You and your physician may decide to induce labor after determining that it is best to not wait any longer for labor to occur on its own. Often, an induction of labor is performed to manage selected medical complications of pregnancy (including a birth that is significantly overdue) and, in certain situations, for the elective timing of delivery. Recent medical studies have uncovered several important findings that have added to our understanding of the risks and benefits of labor induction.

Your first labor and birth is very different than your second or later birth. All aspects of first labors are longer and more challenging, and labor complications such as cesarean birth are more likely to occur with first births. This distinction between first and later births also holds for induction. This is usually not discussed in popular magazine articles, so we will review the differences here. If a woman has previously had a successful vaginal birth, induction of labor can often be safely considered to help plan for subsequent births, as discussed below.

First Births:
Recent medical studies have found differences in induction risks in first births compared to subsequent births. Risks are typically greater in first births. These include a doubling (or more) in the cesarean birth rate (generally from approximately 12-15% to 25-30%), a longer labor and an increase in the rate of vacuum or forceps delivery when compared to mothers who begin labor spontaneously. If the cervix (opening of the womb) is particularly "unfavorable” (described as “closed, long and firm”), then the chance for cesarean birth may be higher. These findings are true whether the induction was done for elective or medical reasons.

There are definite situations in a first labor and birth when it can be advisable to perform an induction for the benefit of the mother or the baby. Inductions are an important consideration for a number of medical conditions, even in a first birth. Examples of these situations include:

• Pre-eclampsia or hypertension (high blood pressure)
  
• Poorly controlled diabetes
  
• Prolonged rupture of the bag of waters (especially over 18 or 24 hours)
  
• Concerns about the baby’s health such as heart rate changes or low amniotic fluid levels
  
• Significantly “overdue” (significantly past the baby’s due date)

Just as there are concerns associated with inductions, problems can arise if inductions are delayed when a medical condition exists. Some babies continue to grow, placentas can age and their function diminish. If you have a medical condition, it is important to discuss with your physician or midwife the risks and benefits of induction, and any possible alternatives.

Second (or later) Births:
Induction in a second (or later) labor and birth presents different considerations. If a woman has given birth to a baby vaginally and if her cervix is already beginning to shorten and open (“ripen”), and she is at or beyond 39 weeks of pregnancy (so there are no baby breathing concerns) there do not appear to be increased rates of complications to the mother or baby from labor induction. Induction may be useful if you live a distance from the hospital or in other circumstances to optimize your care. It is always important to carefully weigh the risks, benefits and alternatives of any procedure before starting. This is especially true when a procedure may be elective.

We appreciate your understanding that all women coming to our birth center are taken according to medical need, so women coming to the hospital in active labor or with a stressed baby are given priority. Therefore, in some circumstances, your induction may need to be delayed until space is available. Our Labor and Delivery staff will try to accommodate you as close as possible to your scheduled induction time and date.

Your Induction of Labor

If you and your doctor have decided on an induction of labor, your doctor or one of his/her office staff will notify California Pacific’s OB Reception Center to plan the induction day and time. Depending on your personal and medical needs, the doctor will request that you be placed on a "wait list" for your requested time.

The Labor and Delivery department is often very busy (births are not usually predictable!) and we are committed to maintaining a safe and comfortable environment for all our patients. Women in active labor or with medical indications requiring delivery will receive the highest priority for admission. In such cases, we may need to change the date and/or time of your induction request. The change can be as little as one hour or sometimes several hours, depending on the Labor and Delivery Department's activity. On some occasions, we may need to plan your induction for another day. This would only occur after consulting with your physician. The Women and Children's Center at California Pacific will make every effort to accommodate you and your doctor.

You will check in for labor and delivery at the OB Reception Center, located at 3700 California Street on the lobby level. In order to expedite your admission process, please send your hospital pre-admission forms prior to coming to the hospital if you have not already done so. Since you will be staying until you have your baby, please bring your “hospital suitcase” as well as the book, A Guide to Your Pregnancy and Newborn.

We look forward to caring for you and your baby!

PLEASE CALL ONE (1) HOUR PRIOR TO YOUR INDUCTION TIME

OB Reception Center Phone Number: 415-600-2100


Related articles:
Overview of Induced Labor
Labor Induction and Augmentation (from Healthwise).