ACOG Standards for the Induction of Labor

Obstetric professionals induce labor in pregnant women when the health of the mother or the fetus is at risk. Labor induction causes the cervix, or the mouth of the uterus, to thin out and open in preparation for a vaginal birth. According to the American College of Obstetricians and Gynecologists (ACOG), for the last two decades, the rate of labor induction has more than doubled. In response, ACOG revised its standards for labor induction in 2009.

Risk vs. Benefit

• The goal of induction is to encourage vaginal delivery and make the birth occur before labor begins naturally. The benefits of doing so must be weighed carefully against the risks associated with the procedure.

  When the health benefits of an early delivery outweigh the potential risks of continuing the pregnancy, inducing labor can be beneficial for all involved. Occasionally, non-health related situations make induction a consideration, such as when a mother's distance from the hospital is too lengthy to make it there in the event of a spontaneous labor, or if the mother is at risk of having an unusually brief labor.

Induction Indications

• The choice to induce labor is conducted on a case-by-case basis and is decided according to the condition of the mother and baby, the status of the cervix and how far along the pregnancy has progressed.

  Maternal health conditions that indicate possible labor induction include chronic or gestational hypertension, pre-eclampsia, diabetes, uterine infection or a post-term pregnancy dating 42 weeks or greater.

  Other conditions that increase the chance of labor induction include fetal growth restriction, premature rupture of the amniotic membranes and placental abruption, when the placenta begins to separate from the uterine wall during the pregnancy.

Induction Contraindications

• Unless a serious problem warrants an earlier delivery, ACOG recommends against labor induction before 39 weeks of pregnancy. The gestational age of the fetus should be determined as closely as possible, and evidence of fetal lung maturity verified through amniocentesis.

  Immature fetal lungs are one reason to hold off on an elective labor induction. Other contraindications include breech or transverse fetal position, a placenta entirely or partially blocking the cervix, umbilical cord prolapse---a condition in which the umbilical cord wedges between the baby's head and the cervix---or an active herpes infection in the mother. In these cases, when evidence continues to indicate that a baby should be born sooner rather than later, cesarean section is usually chosen as the safest route of delivery.