Let’s talk about inductions.
What is an induction of labor?
If an intervention is done that encourages your uterus to produce contractions before your body begins labor on its own, this is considered an induction of labor.
Why might you have an induction?
Your labor might be induced for a variety of reasons. Usually this is because there is considerable concern for the health of the baby or parent. Some common reasons for an induction might be:
- You are at or near 42 weeks gestation
- There are issues with the placenta
- Your bag of waters broke (also known as membranes rupturing) but contractions have not begun
- Your baby may have a medical condition, such as intrauterine growth restriction (IUGR)
- You have a medical condition or are believed to be at higher risk for one (concerns about blood pressure, diabetes or your age are common)
There are also other times when you or your provider decide to have an induction once you’ve reached your 39th week of pregnancy. This is because of a study done (often called the ARRIVE study) that suggests that induction of labor may lower your risk of developing high blood pressure or having a cesarean birth. While this decision isn’t right for everyone, it’s something worth talking about with your provider.
As doulas, we support people giving birth in whatever way feels good and safe to them. And we have supported lots of families whose labor begins with inductions.
One of the things we notice makes inductions feel better, emotionally, is to understand what exactly is going on in this process.
There are multiple things that need to happen, for an induction of labor to result in a vaginal birth (which, for the record is the goal).
Let’s divide these processes into two buckets:
- Cervical Change
- Contractions
Now if you know anything about labor, you know that contractions (the squeezing that your uterus does) have a lot to do with what your cervix (the passage the forms the lower end of your uterus) is doing.
But when it comes to the process of induction, sometimes these things happen separately.
The way I often describe it is that your cervix has to be ripe and ready, in order for contractions to cause it to open (dilate). So if your provider is planning to induce labor, they will likely first learn the state of your cervix.
When it’s time for labor to start, providers want to know:
- Is your cervix is thick and firm?
- Or is it thin and wiggly? (These are effacement and ripening.)
- Where is your cervix in your body (posterior or anterior)?
- Has it begun to open yet at all? (This is your dilation.)
- Where is your baby, in relationship to your pelvis? (This is your baby’s station.)
These things will determine your Bishop score, a measure of how ready your cervix is for labor, and how likely your body is to go into labor on it’s own.
So what does this mean for you?
If you’re scheduled to be induced, or considering it, your provider is likely to do a cervical exam. They’ll notice If you have a low Bishop score (the score ranges from 0-13).
If so, this likely means that your cervix has not changed much on its own, and you’ll need cervical ripening.
Cervical ripening is a process done with chemicals that allow your cervix to become softer and thinner. There are two common methods- Cytotec (a pill that can be inserted, taken orally or allowed to dissolve in your cheek) and Cervadil (a vaginal insert). You may also have an option to use a balloon catheter instead, which will manually open your cervix.
Any of these routes will take some time.
You can discuss the benefits and risks of each with your provider, and what’s right for you.
Once your cervix has made some changes, then it’s time for contractions to begin. Sometimes, the chemical cervical ripeners begin contractions, but often this involves Pitocin (a version of oxytocin). Pitocin can be given over a period of time to increase the number of contractions, and their strength.
The goal of all of these things is to help you have a vaginal birth.
Now, some of you reading this are thinking, “WAIT! That’s not enough information!”
“Isn’t she going to say that Pitocin contractions are SO PAINFUL?”
“What about the risks associated with Cytotec?”
Here’s the thing- we know that sometimes medical intervention is desired or needed during pregnancy, and when it’s time for labor.
That’s why we don’t describe any of this by focusing on fear or pain. Instead, we want you to have as much information as you wish, and to use your BRAIN for decision making. Each of these interventions has benefits, risks, and times when it is the best decision for you. You also have intuition, and may have the option to wait a bit.
What we encourage is that you talk to your provider about any questions you have. Have a conversation and get any answers you need.
And if you take childbirth education class with us, we give more information on each of these possible tools. Because that’s just the thing- they’re all tools, with the goal of you meeting your baby.
Other methods to induce labor are considered non-medical and can be effective if you and your provider determine that they’re safe for you. You might explore things like:
- Evening primrose oil (talk to your provider about how best to use this)
- Induction massage with a trained massage therapist
- Sex*
- Acupuncture for induction
- Chiropractic work throughout pregnancy
(*When we say sex, we mean the kind where everyone is having fun and pleasure since orgasms are a key piece of this puzzle. Penis-in-vagina sex has two benefits: chemicals in semen- prostaglandins- as well as oxytocin released during orgasm for the birthing person.)
We encourage you to make these decisions with a provider who knows your medical history, since even a “natural” induction alters labor.
No matter what you and your midwife or OB decide, or what’s right for your health, we trust you and your body.
We’ve seen people have beautiful births that began with induction. If you want to know more about how, let’s talk!
