What are my options if I don’t want to have my labor induced?

Assuming you don’t have any medical reasons for inducing labor, you can wait for labor to begin on its own. In that case, going into labor on your own is generally safer than having labor induced or having a C-section.

If you decide to wait for labor to begin on its own, it’s important to understand that things can come up that could lead to labor induction or even a planned cesarean before labors starts. In every case that is not an emergency, it would be wise to understand the situation, your options, their pros and cons and whether there is truly clear evidence that intervening is the best approach.

To watch for problems that may develop at the end of pregnancy, your care providers may recommend more frequent prenatal visits, tests to check on the wellbeing of your baby or both. Sometimes they can find complications early enough to deliver the baby safely before the situation worsens.

Unfortunately none of the testing methods are perfect and “false positive” results (when the test indicates a problem that doesn’t really exist) are common. These may lead to unnecessary inductions or C-sections. Research has not proven whether or when these tests lead to better health outcomes.

The tests that are used to monitor fetal wellbeing at the end of pregnancy include:

• A fetal nonstress test involves monitoring the fetal heart rate for 20 minutes or longer to see if the heart rate goes up (a good sign) or down (a sign that the baby may be in danger). Trustworthy research has not clarified whether use of electronic fetal monitoring for a brief period in pregnancy improves pregnancy outcomes.Grivell, R.M., Alfirevic, Z., Gyte, G.M.L., & Devane, D. (2015). Antenatal cardiotocography for fetal assessment. Cochrane Database of Systematic Reviews, 9.
• A biophysical profile uses an ultrasound to measure fetal movements, breathing and muscle tone and estimates the amount of amniotic fluid. Use of this test is associated with increased labor induction and cesarean birth, but we lack information to know about possible benefits for high-risk pregnancies.Lalor, J.G., Fawole, B., Alfirevic, Z., & Devane, D. (2008). Biophysical profile for fetal assessment in high risk pregnancies. Cochrane Database of Systematic Reviews, 1.
• Counting how often the fetus moves, either throughout the day or during a certain time frame (like a few hours after eating) can help show if the baby is getting enough oxygen. Decreased fetal movement may be a sign that the baby needs to be delivered. However, trustworthy research has not clarified whether fetal movement counting improves pregnancy outcomes.Mangesi, L., Hofmeyr, G.J., Smith, V., & Smyth, R.M.D. (2015). Fetal movement counting for assessment of fetal wellbeing.Cochrane Database of Systematic Reviews, 10.

In a few cases, the best alternative to induction of labor is to schedule a cesarean section. Your care provider may recommend a C-section if there are severe complications that make labor unsafe for you or your baby.

How can I lower my chance of being induced unnecessarily?

• Choose a care provider with a low induction rate. Styles of practice vary widely across physicians and midwives, so it’s important to discuss induction and your preferences, and understand their position, when you’re choosing your care provider.
• Choose a birth setting with a low induction rate. Some hospitals have quality improvement programs to reduce induction rates, including programs to avoid scheduling births before the 39th week of pregnancy whenever possible. In general, rates of intervention are much lower for out-of-hospital birth centers and home births, compared with hospitals.
• Educate yourself. You’re already doing that by reading this website — great! Keep reading to understand your options and their possible benefits and harms. You may also want to review your rights to informed refusal, in case you choose to exercise this right.
• Try to make sure your estimated due date (EDD) is accurate. Care providers often recommend induction based on how far along the pregnancy is. Having an accurate EDD may lower the chance that your labor will be induced based on an incorrect due date. An ultrasound in early pregnancy is the most accurate way to estimate your due date, unless you know the exact day of your last period and exactly when you were expecting your next period and you have not recently been pregnant or used hormonal birth control like the pill. Bring as much information as possible (e.g., dates of your last several periods, dates you might have conceived, date and results of pregnancy tests) to your first prenatal appointment to increase the chance of getting an accurate due date. It is rarely appropriate to change the estimated due date later in pregnancy based on additional information.

If my labor is induced, how can I increase my chance of having a vaginal birth?

• Choose a care provider with a low C-section rate. The C-section rate in induced labors varies a lot by care provider. Those with a low overall C-section rate may be less likely to perform C-sections in women having labor induced.
• Prepare for labor to take a long time to kick in and progress. Induction forces your body to go into labor before it is ready, so the body changes and processes that normally happen over a period of days or weeks have to take place over a period of hours. If you and your baby are doing well, reaching “active” labor (cervix is dilated to 6 cm or more) through induction can take 24 hours or longer.
• Plan for excellent labor support. Because labor may be longer and more difficult, you may benefit significantly from having a skilled labor support companion. Working with a labor support companion (doula) can increase your chance of vaginal birth, lower the need for pain medication, and make you more satisfied with your birth process.
• If your caregiver recommends a C-section and it is not an emergency, ask questions. Ask what your chance of having a vaginal birth might be if you continue to labor longer, and what risks would be involved with waiting.

How can I protect my baby’s health and safety if my labor is induced?

• Choose to be induced only for a medical reason. Induction without a medical reason exposes your baby to procedures and drugs that can be risky, without counter-balancing benefits.
• Be as certain as possible that the baby’s lungs are fully developed. Babies born before the lungs are fully developed may have serious breathing problems that require respiratory support in an intensive care unit. If you are certain about your estimated due date, waiting until 39 completed weeks of pregnancy is a reliable way to help ensure that the baby’s lungs will be developed. If you are not sure of your estimated due date, or your care provider is recommending medically necessary induction before 39 completed weeks, an amniocentesis (using a needle to remove a small amount of amniotic fluid) and testing can estimate lung development. If you need to have labor induced before the lungs are developed, your provider can give you a medication to speed up lung development. Be aware that some babies may still experience respiratory distress or other poor health outcomes even if you take these steps.
• Tell your care provider if your contractions seem to be lasting more than a minute-and-a-half or are coming more often than every 2-3 minutes. These are signs that your uterus may be overstimulated by the medications used to induce labor, and this can decrease the amount of oxygen available for your baby. Your provider can adjust the dose of your medication and try other techniques to allow more oxygen to your baby.

What else should I keep in mind?

You have the right and responsibility to make informed maternity care decisions for yourself and your baby. This may mean agreeing to (consenting to) or refusing an intervention or procedure. Your care provider has the responsibility to provide accurate, unbiased information to help you make an informed decision.

Whether, when and how to induce labor are rarely clear-cut decisions. They often involve uncertainty about benefits and harms. It is important to make this decision based on both accurate information and your own preferences and priorities. As the person receiving care and the mother of your baby, you are in the best position to consider the trade-offs.

Ideally, your care provider will be able and willing to provide unbiased and complete information, and you can make this decision together. However, some care providers may face financial incentives to encourage induction of labor (because they are able to bill for payment for attending your birth), or may have a preference for induction of labor based on its convenience relative to their professional and personal commitments. Busy care providers face challenges in staying up-to-date with the large, continually growing body of research about best practices. Therefore, it’s especially important that you come to the table with as much information as you can and think about what you’d like to do before you’re faced with tough decisions.