Everything You Need to Know About Being Induced

February 25, 2020

If you are planning a labor induction, then this is the guide for you.

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 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.

Why I am here and who I am:

Hey mama, I am Trish— AKA Labor Nurse Mama. I am a labor and delivery nurse with over 15 years of high-risk OB experience. I am also a mama to 7 kids and have given birth to 6. I have labored thousands of mamas and delivered many, many babies. I am the online birth class educator for Calm Labor Confident Birth and The VBAC Lab birth classes. I am passionate about your birth and motherhood journey! If you ahve not taken a birth class yet, you are in luck!! Ours is self paced and online, you can binge it and get it done today! Read why you should take a birth class here!

We make a small commission from some of the links (you don’t pay any more for using our links); however some of the recommendations, we do not earn anything; we just love ’em and want you to know about them. Click here for our full disclosure. Thank you!

Things to consider if you are being induced

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, that 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 is 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)

What is the difference between going into labor (spontaneous labor) and 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.

When our body begins the labor process on its own, the chances of problems during your delivery are less likely. Labor induction brings risks and one of those is the cascade effect of interventions including cesareans. 

This is 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)

What should I know before considering a labor induction?

One thing to be aware of is the state of your cervix. This is critical in understanding the chances of successful labor induction.

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

Cervical Position:

Posterior (score 0 points)

Mid (score 1 point)

Anterior (score 2 points)

Cervical Consistency:

Firm (score 0 points)

Medium (score 1 point)

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 point)

-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 were 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.

What should I consider before 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!

Nervous about getting a cervical exam? Check out my Instagram post and find out what you can do about it!

Why would my doctor recommend labor induction?

  • You have Pregnancy Induced Hypertension (high blood pressure)
  • 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.
  • Pregnancy complications making it safer for baby to be out of the womb (like preeclampsia or in some cases gestational diabetes)

Once it is determined that you will be induced, your obstetrician or midwife'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.

Tips from my birth class:

If you are being induced for medical or elective reasons, I say get that body ready.

Here are so tips: (make sure to clear with your provider)

Ask for your provider to strip your membranes aka membrane sweep

Do nipple stimulation for 30 minutes daily (15 on each side) after 38 weeks

Curb walking

sex with semen on the inside

Methods of Induction of Labor

The kind of labor induction your doctor chooses to schedule depends on your cervix. It important for them to pick the right for for a successful labor start. 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.

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.

Back in the day they used to use a prostaglandin gel, but I personally have not seen that used.

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. I am a huge fan of mechanical dilators like the foley bulb also known as cook's catheter and the rods.

Rupturing Membranes:

Breaking your bag of water is called rupture of the membranes, rupturing your membranes, breaking your water or ROM for short. More often then 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.

Most providers use what is called an amni hook to break your water. It looks like a long crochet hook.

What can I expect during once my cervix is soft?

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.

Are Pitocin contractions worse?

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??

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.

My spontaneous 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 stagesLabor induction goes from zero to sixty in a short time.

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, and can lead to more interventions. Be an advocate for yourself and baby and read up!

What are the pros and cons of inducing labor?

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.

What can I expect during 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.

Common Labor Induction Questions and Answers:

What are some questions I can ask my provider:

Ask you provider is there are alternative to being induced? (maybe a membrane sweep and some nipple stimulation at home, sex....)

Can I wait and not get induced?

If we decided to do a labor induction, can we start with foley bulb and not medication?

How often do I have to have cervical exams during induced labor?

Do they send you home after being induced?

Some providers will use Cytotec or another cervical softening method, like the foley bulb, and send you home to come back in the morning. I love this. I feel like it ups your chances of having less interventions. 

Is being induced really painful?

The amount of pain you feel during your induction is really dependent on you and your method of labor induction. Some women feel like the foley bulb insertion is horrible. Some feel that it is a walk in the park. I suggest you practice some relaxation techniques and take a birth class that teaches pain coping methods. We teach several in our online birth class Labor Nurse Mama Birth Course: Calm Labor Confident Birth. 

Can you walk around after being induced?

Yes, absolutely, unless there is a medical reason that requires you not to be up and about. Ask your provider for wireless monitoring so that movement is possible. Girl, moving is key to an uneventful birth.

Why does labor induction fail?

There are several reasons, but the most common is simply the fact that your body was not ready or favorable for induction. This is another reason, I suggest waiting for spontaneous birth to happen. It just goes so much smoother.

What to pack for labor induction?

Same as you would pack for the hospital, plus a few extra entertainment options, as you will be there longer. What to pack is an awesome question, grab my free packing list here: https://labornursemama.com/hospital-bag-checklist

What happens if labor induction fails?

This is tricky. If you are an elective induction and you do not let them break your water, then you can go home and wait for your body. If your water is broken, this means that the amniotic sac which protects the inside of the uterus and the baby from infection is gone. Sp the next step could be waiting and giving your body a short break, then starting again. It could also mean choosing a cesarean if labor does not begin.

Remember the baby makes the amniotic fluid and it is constantly being made.

Can I be induced without an epidural?

Yes, yes! I did it 3x. IT is completely possible to have an unmedicated induced birth. But you have to be educated and have a lot of coping tools ready to use.

If you do want to get an epidural be sure to read all about laboring down in this informative article.

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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. 

This group, board, and guidance have been absolutely invaluable.

I was extremely comfortable asking questions, making decisions and even though nothing went according to my "plan", I couldn't be any happier with the way everything went!!!
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