeks' gestation. |journal=The Cochrane Database of Systematic Reviews |volume=7 |issue=8 |article-number=CD004945 |doi=10.1002/14651858.CD004945.pub5 |pmc=7389871 |pmid=32666584}}</ref>

If waters break ([[Rupture of membranes|membranes rupture]]) between 24 and 37 weeks' [[gestation]], waiting for the labor to start naturally with careful monitoring of the woman and baby is more likely to lead to healthier outcomes.<ref>{{cite journal |last1=Bond |first1=DM |last2=Middleton |first2=P |last3=Levett |first3=KM |last4=van der Ham |first4=DP |last5=Crowther |first5=CA |last6=Buchanan |first6=SL |last7=Morris |first7=J |title=Planned early birth versus expectant management for women with preterm prelabour rupture of membranes prior to 37 weeks' gestation for improving pregnancy outcome. |journal=The Cochrane Database of Systematic Reviews |date=3 March 2017 |volume=2017 |issue=3 |article-number=CD004735 |doi=10.1002/14651858.CD004735.pub4 |pmid=28257562|pmc=6464692 }}</ref> For women over 37 weeks pregnant whose babies are suspected of not coping well in the womb, it is not yet clear from research whether it is best to have an induction or caesarean immediately, or to wait until labour happens by itself.<ref>{{Cite journal|last1=Bond|first1=Diana M.|last2=Gordon|first2=Adrienne|last3=Hyett|first3=Jon|last4=de Vries|first4=Bradley|last5=Carberry|first5=Angela E.|last6=Morris|first6=Jonathan|date=2015-11-24|title=Planned early delivery versus expectant management of the term suspected compromised baby for improving outcomes|journal=The Cochrane Database of Systematic Reviews|volume=2016 |issue=11|article-number=CD009433|doi=10.1002/14651858.CD009433.pub2 |pmid=26599471|pmc=8935540 }}</ref> Similarly, there is not yet enough research to show whether it is best to deliver babies prematurely if they are not coping in the womb or whether to wait so that they are less premature when they are born.<ref>{{Cite journal|last1=Stock|first1=Sarah J.|last2=Bricker|first2=Leanne|last3=Norman|first3=Jane E.|last4=West|first4=Helen M.|date=2016-07-12|title=Immediate versus deferred delivery of the preterm baby with suspected fetal compromise for improving outcomes|journal=The Cochrane Database of Systematic Reviews|volume=2016|issue=7|article-number=CD008968|doi=10.1002/14651858.CD008968.pub3 |pmid=27404120|pmc=6457969}}</ref>

Sometimes when a woman's waters break after 37 weeks she is induced instead of waiting for labour to start naturally.<ref name=":3">{{Cite journal |last1=Middleton |first1=Philippa |last2=Shepherd |first2=Emily |last3=Flenady |first3=Vicki |last4=McBain |first4=Rosemary D. |last5=Crowther |first5=Caroline A. |date=2017 |title=Planned early birth versus expectant management (waiting) for prelabour rupture of membranes at term (37 weeks or more) |journal=The Cochrane Database of Systematic Reviews |volume=1 |issue=1 |article-number=CD005302 |doi=10.1002/14651858.CD005302.pub3 |pmc=6464808 |pmid=28050900}}</ref> This may decrease the risks of infection for the woman and baby but more research is needed to find out whether inducing is good for women and babies longer term.<ref name=":3" />

Women who have had a caesarean section for a previous pregnancy are at risk of having a [[uterine rupture]], when their [[Uterine niche|caesarean scar]] re-opens.<ref name=":1">{{Cite journal |last1=West |first1=Helen M. |last2=Jozwiak |first2=Marta |last3=Dodd |first3=Jodie M. |date=2017 |title=Methods of term labour induction for women with a previous caesarean section |journal=The Cochrane Database of Systematic Reviews |volume=2017 |issue=6 |article-number=CD009792 |doi=10.1002/14651858.CD009792.pub3 |pmc=6481365 |pmid=28599068}}</ref><ref name=":7">{{Cite journal |last1=Dodd |first1=Jodie M. |last2=Crowther |first2=Caroline A. |last3=Grivell |first3=Rosalie M. |last4=Deussen |first4=Andrea R. |date=2017 |title=Elective repeat caesarean section versus induction of labour for women with a previous caesarean birth |journal=The Cochrane Database of Systematic Reviews |volume=2017 |issue=7 |article-number=CD004906 |doi=10.1002/14651858.CD004906.pub5 |pmc=6483152 |pmid=28744896}}</ref> Uterine rupture is a serious threat for the woman and the baby, and induction of labour increases this risk further. There is not yet enough research to determine which method of induction is safest for a woman who has had a caesarean section before.<ref name=":1" /> There is also no research to say whether it is better for these women and their babies to have an elective caesarean section instead of being induced.<ref name=":7" />

There is insufficient scientific evidence to determine if inducing a woman's labor at home is a safe and effective approach for both the woman and the baby.<ref>{{cite journal |last1=Alfirevic |first1=Zarko |last2=Gyte |first2=Gillian ML |last3=Nogueira Pileggi |first3=Vicky |last4=Plachcinski |first4=Rachel |last5=Osoti |first5=Alfred O |last6=Finucane |first6=Elaine M |date=27 August 2020 |title=Home versus inpatient induction of labour for improving birth outcomes |journal=Cochrane Database of Systematic Reviews |volume=2020 |issue=8 |article-number=CD007372 |doi=10.1002/14651858.CD007372.pub4 |pmc=8094591 |pmid=32852803}}</ref>

=== Predicting the necessity of induction ===
Clinicians assess the odds of having a [[vaginal delivery]] after labor induction by a "[[Bishop score]]". However, recent research has questioned the relationship between the Bishop score and a successful induction, finding that a poor Bishop score actually may improve the chance for a vaginal delivery after induction.<ref name="cmaj.ca">Ekaterina Mishanina et al., "Use of labour induction and risk of cesarean delivery: a systematic review and meta-analysis", April 2014, Canadian Medical Association Journal, [http://www.cmaj.ca/content/early/2014/04/28/cmaj.130925]</ref> A Bishop Score is done to assess the progression of the cervix prior to an induction. In order to do this, the cervix must be checked to see how much it has effaced, thinned out, and how far dilated it is. The score goes by a points system depending on five factors. Each factor is scored on a scale of either 0–2 or 0–3, any total score less than 5 holds a higher risk of delivering by caesarean section.<ref>
Doheny, K. (2010, June 22). Labor Induction May Boost C-Section Risk. HealthDay Consumer News Service. Retrieved from EBSCOhost.
</ref>

== Women's experiences ==
Women often do not receive clear and detailed information about the process of labor induction, its benefits and risks.<ref>{{Cite journal |last1=Roberts |first1=Julie |last2=Evans |first2=Kerry |last3=Spiby |first3=Helen |last4=Evans |first4=Catrin |last5=Pallotti |first5=Phoebe |last6=Eldridge |first6=Jeanette |date=15 January 2020 |title=Women's information needs, decision-making and experiences of membrane sweeping to promote spontaneous labour |url=https://linkinghub.elsevier.com/retrieve/pii/S0266613819303171 |journal=Midwifery |language=en |volume=83 |article-number=102626 |doi=10.1016/j.midw.2019.102626|pmid=31954296 }}</ref><ref name=":8">{{Cite journal |last1=Coates |first1=Rose |last2=Cupples |first2=Georgina |last3=Scamell |first3=Amanda |last4=McCourt |first4=Christine |date=1 November 2018 |title=Women's experiences of induction of labour: Qualitative systematic review and thematic synthesis |url=https://linkinghub.elsevier.com/retrieve/pii/S0266613818303115 |journal=Midwifery |language=en |volume=69 |pages=17–28 |doi=10.1016/j.midw.2018.10.013|pmid=30390463 |url-access=subscription }}</ref><ref>{{Cite journal |last1=von Dadelszen |first1=Peter |last2=Tohill |first2=Susan |last3=Wade |first3=Julie |last4=Hutcheon |first4=Jennifer A. |last5=Scott |first5=Janet |last6=Green |first6=Marcus |last7=Thornton |first7=James G. |last8=Magee |first8=Laura A. |last9=the WILL Pilot Trial Study Group |date=2022-11-21 |title=Labor induction information leaflets—Do women receive evidence-based information about the benefits and harms of labor induction? |journal=Frontiers in Global Women's Health |volume=3 |doi=10.3389/fgwh.2022.936770 |doi-access=free |issn=2673-5059 |pmc=9719962 |pmid=36479232}}</ref><ref name=":9">{{Cite journal |last1=Coates |first1=Dominiek |last2=Goodfellow |first2=Alison |last3=Sinclair |first3=Lynn |date=24 January 2020 |title=Induction of labour: Experiences of care and decision-making of women and clinicians |url=https://linkinghub.elsevier.com/retrieve/pii/S1871519219302318 |journal=Women and Birth |language=en |volume=33 |issue=1 |pages=e1–e14 |doi=10.1016/j.wombi.2019.06.002|pmid=31208865 |url-access=subscription }}</ref> For example women might not know how long the process will last, how long they need to stay in the hospital and how strong the pain caused by the procedure would be.<ref name=":8" /> Providing up-to-date information about the procedure allows women to make an informed choice and give an [[informed consent]] or refuse the induction.<ref>{{Cite journal |last1=Coates |first1=Dominiek |last2=Makris |first2=Angela |last3=Catling |first3=Christine |last4=Henry |first4=Amanda |last5=Scarf |first5=Vanessa |last6=Watts |first6=Nicole |last7=Fox |first7=Deborah |last8=Thirukumar |first8=Purshaiyna |last9=Wong |first9=Vincent |last10=Russell |first10=Hamish |last11=Homer |first11=Caroline |date=2020-01-29 |editor-last=Mastrolia |editor-first=Salvatore Andrea |title=A systematic scoping review of clinical indications for induction of labour |journal=PLOS ONE |language=en |volume=15 |issue=1 |article-number=e0228196 |doi=10.1371/journal.pone.0228196 |doi-access=free |issn=1932-6203 |pmc=6988952 |pmid=31995603|bibcode=2020PLoSO..1528196C }}</ref><ref name=":9" /><ref>{{Cite journal |last1=Rydahl |first1=Eva |last2=Eriksen |first2=Lena |last3=Juhl |first3=Mette |date=February 2019 |title=Effects of induction of labor prior to post-term in low-risk pregnancies: a systematic review |journal=JBI Database of Systematic Reviews and Implementation Reports |language=en |volume=17 |issue=2 |pages=170–208 |doi=10.11124/JBISRIR-2017-003587 |issn=2202-4433 |pmc=6382053 |pmid=30299344}}</ref>

Many women reported feeling that they were not [[Shared decision-making in medicine|involved in making the decision]] whether to induce labor and that this decision is made for them instead.<ref>{{Cite journal |last1=Lou |first1=Stina |last2=Hvidman |first2=Lone |last3=Uldbjerg |first3=Niels |last4=Neumann |first4=Lone |last5=Jensen |first5=Trine Fritzner |last6=Haben |first6=Joke-Gesine |last7=Carstensen |first7=Kathrine |date=18 December 2018 |title=Women's experiences of postterm induction of labor: A systematic review of qualitative studies |url=https://onlinelibrary.wiley.com/doi/10.1111/birt.12412 |journal=Birth |language=en |volume=46 |issue=3 |pages=400–410 |doi=10.1111/birt.12412 |pmid=30561053 |issn=0730-7659|url-access=subscription }}</ref> Others reported feeling forgotten or alone in relation to the procedure, not being listened to and the severity of their pain being questioned. Some reported feeling they did not have a choice other than vaginal delivery but others reported being able to choose the date of induction and the method of giving birth.<ref name=":8" /><ref name=":02">{{Cite journal |date=27 March 2024 |title=Maternity services: research can improve safety and quality of care |url=https://evidence.nihr.ac.uk/collection/maternity-services-research-can-improve-safety-and-quality-of-care/ |journal=NIHR Evidence |publisher=National Institute for Health and Care Research |doi=10.3310/nihrevidence_62672|url-access=subscription }}</ref>

Even though women reported seeing hospitals as a safe place for labor induction and giving birth, for some it is also considered an anxiety-inducing setting where they are restricted and not allowed to move around or see family members.<ref name=":8" /><ref name=":02" />

== Criticisms ==
{{Update section|date=February 2025}}
Membrane sweeping, a common method of labor induction, can cause bleeding and irregular contractions and is often done without [[informed consent]] by the pregnant person.<ref>{{cite web | url=https://evidencebasedbirth.com/updated-evidence-on-the-pros-and-cons-of-membrane-sweeping/#:~:text=What%20are%20the%20disadvantages%20of,experience%20bleeding%20after%20the%20procedure | title=EBB 151 - Updated Evidence on the Pros and Cons of Membrane Sweeping | date=27 October 2020 }}</ref>

The medical rationale for performing an induction is decreasing the risk of stillbirth. However, the probability of having a stillbirth post-term is very small, meaning that for the vast majority of [[Postterm pregnancy|post-term pregnancies]], inductions are unnecessary. Approximately 500 inductions are performed in order to avoid 1 stillbirth.<ref>{{cite book | chapter-url=https://www.ncbi.nlm.nih.gov/books/NBK11947/ | title=AHRQ Evidence Report Summaries | chapter=Management of Prolonged Pregnancy: Summary | date=March 2002 | publisher=Agency for Healthcare Research and Quality (US) }}</ref> Many of these unnecessary inductions could potentially provoke other risks, forcing medical practitioners to perform other interventions such as caesarean sections. These additional interventions could cause labor to be more risky for the pregnant person.{{Citation needed|date=February 2025}}

Another criticism of inductions is that the pregnant person's [[Bodily integrity|bodily autonomy]] is overlooked. Many pregnant people might not want to be induced, and rather share in the decision-making process with their medical practitioner.<ref>{{cite journal | pmc=9264300 | date=2022 | title=Women's view on shared decision making and autonomy in childbirth: Cohort study of Belgian women | journal=BMC Pregnancy and Childbirth | volume=22 | issue=1 | page=551 | doi=10.1186/s12884-022-04890-x | doi-access=free | pmid=35804308 | vauthors = Deherder E, Delbaere I, MacEdo A, Nieuwenhuijze MJ, Van Laere S, Beeckman K }}</ref>

Induced labor may be more painful for the woman as one of the side effects of intravenous oxytocin is increased contraction pains, mainly due to the rigid onset.<ref>National Institute for Health and Clinical Excellence, "CG70 Induction of labour: NICE guideline", {{cite web |url=http://publications.nice.org.uk/induction-of-labour-cg70/introduction |title=CG70 - Induction of labour - Introduction - National Institute for Health and Clinical Excellence |access-date=2012-04-10 |archive-url=https://web.archive.org/web/20120422152535/http://publications.nice.org.uk/induction-of-labour-cg70/introduction |archive-date=2012-04-22 }} July 2008, retrieved 2012-04-10</ref> This may lead to the increased use of [[analgesic]]s and other pain-relieving pharmaceuticals.<ref>[[David Vernon (writer)|Vernon, David]], ''[[Having a Great Birth in Australia]],'' [[Australian College of Midwives]], 2005, {{ISBN|0-9751674-3-X}}</ref> These interventions may also lead to an increased likelihood of [[caesarean section]] delivery for the baby.<ref>{{cite journal |author1=Roberts Christine L |author2=Tracy Sally |author3=Peat Brian | year = 2000 | title = Rates for obstetric intervention among private and public patients in Australia: population based descriptive study | journal = British Medical Journal | volume = 321 | issue = 7254|pages=137–41 |doi=10.1136/bmj.321.7254.137 |pmid=10894690 |pmc=27430 }}</ref> However after 41 weeks of gestation there is a reduction of cesarean deliveries when the labour is induced.<ref name="cmaj.ca" /><ref>{{cite journal |last=Caughey A. |date=8 May 2013 |title=Induction of labour: does it increase the risk of cesarean delivery? |journal=BJOG |volume=121 |issue=6 |pages=658–661 |doi=10.1111/1471-0528.12329 |pmid=24738892 |s2cid=33295368 |doi-access=free}}<!--|access-date=11 June 2014--></ref>

The [[Institute for Safe Medication Practices]] labeled [[pitocin]] a "high-alert medication" because of the high likelihood of "significant patient harm when it is used in error."<ref>The Institute for Safe Medication Practices [https://www.ismp.org/newsletters/acutecare/showarticle.aspx?id=15 ''Results Of ISMP Survey On High-Alert Medications: Differences Between Nursing, Pharmacy, And Risk/Quality/Safety Perspectives''] ISMP.org. Retrieved 2017-01-09.</ref>

==See also==
* [[Tocolytic]], labor suppressant

==References==
{{Reflist|30em}}

== External links ==
* {{cite journal | author = Harman, Kim | year = 1999 | title = Current Trends in Cervical Ripening and Labor Induction | url = http://www.aafp.org/afp/990800ap/477.html | journal = American Family Physician | volume = 60 | issue = 2 | pages = 477–84 | pmid = 10465223 | access-date = 2004-09-18 | archive-date = 2011-09-27 | archive-url = https://web.archive.org/web/20110927000358/http://www.aafp.org/afp/990800ap/477.html }}
* [http://www.webmd.com/a-to-z-guides/inducing-labor-naturally-can-it-be-done Inducing Labor] – [[WebMD]]
* [https://web.archive.org/web/20080527024404/http://www.nice.org.uk/guidelineD Induction of labour]. Clinical guideline, UK National Institute for Health and Clinical Excellence, June 2001.
* Josie L. Tenore: [https://www.aafp.org/pubs/afp/issues/2003/0515/p2123.html "Methods for cervical ripening and induction of labor"]; {{Webarchive|url=https://web.archive.org/web/20080516031451/http://www.aafp.org/afp/20030515/2123.html |date=2008-05-16 }}. ''American Family Physician'', 15 May 2003.
* [https://medlineplus.gov/ "Catecholamines – blood"]. National Library of Medicine . N.p., n.d. Web. 28 Mar. 2011.

{{Pregnancy}}
{{Obstetrical procedures}}
{{Uterotonic}}
{{Women's health}}
{{Authority control}}

{{DEFAULTSORT:Labor Induction}}
[[Category:Childbirth]]
[[Category:Medical mnemonics]]
[[Category:Obstetrical procedures]]
[[Category:Theriogenology]]