Oula’s approach to birth is generally to await spontaneous labor (in the absence of medical risk factors), but we also consider the evidence around late term pregnancy and its implications on maternal and fetal well-being. We balance your personal preferences and comfort around medical induction of labor within the context of an evidence-based, personalized medical recommendation.
Oula’s recommendation is that people with no other risk factors should have their labors induced around 41 weeks of pregnancy (1 week after your due date). The absolute earliest you could be considered for an elective induction of labor (an induction without medical indication, only personal preference) is at 40 weeks of pregnancy. The absolute latest we recommend staying pregnant is 42 weeks of pregnancy. Prior to your prenatal visit at 38 weeks, we’ll ask you to choose 3 days between 40 – 42 weeks of pregnancy that you would prefer to be induced if you are still pregnant at that time.
What is an induction of labor?
Labor induction involves the use of pharmacological and/or mechanical methods to initiate and encourage the progression of labor. The decision of whether, when, and how to induce labor is an informed choice that should be made between you and your care team. In the early part of your induction, we will first attempt to “soften” your cervix to prepare it for labor, a process known as cervical ripening. Once your cervix is deemed “ripe”, labor is induced by encouraging your uterus to contract with medications or other methods.
How is labor induced?
Methods for cervical ripening and inducing labor may include the following:
- Stripping or sweeping the amniotic membranes (membrane sweep)—Your provider sweeps a gloved finger through your cervical canal and separates the thin membranes that connect the outside of the amniotic sac to the inside of your uterus. , This cervical manipulation causes your body to release hormones called prostaglandins. This optional procedure is conducted in our office.
- Prostaglandin analogs (Misoprostol/Cytotec)—These are small tablets placed in your vagina or your mouth to start cervical ripening by softening the cervix.
- Cervical ripening balloon (Foley balloon, Cook catheter)—Your provider can place a small balloon-like device in your cervix to mechanically dilate it and help induce labor.
- Rupturing the amniotic sac (Amniotomy, “breaking your water”)—Your provider makes a small hole in the amniotic sac to release the fluid.
- Pitocin—A synthetic form of the hormone oxytocin which will be given through an IV tube in your arm. This medication will cause the uterus to contract. The dosage is slowly increased over time in order to establish regular and strong contractions. Your and your baby’s well being are carefully monitored through the Pitocin administration.
How can risk factors impact the timing of a recommended induction?
Research shows that certain factors can add risk for the birthing parent or the baby towards the end of pregnancy. Induction of labor is sometimes recommended prior to 40 weeks in order to manage this increased risk. We may recommend induction before 40 weeks for patients with pregnancy complications such as diabetes, high blood pressure, fetal growth restriction, or other medical conditions. Your care team will discuss these risk factors and recommendations with you at your prenatal visits.
What is a late term pregnancy?
Why are babies not born on their due date? A due date is ultimately a data-derived estimate of when we expect your baby to be born. While we use this date to guide timing for testing and evaluation, only 3-5% of babies are born on their due dates! Babies born between 37 – 42 weeks are considered to be born at term. A little around the terminology on this:
- Early term – 37 weeks 0 days ~ 38 weeks 6 days
- Full term – 39 weeks 0 days ~ 40 weeks 6 days
- Late term – 41 weeks 0 days ~ 41 weeks 6 days
- Post term – 42 weeks 0 days
The causes behind late-term or post-term pregnancy remain unknown, but there are several factors that may increase your chances of having a late-term pregnancy. These factors include the following:
- This is your first baby.
- You are carrying a male fetus.
- You have had a prior late-term pregnancy.
- You have a larger body habitus.
What are the risks associated with late term pregnancy?
While the health risks for you and your fetus may increase if a pregnancy is late-term or post-term, note that complications occur in only a small number of late-term pregnancies. Most people who give birth after their due dates have uncomplicated labor and give birth to healthy babies. Risks associated with late term pregnancy may include some of the following:
- Excessive growth of the baby, which can impact the fetal passage through the pelvis
- Passage of meconium (baby’s first stool) inside the uterus which can cause serious breathing problems if it is inhaled into the lungs during birth
- Aging of the placenta which can lead to:
- Poor fetal growth due to decreased blood flow through the placenta
- Decreased amniotic fluid, which can cause compression of the umbilical cord and restrict the flow of oxygen to the fetus
- Intolerance of labor contractions cause a natural decrease in oxygen through the placenta, and if the placenta is not functioning well, this can cause distress in the baby
Additional risks include an increased chance of an assisted vaginal delivery, such as a vacuum or forceps, or cesarean delivery. Furthermore, there is an increased chance of infection and postpartum hemorrhage when a pregnancy surpasses its due date.
Are there risks associated with inducing labor?
Inducing labor carries potential risks, including changes in fetal heart rate, infection, and contractions of the uterus that are too strong. You and your fetus will be monitored closely throughout the induction process. Additionally, there’s a chance that labor induction may not be successful, and the method may need to be repeated.. In some cases, you may need to have an assisted vaginal delivery or a cesarean delivery. Just like spontaneous labor, induction of labor can take time – perhaps as long as several days.
Why are we discussing this so far in advance?
We want to initiate this discussion early for two reasons. First, we want you and your support people (your partner, family members, doula) to have the opportunity to discuss labor induction options and make a well-informed decision. Second, the hospital can get busy and we want to make sure that we are able to honor your requested dates. The earlier we receive your request, the more likely we can secure that specific date.
What if I decline?
We want to honor your birthing preferences in a safe and evidence-based way. Declining a post-term induction is ultimately your decision, and we want to ensure you feel supported and informed in making this decision. If you choose to decline a 41-week induction of labor, please bring this up to your provider at your next prenatal visit so we can discuss further!
Where should I look for more information?
If you have not already, we would also strongly encourage you to review educational resources from Evidence Based Birth, American College of Obstetrics and Gynecology and American College of Nurse Midwives, and reach out to us through the portal or ask your provider for more information at your next prenatal visit.