Everything You Need to Know About Being Induced

Are you a first-time momma going into the hospital to have your labor induced? If so read this informative post.

You may be confused about whether it’s the right choice for your birth. Or you may be dead set on being induced and not staying preggo for another minute.

Either way, I want you to be educated about the realities of labor induction. Whether you are having your labor induced for a medical reason or by choice is your business.

Listen, I do have a personal opinion about it but only because I’ve seen the outcomes of someone going into labor on their own in contrast to one who is induced.

I want you is to take this into consideration; when we start intervening, we end up intervening a whole heck of a lot more. It’s like a domino effect.

So educate yourself and ask your OB tons of questions.

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I want to help you survive being induced by educating you!

You will find, that one of the most unexpected and frustrating parts of labor induction is being tethered to the bed. I tell my students inside Labor Nurse Mama Birth Class:Calm Labor, Confident Birth and The VBAC Lab, one of the first things we do to you, which begins a world of problems…is to restrict your movement.

The lack of freedom to move magnifies the entire process of getting your body into labor, which can be days.

During your induction, the fetal monitor will most likely drive you nuts! However, it’s necessary if we are giving you induction medications because one of the more serious side effects of these medications is fetal distress. 

Natural Process VS Labor Induction

In the days preceding birth, the amount of oxytocin (the real body produced Pitocin) receptors on your cervix increases.

These receptors are VITAL to the labor process. If these Oxytocin receptors aren’t present and ready for the job, no amount of Pitocin will work.

This being one of the reasons why we will start with a prostaglandin to soften your cervix. Your readiness for labor (and Pitocin) is determined by what we call the Bishop score. (Read all about that here)

🔆 So what does a favorable cervix mean?

There are a few factors (which we call a Bishop Score) that play into it.

Cervical Position:

Posterior (score 0 points)

Mid (score 1 points)

Anterior (score 2 points)

Cervical Consistency:

Firm (score 0 points)

Medium (score 1 points)

Soft (score 2 points)

Cervical Effacement:

0-30% (score 0 points)

31-50% (score 1 points)

51-80% (score 2 points)

>80% (score 3 points)

Cervical Dilation:

0 cm (score 0 points)

1-2 cm (score 1 points)

3-4 cm (score 2 points)

> 5 cm (score 3 points)

Fetal Station:

-3 (score 0 points)

-2 (score 1 points)

-1/0 (score 2 points)

>+1/+2 (score 3 points)

The higher the score, the better the chance you will go give birth vaginally via induction. Based on your Bishop score your labor induction plan is determined.

• 8 or more points. A score above eight indicates that labor will most likely start spontaneously (and soon). It also tells us that your induced labor will end in a likely successful vaginal birth.
• 6 to 7 points. Bishop scores in this range are eh…. not a great one way or the other.
• 5 or fewer points. Not good, induction is less likely to work. On the flip side, if you are post-dates (42 weeks) or sick (medical reasons) it tells us you need to try an induction because you probably won’t be going into labor on your own soon enough.

My goal in this article about labor induction is more to educate you than to sway you. I want to walk you through your induction as if I am your labor nurse.

As your labor nurse, my hope for you is to research all the risks and benefits of labor induction before your admission to the hospital. If you prefer to help yourself go into labor naturally read this article.

Scheduling a labor induction:

Unless medically indicated, you will not be induced before 39 weeks gestation. This is a safety measure for your little peanut. Do not try to find a loophole. PLEASE!!! You do not want your baby to be admitted to the nursery and have to be away from you. Your pregnancy dates can be inaccurate (unless you are an IVF pregnancy) and change your gestational age (how far along you are).

For example, You may not be as far along in your pregnancy as you think you are and end up with a baby with unforeseen difficulties. One week can make a huge difference in the development of your baby’s lungs!

Medical reasons for labor induction include such things as:

• You have Pregnancy Induced Hypertension
• You have Chronic Hypertension
• You are past your due date. After 42 weeks, the placenta does not function as well and its functioning is vital to the baby’s well-being.
• You have an infection in your uterus (or any other risky infection).
• Your water breaks (which as you read in my post about the six signs of labor, water breaking doesn’t always mean labor)
• You have complicated health problems, for example, diabetes.
• Your baby is not growing correctly.
• You have Rh disease.

Once it is determined that you will be induced, your doctor’s office will call the hospital to request the date and time for your labor induction. If it is an elective induction, we are not as apt to work you into a busy shift. Medically indicated labor inductions take precedence over elective ones.

Types of Labor Induction:

The kind of labor induction your doctor chooses to schedule depends on your cervix. We call this favorable or not favorable. If your cervix is favorable, the labor induction will be more successful. If your cervix is soft, then we skip straight to the big gun, otherwise known as Pitocin.

You can read more details concerning the medications we use in labor and delivery, including labor induction meds in a post I wrote a while ago. Also, make sure you download the free labor medication download to take with you to the hospital so that you are on the same page as your caregivers. THINK EDUCATION PEOPLE!

Cervical Softening:

If your cervix is not soft (effaced) then we will schedule you to come in the night before and start medications called prostaglandins to soften your cervix. Cytotec or Cervidil are the two drugs we use most often to accomplish this. The nurse will place either medication.

Heads up!! You will not see your doctor during the earlier stages of your labor induction unless he/she is already at the hospital for another patient. Many of my patients are surprised at this, I am mentioning now so you are prepared.

What does cervical softening feel like?

Most women complain of mild cramping, but some will experience intense cramping. A majority of you will be able to handle it but there’s always the few who have a low pain tolerance. Occasionally, we have what we refer to as a “Cytotec” baby, meaning you give birth before we start the pit and after Cytotec placement.

I prefer Cervidil because it can be removed quickly in case there are any adverse issues. (same goes for Pitocin, as it can be turned off)

Side note but significant: I would strongly suggest not bringing the entire clan with you for an evening induction. The more people in the room, the less sleep you will get. It is very rare that you will deliver before morning. But that being said, do not kill me if you end delivering during the night and grandma is at home still.

Tip: Download a sound machine app or bring a sound machine. A labor unit is loud even at night!

Foley Bulb Labor induction:

Another option (one I prefer over medication) for cervical softening is a foley bulb insertion. The doctor or midwife insert the Foley catheter into your (already dilated a tiny bit) cervix and inflates the balloon. The catheter will fall out when your cervix is around 3 cm. Most women complain at insertion and also mention varying degrees of cramping afterward.

Dilapan S

This is a type of mechanical dilator. It is a rod that works through osmosis, by absorbing fluid from the tissue around it and swelling to dilate you.

Rupturing Membranes:

More often than not, the OB will see you first thing the next morning to break your water. This will most likely be the first time you see your provider in this process. However, they will not break your water if your baby is too high or dilation isn’t happening. Contractions usually intensify after your water has been ruptured and a time clock is started when your water is broken.

Pitocin:

When your cervix is soft and favorable we will switch to Pitocin. I’m sure you have heard horror stories about Pit and how awful it is. Some of it may be true, and some may be false.

Pitocin makes labor a bit harder to handle.

I have had six natural (pain interventions/med free) births. I was induced for a few of them and I will say that my best labors were the ones that I went to the hospital in full-blown, all hell breaking loose labor.

These labors were less intense because I had the time to build-up to the harder stages of labor gradually.

The Pitocin takes away those hours in which you build increasing tolerance and naturally move onto the next and more difficult stages. Labor induction goes from zero to sixty in a short time.

Girl, I believe in educating my patients about labor as much as possible. An educated patient can’t be coerced into decisions that are not necessary.

Believe it or not, the majority of women (unlike you because you are still reading this) have not educated themselves at all about birth.

Can you believe? Seriously!!! This blows my ever-living mind. How could someone go into something like childbirth without educating themselves??

Here’s to education:

Pitocin contractions are mechanical if you will. The medication is in control of the contractions occurring.

Fake but not fake contractions. Not fake because they semi-sort of do the job.

The job is this: Get your body to say, “what the hell is happening? This is bonk, and I am taking over”

Once your body gets the memo and takes over the control center for the contractions, aka labor, things go more smoothly.

Your body is efficient the way God made it, to do the job it has been designed to perform.

Studies have PROVEN that we only need a certain amount (and that amount is small) of Pitocin to get labor started.

We do not need LARGE amounts that are given in the real world. It is stressful for you and the baby. Be an advocate for yourself and baby and read up!

Truth:

The higher the dose of Pitocin, although shorter time from admission to delivery, the higher the rate of cesarean section.

THINK: LOW AND SLOW

BE INSISTENT that a lower dose be used and ask for the Pitocin to be turned off or decreased once you are in an adequate labor pattern and making a consistent cervical change (aka real labor)

Add this to your birth plan!

Remember you can still have a “natural” birth while being induced. Now some would argue that it is not natural if you are having a labor induction. However, I am referring to not having pain interventions.

A typical labor induction:

1. Labor induction is scheduled with the hospital unit.
2. Day of induction you will arrive at the hospital at the pre-arranged time.
3. Admission process: Change into a stiff hospital gown that has been worn by countless patients or a custom Labor gown (you can bring your own like this one!!), take everything off, think undies or bra. You will get into the bed and we will begin fetal monitoring. The results of fetal monitoring will determine the start of the labor induction. Next, An IV will be placed, labs are drawn from your IV site and IV fluids started. Your nurse will ask a ton of questions, some of which are sensitive.
4. Vaginal Exam: Your nurse will perform the oh so exciting Vaginal exam. She will then determine your Bishop score and based on the score your provider will issue your induction orders.
5. Cervical Ripening: Cytotec or Cervidil will be placed if your Bishop Score is not favorable. You will be asked to lay in the bed for 2 hours without getting up. This ensures the Medications stay put where we want them. Check out this post for more details on both medications.
6. Once your Cervix has softened and begun to dilate, We will then start IV Pitocin. The dosage is increased every 30-60 minutes until adequate labor is achieved.

For those of you wishing for a natural birth, start preparing your body EARLY and read my Natural Birth guide!  Make sure you get your postpartum vaginal delivery pack ready and happy birthing!

Just a little disclaimer: As always, I am just writing my thoughts and what I’ve learned along the way. Although I am a labor and delivery RN, This is not medical advice. You should always seek and follow the advice of your care provider.