At some point near the end of your pregnancy, your obstetrician may tell you that he or she wants to schedule you for an induction. An induction is when the doctor takes steps to get your labor started artificially. While the induction rates in the United States have been falling, at least for women at 37 or 38 weeks of pregnancy, the induction rate is still above 18%, which means that many women will encounter a recommendation for induction during their childbearing years. Whether you're generally opposed to induction or you're relieved at the thought of finally being done with the pregnancy, there are some important questions you'll want to ask before agreeing to an induction.

Why?

While not every induction performed is strictly medically necessary, there are valid medical reasons to have an induction. When your doctor recommends an induction, the first thing that you need to know is why they're making that recommendation. Certain medical conditions, like diabetes, preeclampsia, eclampsia, and hypertension may cause health problems for you or the baby that necessitate an abrupt end to the pregnancy. If you're past your due date and approaching 42 weeks of pregnancy, your doctor may be concerned about your ability to deliver a large baby or that your placenta may not be able to adequately nourish the baby any longer.

On the other hand, some OBs will recommend induction for other reasons. They may want to ensure that you're in the hospital when they are on call, as opposed to another doctor, or may be responding to your feelings of exhaustion or impatience (and it's normal to feel tired of being pregnant by the end of the pregnancy!). Be wary of an induction for nonmedical reasons, as inductions are linked to a higher risk of an emergency C-section.

How?

The next thing that you'll need to know is how your doctor plans to induce labor. There are several options, and if one doesn't appeal to you, another might be a better option, depending on the circumstances. Take a look at the most common methods of induction.

• Pitocin – Pitocin is the synthetic form of oxytocin, the hormone that causes your uterus to contract in labor. For a Pitocin induction, you'll be hooked up to an IV that will administer the drug until your contractions reach a certain strength. Pitocin may be used alone or in conjunction with other methods.
• Misoprostol – Misoprostol may be used if the doctor determines that your cervix is not yet ready for labor. It softens the cervix and brings on uterine contractions. It may be used alone or in conjunction with Pitocin. It should not be used if you're attempting a vaginal birth after a C-section, as it increases the risk of uterine rupture.
• Breaking the Water – if you prefer that your doctor try a non-drug approach first, they may attempt to break your water manually by inserting a sterile hook to snag and break the amniotic membrane bag. This is called an amniotomy.

If you don't have an emergency need to induce labor but you and your doctor would like it to start sooner rather than later, you may also consider a procedure called stripping the membranes. This is done by manually separating the amniotic membrane from the cervix, which allows the cervix to soften and may bring on labor more quickly.

Are There Other Alternatives?

Before agreeing to an induction, it's a good idea to find out if there are other alternatives that could be considered or tried first. If you and the baby are not in immediate medical danger, your OB may suggest testing and monitoring on a regular basis until labor begins on its own, or until testing reveals that an induction is necessary immediately.

The non-stress test, which monitors the baby's heartbeat, and the biophysical profile, which monitors the baby's body and breathing movements and your amniotic fluid levels, are examples of testing that can be used when an induction is delayed.

Asking your doctor for more information helps you to make the most informed medical decisions possible. Ultimately, whether or not to induce is your decision, and you should be aware of all the reasons to consider it, the methods, and the alternatives before you make a decision. Contact a professional like Patricia A. Giuffre, MD for more information.