Research appears to show that it's your baby's own body that gives your body the go-ahead when it's time for birth to get started. Hormones produced by the baby set off a complex array of reactions into place that soften the cervix (mouth of the uterus) and make wavelike contractions happen to the uterus as it prepares to push the baby out into the world.

Most pregnancies last between 38 and 42 weeks. Between 40 and 42 weeks your pregnancy will be considered "past date." After 42 weeks, or if your placenta is showing signs of trouble, your healthcare provider may recommend that artificial chemicals that mimic the action of hormones be used, such as Pitocin® to make your uterus go into labor (induction), or, if you're having contractions, to make them stronger (augmentation).

If your cervix, the mouth of your uterus is still tightly closed instead of thinning and opening, it will be considered "unripe," and you may be given medication as a suppository, as something taken by mouth, or as a gel or tablet inserted inside your vagina to help it soften and become "ripe" so induction will work better.

Inducing a labor when the body still hasn't begun contractions is considered one of the most drastic ways to intervene in the natural process of birth. To try to make birth happen when a woman's cervix isn't ready for it can lead to induction failure; a long and very exhausting labor; a higher-than-average risk of having to have an emergency cesarean section and other risks that can affect your baby's well-being and oxygen supply.

Softening the mother's cervix first with substances such as prostaglandins increases the success of induction, but also the possibility of her uterus contracting too much. There are mechanical devices, such as small balloons or reeds that are sometimes used to expand the cervix without causing the uterus to contract too fast or to freeze.

Once your cervix appears softened and ready for birth, you will then be given a uterine stimulant, such as Pitocin®. Typically that's done with an IV line into a vein on your hand or arm. You will feel your contractions begin to change. They may become more painful and closer together.

Baby Size Isn't Usually An Issue

Some health care providers may suggest that a pregnant woman should have an induction because her baby is growing "too large," but the American Academy of Obstetricians and Gynecologists has issued a practice guideline stating that baby size should not be the only reason for asking a mother to undergo induction of labor, unless the mother or baby have other indicators for the need for it, such as the mother's diabetes mellitus, or her history of having huge babies in the past.

When it comes to normal pregnancies, estimates of baby's actual due dates and of baby size are notoriously inaccurate in the weeks preceding birth. Sonograms, although they may be able to accurately guess the ages of babies during the second trimester, become increasingly inaccurate in estimating baby size as the baby's due date gets nearer.

Why Waiting is Important

If you are tired of waiting on your baby, elective (self-chosen) induction may sound appealing to you because it would appear to give you some level of control over the time and circumstances of your baby's birth; however, it' s important to be aware that artificially inducing labor can sometimes have serious consequences for both mother and baby.

Whether you should have your labor augmented after your labor has already started is purely a decision left up to your health care provider. You may be less likely to have augmentation suggested if you stay at home until your labor is well established and very active and then go to the hospital if yours is a normal pregnancy.

As a patient, you always have the right to "informed consent," that is, to refuse a treatment, especially if you feel your labor is moving along normally, and there are no clear medical indications that justify forcing your uterus to work overtime.

Your health care provider has the responsibility of fully informing you, not only of the benefits of having your labor augmented, but also all the risks involved, even if they're remote. "It will make your baby arrive sooner," is not a benefit, especially if your baby isn't into position yet.

If you do have augmentation, and you find yourself in serious pain, or feel your uterus contracting rapidly over and over with no breaks in between, let the labor and delivery nurse overseeing your care know immediately, and make the request that your medication be backed down or counteracted.

Tests to See If Postponing is OK

If you go beyond your due date, your health care provider may suggest that you do a "kick count" to see how active your baby is being over a given amount of time, and he, or she, may also recommend that you take a painless, non-stress test. It's simply a way to measure your baby's movements and changes in the speed of his heart rate for 20-30 minutes in relation to the baby movements you're feeling. Other tests may be requested for you, such as a biophysical profile (BPP) that use a sonogram to measure your amniotic fluid volume, fetal activity, fetal muscle tone, and the movement of your baby's lungs.

Again, if the tests show that your baby is reacting normally and your internal systems are performing adequately, you may prefer to wait a few days to see if you naturally go into labor, rather than artificially trying to force labor to start.

Getting a Second Opinion

It's wise to think twice about having an elective (non-medically required) induction simply for convenience's sake; because your health care provider plans be out of town the week you're due; or your caregiver tells you that your baby is growing too large.

If you feel there is not a sufficient medical emergency that requires an induction, and you don't wish to subject yourself to the added risk of a cesarean section or your baby to the risks of being born too early, then we suggest asking for tests to show that there genuinely is a need for the baby to be born now, and not, say, 10 days from now.

If you're in doubt about how to proceed, you can always seek a second opinion from another obstetrician or from a specialist in maternal-fetal medicine -- an obstetrician with extra training in managing risks for mothers and babies.