Editing Labor induction (section)

== Timing and risks ==
{{See also|Gestational age|Postterm pregnancy}}
Labor induction before 39 weeks of pregnancy is not recommended unless there the mother or her child would be at risk otherwise.<ref>{{Cite journal |last=Grobman |first=William A. |date=2022-09-06 |title=The role of labor induction in modern obstetrics |url=https://linkinghub.elsevier.com/retrieve/pii/S0002937822001909 |journal=American Journal of Obstetrics and Gynecology |language=en |volume=230 |issue=3 |pages=S662–S668 |doi=10.1016/j.ajog.2022.03.019|pmid=38299461 }}</ref><ref>{{Cite web |title=Induction of Labor at 39 Weeks |url=https://www.acog.org/womens-health/faqs/induction-of-labor-at-39-weeks |access-date=2025-02-11 |website=American College of Obstetricians and Gynecologists |language=en}}</ref> Some [[Medical guideline|medical guidelines]] recommend waiting until 41 weeks with low-risk pregnancies before induction.<ref>{{Cite web |date=4 November 2021 |title=Inducing labour. NICE guideline |url=https://www.nice.org.uk/guidance/ng207/ |access-date=2025-02-11 |website=National Institute for Health and Care Excellence}}</ref><ref name=":6">{{Cite book |url=https://iris.who.int/bitstream/handle/10665/363138/9789240052796-eng.pdf |title=WHO Recommendations on Induction of Labour, at or Beyond Term |date=2022 |publisher=World Health Organization |isbn=978-92-4-005279-6 |edition= |location=Geneva}}</ref> Doctors and pregnant women should have a discussion of risks and benefits when considering an induction of labor in the absence of an accepted medical indication.<ref name="ACOGfive">{{Citation |author1=American Congress of Obstetricians and Gynecologists |title=Five Things Physicians and Patients Should Question |work=[[Choosing Wisely]]: an initiative of the [[ABIM Foundation]] |url=http://www.choosingwisely.org/doctor-patient-lists/american-college-of-obstetricians-and-gynecologists/ |access-date=August 1, 2013 |archive-url=https://web.archive.org/web/20130901094916/http://www.choosingwisely.org/doctor-patient-lists/american-college-of-obstetricians-and-gynecologists/ |archive-date=September 1, 2013 |url-status=dead |publisher=[[American Congress of Obstetricians and Gynecologists]] |author1-link=American Congress of Obstetricians and Gynecologists}}, which cites

* {{cite book |author1=American Academy of Pediatrics |author-link1=American Academy of Pediatrics |title=Guidelines for perinatal care |author2=American College of Obstetricians and Gynecologists |author-link2=American College of Obstetricians and Gynecologists |publisher=American Academy of Pediatrics |year=2012 |isbn=978-1-58110-734-0 |edition=7th |location=Elk Grove Village, IL}}
* {{Cite journal |author=ACOG Committee on Practice Bulletins |year=2009 |title=ACOG Practice Bulletin No. 107: Induction of Labor |journal=Obstetrics & Gynecology |volume=114 |issue=2, Part 1 |pages=386–397 |doi=10.1097/AOG.0b013e3181b48ef5 |pmid=19623003}}</ref>

Inducing labor before 39 weeks in the absence of a medical indication (such as [[Hypertensive disease of pregnancy|hypertension]], [[intrauterine growth restriction]], or [[pre-eclampsia]]) increases the risk of complications of [[Preterm birth|prematurity]] including difficulties with respiration, infection, feeding, [[jaundice]], [[neonatal intensive care unit]] admissions, and perinatal death.<ref>{{cite web |date=2011-07-18 |title=Doctors To Pregnant Women: Wait At Least 39 Weeks |url=https://www.npr.org/templates/transcript/transcript.php?storyId=138473097 |access-date=2011-08-20 |website=[[NPR]]}}</ref> Inducing labor after 34 weeks and before 37 weeks in women with [[Hypertensive disease of pregnancy|pregnancy-related hypertensive disorders]] (pre-eclampsia, [[eclampsia]], [[Gestational Hypertension|gestational hypertension]]) may lead to better outcomes for the woman but does not improve or worsen outcomes for the baby.<ref name=":2">{{Cite journal |last1=Cluver |first1=Catherine |last2=Novikova |first2=Natalia |last3=Koopmans |first3=Corine M. |last4=West |first4=Helen M. |date=2017 |title=Planned early delivery versus expectant management for hypertensive disorders from 34 weeks gestation to term |journal=The Cochrane Database of Systematic Reviews |volume=1 |issue=1 |pages=CD009273 |doi=10.1002/14651858.CD009273.pub2 |pmc=6465052 |pmid=28106904}}</ref> 

[[Postterm pregnancy|Postterm pregnancies]] lasting beyond 41-42 weeks are associated with increased risks of [[stillbirth]], [[Perinatal mortality|neonatal death]] and [[caesarean section]] which can be reduced by inducing labor.<ref>{{Cite journal |last1=Borovac-Pinheiro |first1=Anderson |last2=Inversetti |first2=Annalisa |last3=Di Simone |first3=Nicoletta |last4=Barnea |first4=Eytan R. |last5=the FIGO Childbirth and Postpartum Hemorrhage Committee |date=8 October 2023 |title=FIGO good practice recommendations for induced or spontaneous labor at term: Prep-for-Labor triage to minimize risks and maximize favorable outcomes |url=https://obgyn.onlinelibrary.wiley.com/doi/10.1002/ijgo.15114 |journal=International Journal of Gynecology & Obstetrics |language=en |volume=163 |issue=S2 |pages=51–56 |doi=10.1002/ijgo.15114 |pmid=37807591 |issn=0020-7292|url-access=subscription }}</ref><ref>{{Cite web |title=Labor Induction |url=https://www.acog.org/womens-health/faqs/labor-induction |access-date=2025-02-11 |website=American College of Obstetricians and Gynecologists |language=en}}</ref><ref name=":6" /><ref>{{cite journal |last1=Middleton |first1=P |last2=Shepherd |first2=E |last3=Morris |first3=J |last4=Crowther |first4=CA |last5=Gomersall |first5=JC |date=15 July 2020 |title=Induction of labour at or beyond 37 weeks' gestation. |journal=The Cochrane Database of Systematic Reviews |volume=7 |issue=8 |pages=CD004945 |doi=10.1002/14651858.CD004945.pub5 |pmc=7389871 |pmid=32666584}}</ref>

If waters break ([[Rupture of membranes|membranes rupture]]) between 24 and 37 weeks' [[gestation]], waiting for the labor to start naturally with careful monitoring of the woman and baby is more likely to lead to healthier outcomes.<ref>{{cite journal |last1=Bond |first1=DM |last2=Middleton |first2=P |last3=Levett |first3=KM |last4=van der Ham |first4=DP |last5=Crowther |first5=CA |last6=Buchanan |first6=SL |last7=Morris |first7=J |title=Planned early birth versus expectant management for women with preterm prelabour rupture of membranes prior to 37 weeks' gestation for improving pregnancy outcome. |journal=The Cochrane Database of Systematic Reviews |date=3 March 2017 |volume=2017 |issue=3 |pages=CD004735 |doi=10.1002/14651858.CD004735.pub4 |pmid=28257562|pmc=6464692 }}</ref> For women over 37 weeks pregnant whose babies are suspected of not coping well in the womb, it is not yet clear from research whether it is best to have an induction or caesarean immediately, or to wait until labour happens by itself.<ref>{{Cite journal|last1=Bond|first1=Diana M.|last2=Gordon|first2=Adrienne|last3=Hyett|first3=Jon|last4=de Vries|first4=Bradley|last5=Carberry|first5=Angela E.|last6=Morris|first6=Jonathan|date=2015-11-24|title=Planned early delivery versus expectant management of the term suspected compromised baby for improving outcomes|journal=The Cochrane Database of Systematic Reviews|volume=2016 |issue=11|pages=CD009433|doi=10.1002/14651858.CD009433.pub2 |pmid=26599471|pmc=8935540 }}</ref> Similarly, there is not yet enough research to show whether it is best to deliver babies prematurely if they are not coping in the womb or whether to wait so that they are less premature when they are born.<ref>{{Cite journal|last1=Stock|first1=Sarah J.|last2=Bricker|first2=Leanne|last3=Norman|first3=Jane E.|last4=West|first4=Helen M.|date=2016-07-12|title=Immediate versus deferred delivery of the preterm baby with suspected fetal compromise for improving outcomes|journal=The Cochrane Database of Systematic Reviews|volume=2016|issue=7|pages=CD008968|doi=10.1002/14651858.CD008968.pub3 |pmid=27404120|pmc=6457969}}</ref>

Sometimes when a woman's waters break after 37 weeks she is induced instead of waiting for labour to start naturally.<ref name=":3">{{Cite journal |last1=Middleton |first1=Philippa |last2=Shepherd |first2=Emily |last3=Flenady |first3=Vicki |last4=McBain |first4=Rosemary D. |last5=Crowther |first5=Caroline A. |date=2017 |title=Planned early birth versus expectant management (waiting) for prelabour rupture of membranes at term (37 weeks or more) |journal=The Cochrane Database of Systematic Reviews |volume=1 |issue=1 |pages=CD005302 |doi=10.1002/14651858.CD005302.pub3 |pmc=6464808 |pmid=28050900}}</ref> This may decrease the risks of infection for the woman and baby but more research is needed to find out whether inducing is good for women and babies longer term.<ref name=":3" />

Women who have had a caesarean section for a previous pregnancy are at risk of having a [[uterine rupture]], when their [[Uterine niche|caesarean scar]] re-opens.<ref name=":1">{{Cite journal |last1=West |first1=Helen M. |last2=Jozwiak |first2=Marta |last3=Dodd |first3=Jodie M. |date=2017 |title=Methods of term labour induction for women with a previous caesarean section |journal=The Cochrane Database of Systematic Reviews |volume=2017 |issue=6 |pages=CD009792 |doi=10.1002/14651858.CD009792.pub3 |pmc=6481365 |pmid=28599068}}</ref><ref name=":7">{{Cite journal |last1=Dodd |first1=Jodie M. |last2=Crowther |first2=Caroline A. |last3=Grivell |first3=Rosalie M. |last4=Deussen |first4=Andrea R. |date=2017 |title=Elective repeat caesarean section versus induction of labour for women with a previous caesarean birth |journal=The Cochrane Database of Systematic Reviews |volume=2017 |issue=7 |pages=CD004906 |doi=10.1002/14651858.CD004906.pub5 |pmc=6483152 |pmid=28744896}}</ref> Uterine rupture is a serious threat for the woman and the baby, and induction of labour increases this risk further. There is not yet enough research to determine which method of induction is safest for a woman who has had a caesarean section before.<ref name=":1" /> There is also no research to say whether it is better for these women and their babies to have an elective caesarean section instead of being induced.<ref name=":7" />

There is insufficient scientific evidence to determine if inducing a woman's labor at home is a safe and effective approach for both the woman and the baby.<ref>{{cite journal |last1=Alfirevic |first1=Zarko |last2=Gyte |first2=Gillian ML |last3=Nogueira Pileggi |first3=Vicky |last4=Plachcinski |first4=Rachel |last5=Osoti |first5=Alfred O |last6=Finucane |first6=Elaine M |date=27 August 2020 |title=Home versus inpatient induction of labour for improving birth outcomes |journal=Cochrane Database of Systematic Reviews |volume=2020 |issue=8 |pages=CD007372 |doi=10.1002/14651858.CD007372.pub4 |pmc=8094591 |pmid=32852803}}</ref>

=== Predicting the necessity of induction ===
Clinicians assess the odds of having a [[vaginal delivery]] after labor induction by a "[[Bishop score]]". However, recent research has questioned the relationship between the Bishop score and a successful induction, finding that a poor Bishop score actually may improve the chance for a vaginal delivery after induction.<ref name="cmaj.ca">Ekaterina Mishanina et al., "Use of labour induction and risk of cesarean delivery: a systematic review and meta-analysis", April 2014, Canadian Medical Association Journal, [http://www.cmaj.ca/content/early/2014/04/28/cmaj.130925]</ref> A Bishop Score is done to assess the progression of the cervix prior to an induction. In order to do this, the cervix must be checked to see how much it has effaced, thinned out, and how far dilated it is. The score goes by a points system depending on five factors. Each factor is scored on a scale of either 0–2 or 0–3, any total score less than 5 holds a higher risk of delivering by caesarean section.<ref>
Doheny, K. (2010, June 22). Labor Induction May Boost C-Section Risk. HealthDay Consumer News Service. Retrieved from EBSCOhost.
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