Induction of Labour
This page is to help explain your choices for how and when to have your baby. Every pregnancy is different, and your healthcare team will help guide you based on what’s best for you and your baby. In many cases, allowing for labour to start naturally is the best option. Here,we will focus on induction of labour—what it is, why it might be needed, and what to expect.
What is induction of Labour?
Induction of labour (IOL) means starting labour using medicine or other methods when it hasn’t started on its own. The goal is to help the body begin contractions and have a vaginal birth within 48 hours.
Why might someone get induced?
Medical Reasons
In some cases, induction is recommended for medical reasons, like high blood pressure, diabetes, a small baby, or pregnancy going past 41 weeks. Medical societies provide guidance as to which week this should occur.
Choosing Induction (Elective IOL)
Some people choose to be induced even when there’s no medical reason. Research shows this is a safe option and may slightly lower the chance of needing a C-section. At THP, this is an option after 39 weeks gestation (or up to 1 week before your due date).
Induction Based on Ethnicity
Data on ethnicity-based risk in pregnancy is limited. There is a study from Australia that showed people from South Asian backgrounds (India, Pakistan, Sri Lanka, Bangladesh, Nepal, Bhutan, Afghanistan, Maldives) might have higher chance of problems after 39 weeks as compared to those of other ethnic backgrounds. This risk was reduced by monitoring the pregnancy more closely after 39 weeks and proceeding with delivery if needed. There is no Canadian data on this topic yet. If you identify as South Asian, in an effort to address this risk your doctor may offer you two options:
- Induction during the 39th week
- An ultrasound between 39-40 weeks to decide if it’s safe to wait for natural labour until 40–41 weeks.
Are there any risks with induction?
Research shows that induction is safe and does not increase pain scores of labour. It usually involves 1–2 additional hospital visits with vaginal examinations and may take 24–48 hours.
What about the risk of c-section?
Usually an induction will not effect the risk of c-section. Some data suggests it may decrease the chances of needing a c-section a little. In rare circumstances, patients undergoing an induction will require a c-section due to their response to the medications we use.
How does induction work?
If you decide to have an induction, the doctor will first do a vaginal exam to check your cervix. This helps decide the best way to start. Your doctor will send a request to the hospital, and a nurse will later call you with details about scheduling your induction.
Induction usually has two steps:
- Cervix Preparation (Ripening)
This step helps to soften the cervix and begin some dilation. Doctors may use a balloon or medicine to help it soften and open more. This is done at the hospital with a vaginal examination. Then you may go home and return later. If your cervix is already open about 3 cm, you may be able to skip this step. - Starting Labour
Once the cervix is 3 cm or more, doctors will break the waters and give medicine to start contractions. At this point, you’ll stay in the hospital until your baby is born.
Additional Questions
Is breaking the waters painful?
Any vaginal examination during pregnancy can be uncomfortable or even painful. The tool used to break the waters does not cause additional pain above the exam itself.
Can I decide on which medications to use during my induction?
Patients must provide consent during every step of induction. We encourage you to discuss any concerns you have with your care providers. Remember, completing an induction successfully requires experience and expertise and your care provider will recommend what’s best for your specific situation.
If you do have concerns, please discuss the various steps of induction before you begin so you feel confident in your decisions.
Can you tell me more about induction for South Asian people?
A study was published in 2012 from Australia. It found that the risk of stillbirth was 1 per 675 deliveries for women born in Australia, and 1 per 282 deliveries for patients originating from South Asia. (This is approximately 2.5 times more likely.)
The rate of stillbirth at 39 weeks amongst the South Asian group was similar to the Australian-born patients at 41 weeks.
Another study from Australia showed when South Asian patients were monitored the risk of stillbirth, neonatal death and neonatal ICU admissions were all decreased.
There are no studies available on this subject from Canada.
At THP, we understand that approximately 60% of our patients identify as South Asian. Although we recognize being South Asian is a risk factor, the decision of whether or not to proceed with induction must be individualized.
South Asian includes:
- India
- Pakistan
- Bangladesh
- Nepal
- Bhutan
- Sri Lanka
- Afghanistan
- Maldives
Can I choose what day to have my induction and delivery?
Due to the high number of patients we care for inductions are booked based on level of urgency and how busy our birthing unit is. When you book your induction, your doctor will provide a range of dates where the team can start your induction. As such we are not able to guarantee an exact induction date.
