Induction vs Waiting for Labor: What to Ask

When the question comes up

Maybe your doctor mentioned induction at your 39-week visit. Maybe your due date came and went, and every text from family asks if the baby is here yet. Or maybe you live far from the hospital and wonder whether a planned date would make things easier. However it starts, you now have a choice to talk through.

This guide does not tell you which path to take. It lays out what the American College of Obstetricians and Gynecologists (ACOG) says about both, in plain words, so your next appointment can be a real conversation. For the detailed questions about your cervix and the methods your doctor may use, our post on what to ask your doctor about induction goes deeper.

What ACOG says about induction

ACOG describes labor induction as the use of medications or other methods to bring on labor, in an effort to have a vaginal birth. It may be recommended when the health of the mother or fetus is at risk. ACOG lists reasons that include:

• The pregnancy has lasted more than 41 to 42 weeks.
• Health problems such as heart, lung or kidney problems.
• Problems with the fetus, such as poor growth.
• Gestational diabetes, or diabetes before pregnancy.
• Chronic high blood pressure, preeclampsia or eclampsia.
• The water breaking before labor begins (prelabor rupture of membranes).

Elective induction and the 39-week option

When you and your fetus are healthy and you choose induction, ACOG calls it an elective induction. It gives examples such as physical discomfort, a history of quick labor or living far from the hospital. ACOG is firm on timing: elective induction should not be done before 39 weeks of pregnancy.

ACOG also says you and your provider may talk about induction at 39 weeks if this is your first full-term pregnancy, you are carrying one fetus, and you are both healthy. Its patient page says research suggests this may reduce the risk of cesarean birth, and that healthy women induced at 39 weeks may have lower rates of preeclampsia and gestational hypertension. ACOG adds that your hospital may offer this option if it has the staff and resources, which is one more question for your tour, covered in our guide to choosing a hospital or birth center.

How induction works, and what can happen

If your cervix is not ready, the first step may be ripening it with prostaglandin medicines or a small balloon catheter. Other methods ACOG describes include sweeping the membranes, oxytocin through an IV, and breaking the amniotic sac (amniotomy). During oxytocin, your contractions and the baby's heart rate are monitored.

Induction can take time. For induction at 39 weeks, ACOG says people should be allowed up to 24 hours or longer for the early phase of labor. ACOG lists possible risks, including contractions that come too often and change the fetal heart rate, infection of the amniotic fluid, placenta or membranes, infection of the baby and, rarely, a tear in the uterus. Sometimes induction does not work. If you and your pregnancy are doing well and your water has not broken, you may be offered the option to go home and try again another day. If you or your baby are not doing well, a cesarean birth may be needed.

What waiting for labor looks like

Your due date is an estimate. ACOG calls a pregnancy that lasts 41 weeks up to 42 weeks late term, and one that lasts longer than 42 weeks postterm. It says health risks may rise in a late-term or postterm pregnancy but that problems occur in only a small number, and most women who give birth after their due dates have uncomplicated labor and healthy babies.

Waiting is usually watchful waiting. ACOG says a pregnancy between 40 and 41 weeks does not necessarily need testing, but at 41 weeks your provider may recommend tests such as a nonstress test or a biophysical profile, weekly or twice weekly, and labor induction may be recommended if your pregnancy reaches 41 weeks. Your provider sets the schedule for you. If you would like to wait, ask what would change that advice, so you both know the plan ahead of time and nothing feels sudden.

Questions to ask, and how a doula helps either way

Bring these to your next visit, and ask for time to think if you need it:

• Is this a medical reason or an elective choice, and what is the reason in my case?
• What do you expect if we wait another few days, and what testing would we do?
• Which method would you start with, where, and about how long might it take?
• What happens if the induction does not work?
• What pain relief can I use during an induction? Our guide to labor pain relief options can help you prepare.
• What signs mean I should call you or come in while I wait?

Where a doula fits, and where she does not

A doula does not recommend induction or waiting, and does not judge your baby's health or your cervix. What a doula can do is help you write your questions down, think through the answers afterward, and plan for a long induction or a long wait. In a long induction that might mean comfort measures, rest breaks, position changes and keeping your partner fed. While you wait, it might mean reassurance and a reminder to call your provider when something feels off.

Northeast Doulas' labor doulas support "an unmedicated birth, an epidural, an induction, or caesarean," and birth clients have a doula team that is on call for them throughout pregnancy. If a symptom worries you, though, a doula is not the call to make first. Call your doctor or midwife.