Labor Induction
As a doula, I typically support hospital births. It is never my goal to tell you what type of birth is best, it is to give you information so that YOU can choose the right birth for you. Recently, I have been getting a lot of questions from my clients about inductions. I found that even clients who have chosen to take Childbirth Education classes to prepare for their birth are still unsure about what an induction is, or how it could affect their birth plan.
This post is to share what an induction often will look like, a few reasons your provider might suggest an induction, and questions you should ask so that you can decide if an induction is best for you and your baby. In no way is this post meant to be pro/anti-induction. This post also does not talk about the safety of an induction for any given individual, because I feel that is a conversation between you and your healthcare provider. An induction is a tool that can sometimes be used (or offered) in the birthing process, so I think it is important for you to have non-biased information about it.
What is an induction? Labor induction is the use of medications or other methods to bring on (induce) labor. When you Induce labor you are artificially inducing contractions before labor has begun in order to get labor started. This post is specifically addressing hospital inductions.
Why might an induction be used for your birth? There are many reasons that your provider may suggest an induction for your birth. Here are some of the most common reasons an Induction is suggested:
You're approaching two weeks beyond your due date, and labor hasn't started naturally (post-term pregnancy)
Your baby is too big (fetal macrosomia)
Your water has broken, but labor hasn't begun (premature rupture of membranes)
You have an infection in your uterus (chorioamnionitis)
Your baby has stopped growing at the expected pace (fetal growth restriction)
There's not enough amniotic fluid surrounding the baby (oligohydramnios)
You have diabetes
Your placenta is no longer performing as well as it should at transferring nutrients to your baby
You have a high blood pressure disorder
Your healthcare provider may be going on vacation
You are feeling either physically or emotionally drained by a difficult or uncomfortable pregnancy
You have a preexisting medical condition
Your partner has limited availability to be at your birth (ex. military service)
How do you decide if an induction is right for your birth? With any induction, I suggest you take a moment to research the reason your healthcare provider has offered as to why an induction is suggested for your birth. Determine if they are suggesting an elective induction or if it is medically necessary for the safety of you or your baby. Ask them to share evidence-based research to back up their suggestions. Find out your Bishop Score to determine your chances for a successful induction. Familiarize yourselves with the risks versus benefits. Once you have gathered this information, I feel you are in a much better place to make an informed decision about whether or not you would like to move forward with an induction.
If I choose to be induced, will that change my birth experience? Honestly, it may or may not change your birth experience. That would depend on what your initial hopes for your birth experience were. If your initial Birth Wishes were to have the least medical intervention possible in your birth, and the freedom to move at will without being connected to monitors or cords then an induction would look very different. If however, your Birth Plans included pharmaceutical pain management, like an epidural, then an induction may not look as different from your original plan as you would think.
What does an average induction look like? Like every spontaneous labor, every labor induction will look different. There really is never a specific prescription for birth however, when you have attended enough births you will find that most do follow a common “flow”. An induction “flow” commonly will look like this:
Depending on the ripeness of your cervix or your Bishop Score you may be asked to come into the hospital the night before to begin your induction. At this time they would usually place medication inside the vagina, to thin or soften (ripen) the cervix. Sometimes they will choose to use a small catheter with a balloon on the end to manually stretch and ripen your cervix. Either way, once they have started your induction, both you and your baby will be continuously monitored. Your ability to eat is closely monitored and restricted if you are being induced in a Kansas City area hospital, but that may not be the case depending on your location.
If your cervix is already favorable for an induction or if you have already spent the night in the hospital to help achieve that, then your next step is most likely Pitocin. Pitocin (synthetic oxytocin) is an IV medication that is used to induce contractions. Typically this is started first thing in the morning so that you can labor throughout the day and your physician can check on you when doing their rounds. Pitocin is generally started at a very low dose and is gradually increased until your contractions have achieved a good pattern. You are still able to be mobile at this time as long as both mother and baby are coping with labor well and you are not on pain management. You will need to be continuously monitored and you will also be attached to the IV so you may be somewhat limited in your mobility. You may wish to check with your hospital about if they offer a reliable wireless monitoring option. Your choice to use water (tub or shower) as a comfort measure may also be limited at this time.
Amniotomy or rupturing the amniotic sac (breaking your water) is another common tool used during labor induction. Your physician will use a tool with a small plastic hook to break your water. You may or may not feel a gush of fluid depending on how low in the pelvis your baby’s head is. Once your water is broken, you will continue to leak fluid until delivery. This procedure helps baby to come down and allows its head to put additional pressure on your cervix thereby encouraging contractions and dilation. It is important to ask your provider if there is a time restriction placed on your birth once your water is broken.
These are the most common tools used for a hospital labor induction. Each of these options carries its own set of benefits and risks and I encourage you to speak to your healthcare provider to determine what is right for you. Your ability to eat, be mobile, or be free from continuous monitoring will be closely regulated so if these things are important to you during your labor, I encourage you to talk to your provider about your hospital’s policies.
Knowledge is power. This post is meant to offer you additional information about inductions. I think it is important to talk with your birth team including your partner, medical provider, and doula, to determine what is the best decision for your birth. Far too often we do not know what questions we should be asking regarding our pregnancy and birth, and I feel if you had more information you may have made a different decision (in either direction) and that is important to me. Making sure that we honor women/birthing individuals’ intelligence, intuition, and autonomy to make the most informed decisions for their bodies and their birth is crucial. I hope that the information that I have shared with you here will inspire additional conversations between you and your birth team and thereby allow you to have the best birth possible.