Tell me more about inductions...
This is a guest post from Justine LeDuc, a registered Labor and Delivery nurse, find out more about her at the end of the piece. This post is written from an American point of view and some procedures differ slightly in the UK.
Sometimes, when you are edging closer to your due date you will start to hear whispers of induction. Hey, sometimes you might hear shouting.
But what is an induction? And why is it ever so popular?
An induction is when we use medical interventions to start labour. An induction can sound appealing because you finally have a set date! No more waiting! Right? Well actually an induction can take up to 72 hours, 40 hours being the average that I have seen. It increases the amount of discomfort medication requested. In the states we are no longer allowing elective inductions before 39 weeks because of the risk for Cesarean births from the stress an induction can have on the baby. I have had multiple patients tell me how much worse their induction birth was vs. their spontaneous one.
Many support only getting an induction if it is medically necessary. Here are some reasons for an induction:
Complications such as: hypertension, preeclampsia, heart disease, gestational diabetes or bleeding during pregnancy.
If baby is in danger of not getting enough nutrients
Ultrasounds show baby is small for gestational age
Water broke and labour hasn’t started
You have gone 42 weeks (and there’s many debates about this)
If there is an infection inside called “Chorioamnionitis”
If you are going to be getting an induction your provider will schedule a time for you to plan on coming in. You will call the hospital and make sure there is a bed available. In the hospital I work at there is usually a 12 hour delay on beds on elective inductions because we have to take the active labours/emergencies first but as soon as there is one available you will head in!
You will get a fashionable gown (ha) and be placed on fetal monitoring to see what your babe is up to. One your nurse asks one million questions we will ask if it is OK if we check your cervix to figure out what the plan is going to be. We are checking for dilation (how open), consistency (is it soft like your earlobe or hard like your nose), effacement (how thin is it), and station (where is your baby’s head in your pelvis). In this photo you can see what a cervix does during labour.
These are 5 common interventions used for inductions
Cytotec: also known as Misoprostol is a medication used to prevent gastric ulcers but is a prostaglandin and can cause uterine contractions. It is not approved by the FDA for this use but it is used both in and out of the hospital. The pill is either placed vaginally or swallowed, studies favouring the vaginal route for effectiveness. The pill dissolved and in most facilities the patient can get up and walk about after an hour of tracing the baby. The max dose is 150 mcg (so 6 pills) and can be placed every 4 hours. Cytotec is the favourite drug for softening your cervix during an induction (we soften before open). Studies have shown that patients that use patients that receive Cytotec use less Pitocin overall.
Cervidil: also known as dinoprostone is similar to Cytotec. It is also used to help soften and efface your cervix but stays in and sits across your cervix (it’s shaped like a thin/flat tampon). It release medication over time and although is not as effective as Cytotec there are not as many risk factors such as too many contractions that can cause stress on the baby. It can also be taken out unlike Cytotec that is dissolved.
Pitocin: the synthetic form of Oxytocin which is the hormone produces by our body during labour to create uterine contractions. Pitocin for induction is given through an IV at a specific rate depending on the contraction pattern and babies heart rate. Pitocin has a short half life which means it doesn’t stay in your system for very long after you turn it off. Within an hour after there had been continuous infusion it’s affects will no longer be present. I think Pitocin is overused, but I think it has a bad rap. I am glad it exists because I have seen women not able to make any progress until it was started BUT, I think many providers are impatient on waiting to see what our bodies can do.
Foley Bulb: opening up your cervix mechanically. The foley bulb can only be placed if your cervix is slightly open already. A catheter is placed just inside your cervix. Then there is sterile water injected into the balloon to provide constant pressure pulling down onto your cervix. One your cervix is about 4 cm the foley bulb should fall out. There are different methods such as attaching weight to the end for traction or placing the end of the catheter on your leg and slowly pulling it down. There are some facilities that place these the day before your scheduled induction and have you come in when it falls out. I have seen many responses in regards to the pain of the foley bulb. Sometimes women report not feeling it at all when others are in excruciating pain right after placement.
Artificial Rupture of Membranes (AROM): is when your provider takes a small hook (I describe it as a crochet hook) and ruptures your bag of water. The actual rupturing does not hurt, but if you do not have an epidural the exam itself is uncomfortable. Once your bag is ruptured the worry is that your baby is not longer “protected” and you can acquire a fever and infection which could put you and baby in harm's way and lead to a diagnosis called Chorioamnionitis.
Once you are in active labour (six centimetres) then your labour will be much like that of a spontaneous one.
I am very glad inductions exist when it comes to medical reasons. Having a way to start labour when it’s necessary is a blessing. But it is important to understand that your changes of a cesarean will rise with an induction. So if you are wanting an elective induction please do some of your research on natural inductions for you when you check in to the hospital you can have a heads start!
Justine LeDuc is a Registered Labor and Delivery Nurse in Riverside, California. She fell in love with birth during nursing school and fell in love with women’s health when she went to Tanzania to help deliver babies for a month. She started a childbirth education class to serve the families in her community when she realized many of patient’s wanted a class but couldn’t find one.
You can find her on instagram at @babybump.education