Types and Risks of Labor Induction

Weigh the Benefits and Risks of Each Type of Labor Induction

Labor in hospital

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What is induction? We talk about inducing labor as a way to artificially start the process of labor. This usually happens when there is a medical need for the baby to be born sooner or for the mother to not be pregnant.

When labor needs to start, there are multiple ways to approach it. Many people are surprised to find that there are many different types of induction. No single method will work for every pregnancy.

Breaking the Bag of Water

Using an item called an amnihook, your practitioner will make a tiny tear in the bag of water. This will cause the water to begin leaking out. Since the bag does not have nerves, this should be no more painful than your average vaginal exam. The thought is that once the bag is ruptured contractions will usually begin.

Benefits: No chemicals may be needed, you maintain more mobility than if you were required to have an IV.

Disadvantages: Contractions may not start and then this leads you to other interventions such as the use of Pitocin. It may additionally create an infection of the sac, the cushion for the baby is now removed, and rarely, but possibly, the prolapse of a cord, necessitating an immediate cesarean.

Breaking the amniotic sack also requires that you have a baby within a certain amount of time, depending on the circumstances and your practitioner's beliefs. It is better to use amniotomy with other methods of induction.


This is an artificial version of the body's hormone oxytocin. It is given by way of an IV line and is used to cause contractions. The amount of Pitocin used will depend on how your body accepts it. Generally, the amount is increased every 10-30 minutes until a good contraction pattern is achieved. Sometimes this is done in combination with breaking the bag of water.

Benefits: A bit easier to control than say breaking the water, because the drug can be stopped by closing off the IV line. This does not commit you to have the baby. It can be turned off or stopped to allow mom to rest or even go home.

Disadvantages: Can cause fetal distress. May not cause contractions. May cause too many contractions or contractions that last too long. Because of the potential risks, the FDA came out and declared that this drug was not to be used for inductions for convenience or scheduling reasons.

Prostaglandin Gels/Suppositories

These are used more frequently when the cervix is not favorable, meaning that it is dilated less than 3 centimeters, hard, posterior, not effaced, barely effaced, or any combination of the above. By using Bishop's Score your practitioner will decide if this is the best place to start. This can be used alone, or more often will be done 12 or more hours prior to the use of Pitocin.

Frequently it will be given more than once over the course of an evening/night. A suppository or tampon-like substance will be placed in or near your cervix during a vaginal exam.

Benefits: The more favorable your cervix, the less likely the induction is to "fail." Sometimes this is all that is needed, other times Pitocin is also used. It can be done as an outpatient procedure. It does not commit you to having the baby.

Disadvantages: Takes longer to get into active labor, can be nerve-wracking if your institution's policy is that you have to stay at the hospital during the waiting period. Sometimes mom becomes nauseated or has headaches. This cannot be quite as controlled as Pitocin but tends to be milder. Some forms of the prostaglandins now have strings attached making them removable if dangerous contractions occur.

Misoprostol (Cytotec)

This is a pill that can either be ingested orally or placed near the cervix. It is used more often when the cervix is not very favorable.

Benefits: No tethering of the IV line. It can be used alone. The more favorable your cervix, the less likely the induction is to "fail." Not as messy as the suppositories potentially can be. Does not commit you to having the baby.

Disadvantages: May require the use of Pitocin or other means in addition. It can cause a very rapid labor. The recent thought is that this is not a valid option for mothers who are attempting VBAC; discuss this with your practitioner.

Home Induction

There are a number of ways to induce labor at home. They vary from nipple stimulation and intercourse to ingesting herbs and substances like castor oil.

Any method you are interested in using for home induction should be discussed with your practitioner prior to attempting to use it.

Many women will swear by one or all of these, however, not all women will go in to labor with any method of induction.

  • Walking
  • Sexual intercourse
  • Orgasm with or without a partner
  • Nipple stimulation
  • Certain foods (i.e. spicy foods, oily salads)
  • Bumpy car rides
  • Strenuous activity
  • Visualization
  • Castor oil
  • Certain herbs and homeopathics (black and blue cohosh, Caulophyllum, etc.)

Benefits: Typically less intervention and less likely to lead to a cesarean. Generally if your body and baby are not ready these will not work but it varies by method. These are easier to do and less worrisome for most moms.

Disadvantages: There can be serious consequences, particularly if you are not a term and your baby is not ready to be born. Many of the old wives' tales, like castor oil, do not generally work and can have potential complications including things like meconium staining, fetal distress, etc. Always check with your practitioner before using any of these methods.

Factors Affecting Labor Induction

Many times inductions are done for the reason of being past your due date. There has been some research recently that shows that due dates actually need to be longer than 40 weeks. Often there are unnecessary inductions.

Sometimes they are done because a woman is attempting vaginal birth after cesarean (VBAC) or has suspected large baby. Many studies have shown that these are not necessarily good reasons for induction, particularly if the cervix is not ripe.

Some women are fearful of induction for a variety of reasons, including the increased chances of a c-section, the increased need for pain medications, or the fear of the reason for induction, particularly if there is a question about the baby's health.

Will an induction be more painful than natural labor? Not necessarily, that really depends more on your reasons for induction, the type of induction, and whether or not your mobility is limited. Many women are able to be induced and still follow through with their plans for an unmedicated birth, though they can expect certain changes in their birth plans.

A Word From Verywell

If induction is suggested, gather facts and information, and ask questions. Why is it being suggested? How would it be attempted? What happens if it doesn't work? What happens if you do nothing?

There isn't a consensus on the use of induction, though it has its time and place, as any intervention does for medical reasons, though even the experts can't agree on all of the times an induction would be the best choice.

12 Sources
Verywell Family uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. American College of Obstetricians and Gynecologists. Labor Induction. 2017.

  2. Sayed ahmed WA, Hamdy MA. Optimal management of umbilical cord prolapse. Int J Womens Health. 2018;10:459-465. doi:10.2147/IJWH.S130879

  3. Prescriber’s Digital Reference. oxytocin - Drug Summary.

  4. Bakker JJ, Van der Goes BY, Pel M, Mol BW, Van der Post JA. Morning versus evening induction of labour for improving outcomes. Cochrane Database Syst Rev. 2013;(2):CD007707. doi:10.1002/14651858.CD007707.pub2

  5. Smith LK. Outpatient induction of labour with prostaglandins: safety, effectiveness and women’s views. British Journal of Midwifery. 2017;25(12). doi:10.12968/bjom.2017.25.12.774

  6. Macones GA, editor. Management of Labor and Delivery. 2nd edition. Sussex, UK: John Wiley & Sons, Ltd; 2015.

  7. Parveen S, Khateeb ZA, Mufti SM, et al. Comparison of sublingual, vaginal, and oral misoprostol in cervical ripening for first trimester abortion. Indian J Pharmacol. 2011;43(2):172-5. doi:10.4103/0253-7613.77356

  8. Armstrong C. ACOG Updates Recommendations on Vaginal Birth After Previous Cesarean Delivery. Am Fam Physician. 2011;83(2):215-217.

  9. Bovbjerg ML, Evenson KR, Bradley C, Thorp JM. What started your labor? Responses from mothers in the third pregnancy, infection, and nutrition study. J Perinat Educ. 2014;23(3):155-64. doi:10.1891/1058-1243.23.3.155

  10. Duryea E. UT Southwestern Medical Center. The truth about “natural” ways to induce labor. 2017.

  11. Middleton P, Shepherd E, Crowther CA. Induction of labour for improving birth outcomes for women at or beyond term. Cochrane Database Syst Rev. 2018;5:CD004945. doi:10.1002/14651858.CD004945.pub4

  12. Santiago-Munoz P. UT Southwestern Medical Center. Who is a good candidate for VBAC? 2016.

Additional Reading
  • Boulvain M, Kelly A, Lohse C, Stan C, Irion O. Mechanical Methods for Induction of Labor. Cochrane Database of Systematic Reviews. 2001, Issue 4.

  • Bricker L, Luckas M. Amniotomy Alone for Induction of Labor. Cochrane Database of Systematic Reviews. 2000;4. Art. No.: CD002862. doi:10.1002/14651858.CD002862

  • Jozwiak M, Bloemenkamp KWM, Kelly AJ, Mol BWJ, Irion O, Boulvain M. Mechanical Methods for Induction of Labor. Cochrane Database of Systematic Reviews. 2012, Issue 3.

By Robin Elise Weiss, PhD, MPH
Robin Elise Weiss, PhD, MPH is a professor, author, childbirth and postpartum educator, certified doula, and lactation counselor.