It’s common for many pregnant women, especially first-time mothers, to watch their baby’s due date come and go without so much as a contraction. The farther away from the expected delivery date (called the EDD) you get, the more anxious you might become. You may start to wonder — is this baby ever going to come?

Late pregnancy can be challenging — you may feel large all over, your feet and back might hurt, you might not have the energy to do much of anything, and you’re beyond ready to meet the little one you’ve nurtured all this time. Which is why waiting a little longer than you’d expected can be particularly hard.

Still, being past your due date doesn’t guarantee that your doctor will do anything to induce (or artificially start) labour — at least not right away.

What Is It?

Labour induction is what doctors use to try to help labour along using medications or other medical techniques. Years ago, some doctors routinely induced labour. But now it’s not usually done unless there’s a true medical need for it. Labour is usually allowed to take its natural course. However, in some situations, the doctor may recommend induction.

Why It’s Done

Your doctor might suggest an induction if:

• Your water broke but you are not having contractions
• Your baby still hasn’t arrived by two weeks after the due date (when you’re considered post-term — more than 42 weeks into  your pregnancy)
• You have an infection in the uterus (called chorioamnionitis)
• You have certain risk factors (e.g., gestational diabetes or high blood pressure)
• There is not enough amniotic fluid
• There is a problem with the placenta
• The baby is not growing appropriately

Induction also can be appropriate under certain circumstances, as with a mother who is full-term and has a history of rapid deliveries or lives far from a hospital. Some mothers request elective inductions for convenience, but these do come with risks. Doctors try to avoid inducing labour early because the due date may be wrong and/or the woman’s cervix might not be ready yet.

How It’s Done

Some methods of induction are less invasive and carry fewer risks than others. Ways that doctors may try to induce labour by getting contractions started include:

• Stripping the membranes. The doctor puts on a glove and inserts a finger into the vagina and through the cervix (the opening that connects the vagina to the uterus). He or she moves the finger back and forth to separate the thin membrane connecting the amniotic sac (which houses the baby and amniotic fluid) to the wall of the uterus. When the membranes are stripped, the body releases hormones called prostaglandins, which help prepare the cervix for delivery and may bring on contractions. This method works for some women, but not all.
• Breaking your water (also called an amniotomy). The doctor ruptures the amniotic sac during a vaginal exam using a little plastic hook to break the membranes. This usually brings on labour in a matter of hours.
• Giving the hormone prostaglandin to help ripen the cervix. A gel or vaginal insert of prostaglandin (often the drug Cervidil) is inserted into the vagina or a tablet is given by mouth. This is typically done overnight in the hospital to make the cervix “ripe” (soft, thinned out) for delivery. Administered alone, prostaglandin may induce labour or may be used before giving oxytocin.
• Giving the hormone oxytocin to stimulate contractions. Given continuously through an IV, the drug (often Pitocin) is started in a small dose and then increased until labour is progressing well.   After it’s administered, the foetus and uterus need to be closely monitored. Oxytocin is also frequently used to spur labour that’s going slowly or has stalled.

What Will It Feel Like?

Stripping the membranes can be a little painful or uncomfortable, although it usually only takes a minute or so. You may also have some intense cramps and spotting for the next day or two.

It can also be a little uncomfortable to have your water broken. You may feel a tug followed by a warm trickle or gush of fluid. With prostaglandin, you might have some strong cramping as well. With oxytocin, contractions are usually more frequent and regular than in labour that starts naturally.

Risks and Precautions

Inducing labour is not like turning on a faucet. If the body isn’t ready, an induction might fail and, after hours or days of trying, a woman may end up having a Caesarean delivery (C-section). This appears to be more likely if the cervix is not yet ripe.

If the doctor ruptures the amniotic sac and labour doesn’t begin, another method of inducing labour also might be necessary because there’s a risk of infection to both mother and baby if the membranes are ruptured for a long time before the baby is born.

When prostaglandin or oxytocin is used, there is a risk of abnormal contractions developing. In that case, the doctor may remove the vaginal insert or turn the oxytocin dose down. While it is rare, there is an increase in the risk of developing a tear in the uterus (uterine rupture) when these medications are used. Other complications associated with oxytocin use are low blood pressure and low blood sodium (which can cause problems such as seizures).

Another potential risk of inducing labour is giving birth to a late preterm baby (born between 34 and 36 weeks). Why? Because the due date (EDD) may be wrong. Your due date is 40 weeks from the first day of your last menstrual period (LMP).

Babies born late pre-term are generally healthy but may have temporary problems such as jaundice, trouble feeding, problems with breathing or difficulty maintaining body temperature. Even though inductions do come with risks, going beyond 42 weeks of pregnancy can be risky, too. Many babies are born “post-term” without any complications, but concerns include:

• Vaginal delivery may become harder as the baby gets bigger. As babies get bigger, the chance of an injury during delivery, such as a broken bone, increases.
• The placenta that helps to provide the baby with nourishment is deteriorating.
• The amniotic fluid can become low or contain meconium — the baby’s first faeces. If the baby breathes in meconium, it can  cause breathing problems.

Old wives’ tales abound about ways to induce labour, such as the use of castor oil. It is not safe to try to artificially start labour yourself by taking castor oil, which can lead to nausea, diarrhoea, and dehydration. And herbs and herbal supplements meant to induce labour can be harmful. Breast stimulation can cause uterine contractions by causing the release of oxytocin. However, some studies have suggested that the baby might have abnormal heartbeats after breast stimulation. Some women feel that having sex in late pregnancy can induce labour, but there is no conclusion on this yet. Talk to your doctor before doing anything to try to encourage your little one’s arrival. Inducing labour is best left to medical professionals — you may cause more harm than good.

As frustrating as it can be waiting for your baby to finally decide to arrive, letting nature take its course is often best unless your doctor tells you otherwise. Before you know it, you’ll be too busy to remember your baby was ever late at all!