What is induction? Medications or treatment used to either cause changes of the cervix (causing contractions) or medications that cause the uterus to contract (that start labor or move labor along).

Induction is one of the most common medical interventions used in the United States. Induction has a place in labor if it is medically necessary. Rates of induction have steadily risen over time in the United States.

*Rates of induction of labor (IOL) in the U.S:

1989 9%

2000 19.9%

2010 23.5%

2020 31.17%

Why labor may be medically induced:

Birthgiver has health condition(s) that affects their heart, lungs or kidneys
Decrease in the fluid surrounding baby (amniotic fluid)
Poor fetal growth
Uterus infection
Issues with the placenta
Diabetes (gestational or previous diagnosis)
Preeclampsia & eclampsia (preeclampsia symptoms with presence of seizures)
Ongoing high blood pressure
Water breaks before labor starts
Pregnancy at 41-42 weeks

*Per ACOG

Induction is done urgently or electively

Urgent induction normally occurs if there is a non-emergent medical reason (potentially affecting birthgiver or baby)
Elective induction normally occurs when induction is chosen without medical indication. Elective inductions should not occur before 39 weeks.

Often, the induction conversation is brought by care providers on or around 39 weeks of pregnancy, referring back to medical research, specifically the ARRIVE trial (see previous link).

You might hear one or all of the following from your care provider:

“You’ll need to be induced by 39 weeks” “We cannot let you go past 40 weeks”
Reason for using medication to move labor along: “Your contractions aren’t strong enough”—determined by electronic fetal monitoring (EFM) interpretation.

ACOG insight on elective induction

Before considering elective induction of labor, we should take into account:

ARRIVE trial findings & how it specifically applies to the birthgiver
Values & preferences of the birthgiver
Resources available in the hospital (including nurse to patient ratio).
In order to move forward (or not move forward), care providers & staff should have a discussion with the birthgiver and shared-decision making should take place.
When appropriate, OB/GYNs & other obstetric care providers should know how to use & consider using low-interventions for management of low-risk pregnancies during labor that occurs on its own.

*MCN, The American Journal of Maternal/Child Nursing 47(4):p 235, July/August 2022.