Induction of labor

I is for Induction

Induction is a term used to describe any of a number of artificial methods, both medical and non-medical, for bringing on the start of labor. According to the CDC the induction rate in the United States is around 23.3%. Reasons for induction can range from convenience or wanting to pick your baby’s birthday (elective inductions) to the prevention or remediation of life threatening complications (medically necessary inductions). By the end of this post you will: understand what induction is, who is induced, why, and how, alternatives, risks and outcomes (including the cascade of interventions), and common misconceptions.

Why would I be induced? Are there times where I shouldn’t be?

As mentioned in the intro, there are many reasons for induction of labor.

  • Post-Due (at or beyond 42 weeks) – if there are no signs of labor and you are past your due date, your provider may suggest induction. While there are great variations in “full-term” pregnancies, there comes a time where your provider becomes increasingly concerned about your baby passing meconium, the integrity of your placenta, and the risk of stillbirth.
  • Complications – these complications may include: preeclampsia, low or high fluid levels, compromised blood flow to the placenta or baby, gestational diabetes, concerns about placental integrity.
  • Rupture of Membranes with no Contractions – every provider and birthing facility is different in how long they are comfortable letting you wait for labor to progress one your water has broken. After 24 hours the vast majority of providers will want to perform a C section because of the increased risk of infection. If your labor has not begun to progress on its own, your provider may try to induce labor to start before you reach the 24 hour mark.
  • Elective Reasons – if your previous labor was very fast and you are concerned about getting to the hospital on time, your work schedule requires you to be back in the office by a certain date, or your partner has work commitments, you may be able to be electively induced. Providers try to avoid induction before 39 weeks because babies’ lungs are not fully mature (and they want to reduce the chance of a visit to the special care nursery). Elective inductions are at the discretion of your medical provider.

A C section may be preferable if:

  • you or your baby are in distress
  • your baby is not descending in the birth canal
  • your baby’s cord is prolapsed (the cord is in the vagina before the head)
  • your baby is breech
  • you have complications in your pregnancy
  • you are post-due
  • your placenta is partially or fully covering your cervix (placenta previa)
  • you have an active genital herpes outbreak

How does it work?

I feel like I’m starting to sound like a broken record, but every provider and birthing facility are different in the methods they use for inductions. The following methods are the most common. Your provider may opt for one or a combination of any of them depending on you, your baby, and the circumstances surrounding your induction.

  • Cervical Ripening – this is done if the cervix shows no sign of dilation or effacement. It can be accomplished with the use of a prostaglandin gel or vaginal suppository. The prostaglandins soften your cervix and promote dilation and effacement (thus helping to get labor started). If you have already begun to dilate, your provider may use a Foley Bulb, a catheter with a balloon on the end of it, that manually dilates your cervix to 4 cm.
  • Stripping of Membranes – your provider may discuss stripping your membranes if the amniotic sac is intact, you are dilated, but contractions have not started. You must be dilated enough for your practitioner to insert a finger into your uterus and move it between the sac and uterine wall. This can cause the release of prostaglandins, promoting uterine contractions and cervical dilation.
  • Artificial Rupture of Membranes – this can occur as an unintended consequence of stripping your membranes or can be done once labor has begun and your provider wants to give it a little “boost.” Artificial rupture of membranes (AROM) involves breaking your waters manually with an instrument that looks like a crochet hook. Breaking your water can help labor to progress by allowing your baby’s head to make a stronger and more meaningful contact with your cervix during each contraction. You will likely experience an increase in the intensity of your contractions once this procedure is over.
  • Pitocin – a synthetic form of oxytocin, the hormone of labor and delivery, breastfeeding, and bonding. It is given slowly via IV to induce (begin) or augment (increase) contractions. You will experience a marked increase in the strength, regularity, and frequency of contractions within 30 minutes of the IV beginning.

What are some alternatives to a medical induction?

Glad you asked! We have a blog post on Natural Ways to Induce Labor. Without going into the detail of that post, I will list some non-medical options for labor induction below.

Please note: even though these methods for inducing labor are not medical in nature, you should always check with your OB/GYN or midwife before attempting any of them. Your provider best knows your medical history and what your body and your baby can safely tolerate.

  • Sex (with ejaculation in your vagina)
  • Nipple Stimulation
  • Walking, especially on uneven surfaces
  • Lunges or Squatting on a birthing ball
  • Spicy food (or any food that causes you to have loose bowel movements)
    • loose bowel movements are caused by prostaglandins, which promote cervical ripening

induction cascade of interventions

Risks, Outcomes, and The Cascade of Interventions

2005 study by the American College of Obstetricians and Gynecologists found that inducting first time moms was directly associated with an increased risk for Cesarean delivery. Regardless of whether labor was medically induced for elective or medical reasons, 23.8% of elective inductions and 23.4% of medically necessary inductions ended in a C section. This is compared to the roughly 12% of women who go into spontaneous labor and require a C section.

One phrase that frequently comes to mind when pregnant women hear “induction” is Cascade of Interventions. Let’s explore this a bit. First, just because labor did not start on its own and you are being induced does not mean that your labor will follow this cascade. Being aware of how inducing or augmenting labor could potentially effect the progression is imperative to avoiding this cascade, if possible.

I would like to stress that an induction does not mean you will experience this cascade of interventions or that you will end up delivering via C section. Induction ≠ Cascade of Interventions. However, additional interventions do become more likely. I strongly suggest speaking with your OB/GYN or midwife with your questions and concerns regarding induction.

Common Misconceptions

Many of our clients are anxious about inductions because they do not want a high-intervention birth. While it is true that inductions are done more often than necessary, and some with no solid medical reasoning, you can still have a low-intervention delivery that did not begin spontaneously.

You are more likely to have a vaginal delivery with an induction if you have a favorable Bishop Score and your baby is positioned properly. We have had several clients who were induced and delivered their babies with no other interventions (no AROM, no epidural, etc)! It is possible! Yes, many women report their contractions being more uncomfortable with pitocin, but that does not mean it is impossible to get through them without an epidural. Our doulas are experts at instilling strength and dispelling fear in our clients by providing them with physical, emotional, and informational support during their pregnancy and labor and delivery.

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