Induction of Labor: Understanding Your Options
The words “being induced” bring up different imagery for everyone, but for lots of pregnant people, induction is something they want to avoid at all costs. A lot of the time, this is because of stories they’ve heard of friends or families inductions being long, hard births.
While inductions can result in labors that do not progress quickly or easily, this is not always the case. Induction is an amazing medical advancement that can allow other complications to be avoided. The key is to decide if what you are facing is truly medically necessary, and if it is, understanding all of your options.
The best way to navigate the possibility of induction: learn about it! Here we will talk about the two types of induction, elective and medical. We will also talk about what induction generally looks like, so that you are aware of different mechanisms that are often suggested.
Elective vs. Medical Induction
Understanding the difference between elective and medical inductions is crucial for making informed decisions about your labor. Elective inductions are planned in advance and are not necessarily based on medical concerns, while medical inductions are typically initiated due to health concerns for either the mother or the baby.
Elective Inductions
Elective inductions are chosen by the pregnant person or recommended by the healthcare provider for non-medical reasons. These are the inductions that are “scheduled out”. They are incredibly common for those giving birth in the hospital setting– so much so that some providers assume the pregnant people they’re working with want one & schedule it before even asking! The reason for elective inductions generally fall into one of two categories.
Gestational Age
Some providers feel anxious about pregnancy going too far past the “due date”. The reason behind this is data that the risk of stillbirth increases the further post-dates the pregnancy goes. However…the jury is out as to exactly *why* this is.
No study has definitively shown that the placenta "aging" is a problem. There would be warning signs if your placenta was insufficient, including decreased movement from your baby. If a provider is concerned about the placenta “aging” as a pregnancy progresses past the due date, and the pregnant person is wanting to avoid induction, they may ask to come in for nonstress tests. This is simple monitoring and ultrasound of the baby, and can be done as often as daily to check on the status of the baby.
Another commonly cited concern with lengthier pregnancies are “big babies”. The concern being: the baby is too big and labor will result in a cesarean section. As long as your pregnancy has been healthy and without complications, it is extremely unlikely your baby will be too big to be born vaginally. This simply would not make sense evolutionarily - for our bodies to regularly gestate babies that are then too big to be born.
Convenience
Convenience is a perfectly valid reason to choose induction– as long as it is the birthing person making that decision, and they are fully informed on risks & benefits.
Scheduling with a partner or limited time off work after the babies born are very common reasons to choose an elective induction. If an elective induction is being planned, one important factor to consider is the Bishop Score.
The Bishop Score tells us the status of the cervix, and is pretty reliable in terms of predicting how well the body will respond to an induction. If a Bishop Score is low, the birthing person may consider waiting another week, or even another few days, before going in for an induction.
Medical Inductions
Medical inductions are initiated when there are health concerns for either the pregnant person or the baby. These situations are typically more urgent and require prompt attention. Common reasons include:
Maternal Health Issues
Ex: gestational diabetes or preeclampsia
Fetal Health Concerns
Ex: poor fetal growth or decreased amniotic fluid levels
The Gray Area of “Medical”
Often, situations may fall into a gray area where the decision is not straightforward. Understanding the nuances of these situations is essential for informed decision-making.
It is important to understand that the rules of what’s considered a medical reason for induction are not always cut and dry. One provider may suggest going to the hospital to be induced immediately upon a few high blood pressure readings, while another provider may suggest further testing and to come back in the morning for another office visit.
You may leave an appointment after an induction was suggested feeling confused and overwhelmed. Talk to friends and family members who have experienced similar situations. Not to take their word as gospel…but to help you come up with a list of questions to call your provider with. If you are feeling unsettled about coming in for your induction, tell your provider that. Schedule another in-office visit to review questions and concerns.
There are a LOT of resources available online for these “gray area” situations. Do some digging, and then have an in-depth conversation with your provider.
Questions to Ask Your Provider
When facing the possibility of induction, it's important to ask your healthcare provider questions to assess the urgency of the situation. Bring a list with you, and a pen and paper to take notes during your visit. Key questions may include:
Reason for Induction: Understanding the specific reasons for the induction can help clarify its urgency.
What are the concerns of this pregnancy continuing?
Have we exhausted all diagnostics? Are there any other tests that can be run?
Is it possible everything is actually normal and healthy, and the test is not completely accurate?
Alternative Options: Inquiring about alternative approaches or waiting strategies is crucial for informed decision-making.
What if we wait?
Can I come in for nonstress tests, to push off the induction date?
Risks of Induction: Always ask about the risks of induction if one is being suggested. If a provider says that there are no risks, that could be a red flag that they are not being completely transparent, because that is not true.
Be open with your provider about your wishes, or your concerns. They are there to advise you and are a wealth of helpful knowledge. You may be concerned about something that they are not aware of, and they may have a helpful suggestion that you were not aware of. Ask alllll of your questions, and collaborate.
If you are facing an induction, try this:
If induction becomes necessary, or you have an elective induction scheduled, there are things you can try to prepare yourself physically and emotionally. Physically you want to help your body start to facilitate the right hormones and you want to get your baby in an optimal position. Emotionally, process as much as you can and practice techniques for getting in a good headspace.
Cervical Ripening:
Acupuncture. Acupuncture has been shown to improve Bishop Score within 24 hours. Find a provider who is familiar with acupuncture for labor induction.
Membrane sweep. You may request your provider to perform a “membrane sweep” while they’re assessing your cervix. This encourages your body to release hormones that can get labor started.
Sex. Both a female and male orgasm are optimal. Female orgasm releases oxytocin which encourages contractions, and sperm contains prostaglandins which help the cervix ripen.
Optimal Fetal Positioning:
Forward-leaning inversions (linked)
Miles circuit (linked)
Emotional Preparedness:
Write a letter to your baby. Tell them how excited you are to meet them; what your pregnancy has been like so far; and your fears, hopes and dreams for their birth. This can be a great way to process emotions and it will be something your baby will cherish as they grow older.
Practice breathing techniques that will come in handy not only throughout labor, but also on the way to the hospital, as you’re getting checked in…and anytime anxiety or uncertainty shows up.
Visualize your birth. Take time to visualize how it may go, from start to finish. Consider your mindset as you navigate your induction. Meditate on what is important to you, and how you will achieve the birth you’re envisioning.
If you were hoping to avoid induction, allow yourself to grieve the birth you were planning on. Your feelings are valid. Have a good cry!
How Induction Happens, Usually
The provider works with the hospital to schedule a time for the pregnant person to come in for their induction. They have a plan in place for medications/mechanisms for induction, according to the status of the cervix.
When arriving for induction, you would head to a room on the unit. This is the room that you would labor and deliver in. There, a nurse would ask all of the normal intake questions. Medical history, pregnancy history, etc. Next would be monitors on your belly to listen to the babies heart rate as well as monitor for any contractions. After or during the monitoring, they would likely get the IV placed. Most inductions require an IV to deliver Pitocin.
Medications/Mechanisms:
Foley bulb/balloon: This is a saline-filled “bulb”. It looks like a small balloon with a tube. It is placed in the cervix and filled with water. As it swells, it encourages the cervix to dilate mechanically. This can cause some cramping and discomfort. When the cervix is dilated to 3-4cm, the balloon will usually fall out.
Cytotec: Cytotec is a medication used to help start labor. It comes in the form of a small tablet that is placed either in mouth between cheek and teeth to dissolve, or near the cervix. As the tablet dissolves, a substance is released that prompts the cervix to soften and open, initiating the labor process.
Pitocin: Pitocin is a medicine used to help start or speed up labor. It's given through an IV, and it mimics oxytocin. Oxytocin helps the uterus contract, and Pitocin is used to make contractions stronger and more regular during labor. This helps the labor process move forward.
Breaking the waters: Breaking waters, also known as amniotomy, is a procedure used to start or speed up labor. During this process, a healthcare provider uses a thin tool to make a small opening in the amniotic sac, which contains the fluid surrounding the baby. This release of amniotic fluid can help stimulate stronger contractions and progress labor. It's often done when a woman's cervix is already partially dilated.
A quick aside about breaking the waters…the science is really inconclusive as to if this procedure truly helps labor progress. Also, once the amniotic sac is broken and waters are released, the protective barrier for baby is gone. Therefore, there is often a “clock” at that point. This means that there is a certain point post-waters breaking that most providers will want baby to be born. If labor is going long, a cesarean may be suggested at that point. If you decline your waters being broken, that clock does not exist. Not to say there’s never a good scenario to break your water, there’s lots of nuance here. Just make sure to ask lots of questions before consenting to your waters being broken.
The medications/mechanisms used during an induction vary from provider to provider, as well as the status of your cervix at the time of your induction. If your cervix is very favorable (high Bishop Score) they may simply start your induction with Pitocin. Foley bulbs and Cytotec are generally used when the cervix could use some more ripening.
Ask questions before heading in for your induction, to ensure that you understand the game plan. If things change, ask your nurse why. Remember that you are always involved in the decision making.
Inductions can and do lead to positive birth experiences
Being induced does NOT mean your hopes and dreams for a beautiful birth are shattered. Induction exists as a tool that we are lucky to have today, when needed. There are still so many options at your fingertips to make this the birth you’ve always dreamed of.
The keys are: understand if the induction being suggested is an elective induction or a medical induction. Determine your comfort level with the induction. Understand your options. Remember that you are an active participant in this induction, and you are the final say. Take a deep breath and trust yourself. You can do this!
