Labor, Induction & Delivery

Labor and delivery can unfold in many different ways, and each birth experience is unique. Labor may begin on its own or may be induced when medically recommended or as part of a planned birth. During labor, your healthcare team will monitor both you and your baby while supporting your preferences whenever safely possible.

Induction of Labor

Labor induction uses medications or other methods to help start labor before it begins on its own. Induction may be recommended for medical or pregnancy-related reasons and may also be considered electively in some situations.

When Should I Deliver?

For most healthy, uncomplicated pregnancies, there is some flexibility in when delivery occurs. Elective induction of labor can be considered beginning at 39 weeks. If you prefer to wait for spontaneous labor, that is also reasonable, although we generally recommend delivery by 41 weeks.

Between 39 and 41 weeks, the timing of delivery is often based on your preferences. We may occasionally recommend delivery sooner based on your health, your baby's health, your cervical exam, or other circumstances that develop during pregnancy.

If you have a pregnancy complication or another medical reason for delivery, our recommendations may be different and we will discuss the timing with you individually.

Considering a 39 Week Induction?

For healthy patients, induction beginning at 39 weeks is an option even when there is not a medical reason to deliver.

The ARRIVE Trial was a large randomized study of more than 6,000 healthy patients having their first baby. It compared elective induction at 39 weeks with waiting for labor to begin or for another reason for delivery to develop. Elective induction did not increase the risk of cesarean delivery. In the study, cesarean delivery actually occurred somewhat less often in the induction group (18.6% vs. 22.2%). Serious newborn outcomes were not significantly different between the groups.

The decision to schedule an elective induction is still a personal one. Some patients prefer the predictability of induction, while others prefer to wait for spontaneous labor. We are happy to discuss the benefits and tradeoffs with you.

How Elective Induction Scheduling Works

Elective inductions are scheduled differently from medically indicated inductions. Because Labor & Delivery volume changes from day to day, elective inductions are placed on a waiting list and are brought into the hospital as space and staffing allow.

We can begin working on your induction request around 35–36 weeks, although an elective induction cannot begin before 39 weeks. If you already know that you would like an elective induction, please let us know your preferred date. The earlier we know your preference, the higher your name can be placed on the waiting list for that date.

When your requested date arrives, the hospital will contact you when they have space available. Sometimes that is the same day; during busier periods, it may take several days. Unfortunately, we cannot guarantee the exact day or time that an elective induction will begin.

Once you reach 41 weeks, induction is considered medically indicated rather than elective and will take priority over elective inductions.

What if I Prefer to Wait for Labor?

If you prefer to wait for spontaneous labor, we generally continue routine prenatal care. Around 40 weeks, we typically perform an ultrasound to check the amniotic fluid level (AFI) and a nonstress test (NST) to assess fetal wellbeing.

If testing is reassuring and your pregnancy remains uncomplicated, you may continue waiting for spontaneous labor. However, the risk of pregnancy complications, including stillbirth, gradually increases as pregnancy continues beyond the due date. For this reason, we generally recommend induction by 41 weeks in healthy, uncomplicated pregnancies.

If your testing or another aspect of your pregnancy raises a concern, we may recommend delivery sooner.

What Happens During an Induction?

Induction of labor can take time, particularly if this is your first baby or your cervix is not yet dilated when you arrive. It is not unusual for the early part of an induction to focus primarily on helping the cervix soften and begin to dilate before active labor starts. The entire process may take a day or sometimes longer.

We recommend eating a good meal before coming to the hospital, unless you have been given different instructions. Once your induction begins, you will typically be limited to a clear liquid diet.

When you arrive, we'll assess your cervix and your baby's wellbeing. The methods used for your induction will depend largely on how ready your cervix is for labor, and the plan may change as your induction progresses.

Methods of Inducing Labor

Misoprostol (Cytotec)
A medication used to soften the cervix and help it begin to dilate. It can be given by mouth or placed vaginally and is often repeated approximately every 4 hours for several doses, depending on how your cervix and contractions respond.

Cook Catheter (Cervical Balloon)
A small balloon catheter can be placed through the cervix and gently inflated to help the cervix dilate. It is often used along with medication such as Cytotec, but a balloon is not necessary for every induction.

Breaking Your Water (Amniotomy or AROM)
Once your cervix is dilated enough and your baby's head is in an appropriate position, we may recommend breaking the bag of water to help labor progress.

Pitocin (Oxytocin)
Pitocin is given through your IV and gradually adjusted to create a regular pattern of contractions. It may be used after cervical ripening or earlier in the induction depending on your cervical exam and clinical situation.

There isn't one standard sequence that every induction follows. We may use one method or several of these methods together, and we'll adjust the plan based on your cervical exams, contraction pattern, baby's heart rate, and how labor is progressing.

Understanding Your Cervical Exam

During labor, you may hear us describe your cervical exam using three measurements: dilation, effacement, and station.These help us understand how your cervix is changing and how your baby is moving through the pelvis.

During Labor

During labor, your care team will monitor your health, your baby's wellbeing, and your labor progress while helping you navigate decisions as they arise. Your nurse and physician will work closely with you throughout labor, and support people or doulas can also play an important role in helping you feel informed and supported.

Monitoring Your Baby During Labor

During labor, we monitor your baby's heart rate and your contractions to help us understand how your baby is tolerating labor. Most patients will have continuous electronic fetal monitoring, particularly during an induction or when Pitocin is being used.

Sometimes the heart rate tracing changes during labor. If this happens, we may recommend changing positions, adjusting medications, giving IV fluids, or other interventions depending on the situation.

Fetal Heart Rate Monitoring During Labor (ACOG)

Your Preferences During Labor

We want you to feel informed, supported, and involved in decisions throughout your labor. Please talk with us about your preferences and what is important to you. This may include preferences about movement and positioning, pain management, who you would like to support you during labor, and other aspects of your birth experience.

Your preferences do not need to follow a particular format or be written in a formal birth plan. We'll work as a team to respect your preferences whenever possible, while also offering guidance if circumstances arise where we have concerns about your health or your baby's wellbeing.

Partners, family members, and doulas can all be important sources of support during labor. We are happy to work with the people you have chosen to support you throughout your birth experience.

Pain Management During Labor

There are many ways to manage discomfort during labor, ranging from breathing, movement, and other non-medication techniques to IV medications and epidural anesthesia. There is no single “right” approach, and your preferences may change as labor progresses.

Comfort & Supportive Measures

Movement, position changes, breathing techniques, massage, counterpressure, heat, and support from your partner, doula, or nurse can all help with coping during labor. These techniques can be used on their own or along with medication.

IV Pain Medication

IV pain medication can help take the edge off contractions and allow you to rest, particularly earlier in labor. These medications usually do not eliminate pain completely and may cause sleepiness or nausea. Whether IV medication is appropriate may depend on how close you are to delivery.

Nitrous Oxide

Nitrous oxide, sometimes called “laughing gas,” is inhaled through a mask during contractions and can help decrease pain and anxiety while allowing you to remain mobile.

Nitrous oxide is available for some patients at Novant Health Presbyterian Medical Center. Whether it can be used depends on factors such as your gestational age, your baby's heart rate tracing, and other pregnancy or medical considerations.

Epidural Anesthesia

An epidural provides the most effective pain relief available during labor. Medication is given through a small catheter placed in your lower back by the anesthesia team. You remain awake and alert, but most patients experience significant relief from contraction pain.

You do not need to decide in advance whether you want an epidural. Some patients know they would like one, while others prefer to see how labor progresses. It is okay for your preferences to change.

Procedures & Unexpected Events During Delivery

Most births progress without serious complications, but sometimes circumstances arise that require additional procedures or treatment. If this happens, we'll explain what we're seeing, discuss our recommendations with you, and work together to determine the safest next steps for you and your baby.

Some events, such as vaginal or perineal tearing, are relatively common, while others occur less often. The resources below provide more information about some of the situations that may occur during or immediately after delivery.