You’re tired of being pregnant. You’re hot, swollen, uncomfortable and have to pee every five minutes. It’s hard living with the uncertainty of not knowing what day your baby will choose to make her appearance. You might be anxious, or super-excited. Your family is trying to make plans to visit when the baby is born. Your doctor is going on vacation soon. Let’s just do this now! Why not?
Induction: an attempt to artificially start the labor process
If you’re considering induction for any of these reasons, I get it, but first you may want a little more information about how the process works and what might go along with it.
First of all, how does labor begin on its own? Towards the end of pregnancy, your cervix softens, moves forward, thins, and begins to open. Hormones such as prostaglandins cause the softening. The softer and thinner it gets, the easier it can open. Your cervix opens with the pressure of your baby’s head and the pulling up of the uterine muscles. A contraction is when the top of your uterus presses down and the bottom of it pulls up on your cervix. Contractions are caused by the hormone oxytocin. Your body releases oxytocin when it feels the pressure and stretching of the cervix and also when you feel loved and supported. When contractions really get going, this sensation of pressure and stretching also tells your body to release natural pain- killers and mood-elevators, as well as more and more oxytocin. Toward the end of pregnancy, oxytocin receptors in the uterus begin increasing. During labor, the number of oxytocin receptors is even higher.
There are several different induction methods. The application of a cervical ripening agent is meant to soften the cervix and prepare it to begin opening. A foley catheter is a small balloon that can be inserted into the cervix and filled with up to 2 tablespoons of water, which can encourage the cervix to open. Stripping the membrane means that a doctor or midwife inserts their finger into the cervix and sweeps it around between the membrane of the amniotic sac and the wall of the uterus. This can stimulate hormones involved in starting labor. Pitocin is a synthetic version of the hormone oxytocin, which is what causes contractions. An IV drip of Pitocin may be used alone, or in combination with any of the previously mentioned approaches.
Every woman will respond differently to these methods, but one thing that can predict the likelihood that induction will actually get labor started is the Bishop’s Score. The Bishop’s score is determined by whether your cervix is pointing forward or backwards (your cervix is tucked backwards during pregnancy and moves forward when ready for labor), firm or soft (your cervix is firm during pregnancy and becomes soft or “ripe” when ready for labor), how thin it has become (your cervix is very thick during pregnancy, and thins out during late pregnancy and throughout labor), how dilated your cervix is, and how low the baby is in the pelvis (the pressure of baby’s head on the cervix is a big part of what causes dilation.)
Pitfalls of induction
A major reason not to induce unless medically necessary is that due dates are not always accurate and induction could unintentionally cause the baby to be born before she’s ready. Research suggests that it is the baby herself that lets your body know when she’s fully developed and ready to go, thus starting the labor process (there are other factors involved as well.) Those final touches in the last weeks are important. Your baby’s brain doubles in size during the last month in utero. Babies born before 38 weeks are twice as likely to need help breathing. Babies born before 38 weeks have higher rates of jaundice. They’re packing on the fat in the last couple of weeks, which helps them stay warm after they’re born. So as long as mom and baby are healthy, keep that bun in the oven!
One side-effect of induction is the effect it has on the labor process. Pitocin-induced contractions will likely be more intense and closer together, which can be harder for both mother and baby to tolerate. The mom may opt for an epidural in order to cope with these contractions. The baby will need continuous fetal monitoring because the intense pattern of contractions can lead to low heart rate. The body’s natural oxytocin has beneficial effects that pitocin does not have. Pitocin does not cross the blood-brain barrier and so does not elevate mood, enhance bonding, or create warm fuzzy feelings the way oxytocin does (Did you know natural oxytocin is also an amnesiac?) Pitocin disrupts the body’s release of oxytocin and does not follow the feedback loop that oxytocin otherwise would (Pitocin is released as a continuous drip, but can be turned up or down, as needed.)
As you approach -or pass- your due date it may seem like induction is a way to put an end to the uncertainty that you’re feeling about when your baby will finally be born. However, induction is not an exact science. It could cause you to go into labor very quickly (which probably means your body was already prepared to go into labor), or it could mean a long hospital stay and lots of waiting around wondering if something is going to happen, which can lead to mental and emotional exhaustion. About a quarter of the time induction does not work at all. In some cases a mom can go home and try again another day (if there is no medical reason why baby needs to be born that day.) In other cases, a cesarean birth may be necessary.
Medical reasons for inducing labor
There are situations in which induction makes sense, after weighing the benefits of waiting versus the potential complications of waiting. The benefits outweigh the risks if there is a medical reason that the baby would be safer outside of the uterus than in, or the mother’s health is endangered by continuing the pregnancy. Some of these reasons include preeclampsia, uncontrolled high blood pressure, uncontrolled gestational diabetes, baby not growing, problem with the placenta, or low amniotic fluid. However, if mom or baby are in imminent danger, a Cesarean birth is necessary.
The only thing we know for sure about birth is that unexpected things will happen. Making an informed decision can be difficult considering all the emotions surrounding this momentous event. Remember that you can ask questions and ask for time to think about any intervention that is suggested. You will want to find out how the procedure could benefit your or your baby. Ask about what goes along with it and how it will affect other options down the line. Find out if there are other ways that the same goal could be achieved. What would happen if you did nothing? Or waited a day? Then do what seems to you like the best option for the situation at hand. And include a hefty dose of compassion for yourself.
If your labor does take a different path than the one you envisioned, it’s important to have a toolbox of coping skills prepared. If induction causes labor to come on fast and strong, you will want to have an experienced support person with you to help you understand what is happening, to help you advocate for yourself, and to help you cope with the intensity. Similarly, you will want to be sure you have someone to support you during a long wait, which could leave you feeling frustrated, anxious, emotional, exhausted, lonely, or just plain bored. In addition to the skills you can learn in your Lamaze class, there are some fantastic tips in this Labor Induction Survival Guide.