Your Birth, Your Choice: Understanding the Top Reasons for Induction and How to Advocate for Yourself
- Eva Monhaut-Jenkins
- Aug 4
- 6 min read
When it comes to birth, one thing is clear: your choices matter. As a birth doula supporting families virtually and in the Michiana area, I know how important it is to feel informed and empowered—especially when facing decisions about induction.
Labor induction is common, but it’s not always necessary and often mis-used or leveraged for the wrong reasons. After all, when true emergencies happen, a two-day induction is the last thing that would be needed. Understanding why inductions happen and what the evidence says can help you take ownership of your birth experience and advocate for the care that’s right for you.
What Is Labor Induction?
Labor induction is when healthcare providers use medical interventions to start labor artificially rather than waiting for it to begin naturally. It’s a tool that can be life-saving in some situations but can also come with risks and trade-offs. Because induction can change your birth experience significantly, knowing the reasons behind it and the research evidence helps you make empowered decisions with your care team.
Top 3 Reasons People Get Induced -- Let's Take A Deeper Dive
1. "Post-Term" Pregnancy
The most common reason for induction is when pregnancy extends beyond 41 or 42 weeks, often called “post-term.” But it’s important to know that due dates themselves are estimates—often off by a week or more—and that natural variation in pregnancy length is normal.
Due dates aren’t exact: Research shows that only about 5% of babies are actually born on their estimated due date1. This is because the standard due date calculation—based on the first day of your last menstrual period (LMP)—assumes a 28-day cycle with ovulation on day 14, which doesn’t apply to everyone. Studies reveal that gestation length can vary widely between individuals and populations.
Gestational length varies naturally: A landmark study by Jukic et al. (2013) analyzed over 1,000 pregnancies and found that the average natural gestation length is about 41 weeks and 5 days (roughly 290 days), not 40 weeks as commonly stated2. This means many people’s bodies are actually built to carry longer pregnancies without complication and many factors contribute to how long someone will naturally gestate.
Placental aging and risks after 40 weeks: After 40 weeks, the placenta may begin to age and function less efficiently, which can reduce oxygen and nutrient delivery to the baby. This physiological change is what often motivates providers to recommend induction after 41 or 42 weeks. Evidence shows that the relative risk of stillbirth does increase after 41 weeks, but it’s important to consider the absolute risk, which remains quite low.
According to Evidence Based Birth, the risk of stillbirth at 41 weeks is about 1–2 per 1,000 pregnancies, increasing to approximately 3–4 per 1,000 by 42 weeks3.
A 2020 Cochrane systematic review of randomized controlled trials found that inducing labor at or after 41 weeks reduces the risk of stillbirth and meconium aspiration syndrome compared to expectant management (waiting for labor to start naturally), without increasing cesarean birth rates4.
What does this mean for you?
Knowing that due dates are estimates and that natural pregnancies often last longer can help you approach induction decisions with confidence and perspective. You can discuss with your care provider whether to wait with close monitoring—such as ultrasounds and non-stress tests—or to proceed with induction based on your comfort, risk factors, and birth preferences.
2. Medical Conditions Affecting Mom or Baby
Certain health conditions can make induction a medically recommended option to protect the health of the birthing person or baby. These include:
Gestational diabetes is often managed with diet, blood sugar monitoring, and sometimes medication. When blood sugar levels are not well controlled, the risk of complications can increase such as stillbirth, or neonatal hypoglycemia increases1. However, the rates of these increases as well as your individual risk matters in making informed choices.
High blood pressure and preeclampsia are monitored through blood pressure checks, urine tests, and blood work to assess kidney and liver function. These conditions can cause reduced blood flow to the placenta, leading to potential fetal growth problems and increased risk for the birthing person2. Induction is recommended once the risks of continuing pregnancy outweigh those of early delivery.
Intrauterine growth restriction (IUGR) means the baby isn’t growing as expected. This diagnosis depends on ultrasound measurements of fetal size, but it’s important to remember that ultrasounds can have a margin of error of up to 15% in estimating fetal weight3. Additionally, if due dates are off, size assessments might be misinterpreted. Continuous monitoring via ultrasounds, Doppler flow studies, and fetal heart rate tests can help monitor how baby is doing before choosing induction.
Ruptured membranes without labor starting increase the risk of infection (chorioamnionitis) the longer the baby remains inside without contractions. Usually, if labor doesn’t begin within 24 hours, induction is recommended to reduce infection risk4. However, there are multiple factors to consider and the decision should always come down to you having all the information to make the best choice for yourself.
What does the evidence say?
The American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) provide guidelines supporting induction in these scenarios because evidence shows continuing pregnancy under these conditions increases risks for both the parent and baby5.
For example, poorly controlled gestational diabetes increases the risk of stillbirth by approximately 3–4 times compared to pregnancies without diabetes1.
Severe preeclampsia has significant risks of maternal stroke, organ damage, and fetal growth restriction. Induction or cesarean delivery is often necessary to prevent serious complications2.
IUGR is associated with increased risks of stillbirth and neonatal complications if the pregnancy continues without intervention3.
When membranes rupture early without labor, the risk of infection rises sharply after 24 hours, which is why timely induction is evidence-based to protect both lives4.
Balancing induction timing and your preferences
As your doula, I help you understand the medical reasons behind induction recommendations, what monitoring looks like, and how to ask your provider questions so you can advocate for yourself while making the best choice for you and your baby.
3. Elective Induction (Non-Medical Reasons)
This one often raises questions and debate. Elective induction means starting labor for non-medical reasons, such as scheduling convenience or discomfort late in pregnancy. While some people choose this intentionally, evidence shows that elective induction before 39 weeks can increase risks like longer labor, cesarean delivery, and respiratory issues for the baby12.
The American College of Obstetricians and Gynecologists (ACOG) recommends that elective inductions not be done before 39 weeks unless medically necessary1. If you’re considering this, it’s vital to discuss the risks and benefits with your provider and ensure your baby’s lungs and health are fully ready.
How I Support You in Navigating Induction Decisions
Choosing whether or when to induce labor is a deeply personal decision. It’s rarely black and white. As your birth doula, my role is to:
Provide evidence-based information tailored to your unique situation.
Encourage open dialogue with your care team, helping you prepare questions.
Support your emotional and physical well-being regardless of the path chosen.
Advocate for your preferences and informed consent at every step.
Whether you’re planning an in-person birth in Michiana or working with me virtually, I’m here to guide you through the process. Having someone by your side who understands both the medical info and your emotional journey makes all the difference in feeling confident and respected.
Your Birth, Your Voice
Induction is a common part of modern maternity care, but that doesn’t mean it’s a one-size-fits-all solution. The more you know about why inductions happen and what the research says, the better you can partner with your provider to make the best decision for you and your baby.
If you’re curious or concerned about induction, let’s talk. I’m here to help you sort through the evidence, prepare for your options, and advocate for your empowered birth—no matter where you are on your journey.
Your birth, your choice. And you don’t have to do it alone.
Citations & References for Further Reading
American College of Obstetricians and Gynecologists (ACOG). Induction of Labor. Practice Bulletin No. 107. 2020.https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2020/02/induction-of-labor
Jukic AMZ, Baird DD, Weinberg CR, McConnaughey DR, Wilcox AJ. Length of human pregnancy and contributors to its natural variation. Human Reproduction. 2013 Oct;28(10):2848–2855.doi:10.1093/humrep/det290https://academic.oup.com/humrep/article/28/10/2848/631455
Evidence Based Birth. Induction of Labor. 2023.https://evidencebasedbirth.com/induction-of-labor/
Cochrane Database of Systematic Reviews. Induction of labour at or beyond term. 2020.https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004945.pub5/full
Society for Maternal-Fetal Medicine (SMFM). SMFM Consult Series #53: Induction of labor. American Journal of Obstetrics & Gynecology. 2021.https://www.ajog.org/article/S0002-9378(21)00203-4/fulltext
Grobman WA, Rice MM, Reddy UM, et al. Labor Induction versus Expectant Management in Low-Risk Nulliparous Women. New England Journal of Medicine. 2018;379(6):513-523.doi:10.1056/NEJMoa1800566https://www.nejm.org/doi/full/10.1056/NEJMoa1800566
Comments