Your doctor may recommend scheduling an induction of labor for many reasons. For some this can be a welcome suggestion; you get to know more definitively when you will meet your new baby! For others, induction can be a scary or unwanted option. No matter how you come to the decision to induce, there are a few things to consider.
1. Methods of induction
There is no one-size-fits-all approach to induction. Multiple different methods may be used based on your personal history, any medical concerns, and your doctor's preference. There can be pros and cons for each method, so it can be helpful to talk through your options in advance with your doctor. Here are some of the most common methods:
Pitocin is the synthetic form of the hormone Oxytocin, which helps trigger contractions during spontaneous labor. Pitocin is given through an IV line in labor, and the hospital staff may adjust the dose as needed throughout the induction. Sometimes Pitocin can cause contractions longer and stronger than spontaneous contractions would be, but it is often an effective method of induction.
Cervidil is a medication that helps soften the cervix. This preparatory softening can help stronger induction medications be more productive, so many doctors will recommend Cervidil overnight the night before an induction is officially set to start. Cervidil is applied right by the cervix on a cloth tape and can be left in for many hours. Many people find this no more uncomfortable than a regular cervical check. One of the good things about Cervidil is that if the contractions are too strong or if there is a problem, the tape can be removed, limiting further effects.
Cytotec is a brand name of the drug Misoprostil. This medication can help soften the cervix and bring contractions, so it is often used during labor inductions. Use for inductions is actually an off-label use not recommended by the FDA, but it is often very effective. Cytotec is packaged in tablets that can be given multiple ways, but it is most often placed internally by the cervix for induction. Although it is effective, Cytotec can be a bit controversial when used for labor induction since it can produce contractions so long and strong that baby becomes distressed. Unlike Cervedil or Pitocin, Cytotec cannot just be removed or turned off if there are complications; once it has dissolved, it's gone.
Foley Bulb/Cook Catheter
Foley Bulb Catheters and Cook Catheters are very similar options that both function the same way. Both of these options can be used to manually dilate the cervix without the use of medications. These work like balloons; a long balloon-like tube is inserted into the tip of the cervix. Saline is then used to inflate the end, which begins to wedge open the cervix. You do need to be at least 1cm. dilated for this to work, and it may not work for everyone if your cervix isn't ready. The level of discomfort this procedure causes varies person to person, but it may not be comfortable to have the cervix physically stretched. Some providers will require the patient to remain in hospital once a bulb is placed. Others will place the bulb and ask the patient to come back when it falls out, which would mean they should be 3-5cm dilated. If there are problems, the bulb can be deflated and removed quickly and easily.
Homeopathy and Natural Induction Methods
Homeopathic remedies and herbs are not frequently recommended by OB/GYNs, but they may be a good option for some. There are multiple homeopathic remedies that may be effective to nudge someone into labor. As with any other intervention, we always recommend you speak with your doctor or midwife about what options may be best for you.
Acupuncture is a centuries-old practice that may be used to start labor. There are specific pressure points a knowledgeable acupuncturist may use if the goal is induction, although it may not work for everyone. Sometimes multiple treatments are needed, but acupuncture can be a good option to try if one wishes to avoid a more medicalized induction.
Chiropractic care from a Webster-certified provider does not directly start labor, but it can help align the pelvis properly so that baby can find the best position. Sometimes labor doesn't start because a misalignment doesn't allow baby to drop or sit properly; a good adjustment may help with that.
Breast pump and/or nipple stimulation can be used to naturally produce oxytocin that may trigger contractions. It can be possible to overstimulate the uterus if this is done too frequently, so it is often recommended to stop the stimulation once contractions are established. As with anything else, it's best to check with your provider if there are concerns.
2. What are the chances an induction will be successful?
The Bishop score is a test that looks at multiple aspects of your history to estimate if an induction would be successful. This scoring system looks at cervical position, cervical consistency (softness), cervical dilation, cervical effacement (thinning), and fetal station (how high baby is in the pelvis). These aspects are rated on a scale of 0-3, and a score of 8 or above is believed to mean that either the body will begin labor spontaneously or that an induction would be successful. Low scores often correlate with unsuccessful inductions, and the doctor may move to recommending a Cesarean birth.
3. We've started an induction; now what?
There is no hard and fast rule about how an induction will proceed. A lot depends on how ready your body was at the beginning. For some people, a little nudge is all that's needed to push them into full blown labor. For others, the body needs a bit more coaxing, and the induction may take a bit more time. Sometimes an induction can be a lengthy process; some inductions may actually take multiple days.
It's normal to not feel much at the beginning; depending on your personal tolerance, it can take hours for the medications used to produce uncomfortable contractions. If this is true for you, that can be a good time to rest while you can. Inductions can become very intense suddenly, so taking every chance you have to just rest and take it easy can pay off in the long run.
Once contractions are strongly established, some providers will lower or disconnect the medications. Often the body will take over and continue contractions. Others may leave the meds running throughout to make sure contractions stay strong. If you would wish to cut the medications as soon as contractions are established, we recommend you discuss this possibility with your provider in advance.
4. Can a doula help in an induced birth?
Yes! Doulas can be wonderful support for any type of birth, including inductions. Our support in an induction changes very little and is tailored to each client. Often, we accompany you as you get settled in to start the induction. Some clients then choose to send us home until things ramp up, but that is totally up to the client. We can stay with you, or we can return whenever you're ready. From there the support is the same as any other birth; we can help with comfort measures, talking through upcoming options, and whatever else you most need.
Throughout the whole process of induction, communication with your provider is important. A birth plan can be a great way to go over your thoughts with your provider, but it is always important to remember that nothing with labor is ever set in stone.
If you would like to meet to discuss how we can support you through your upcoming birth, please let us know! We'd be happy to schedule a consultation or a phone call to answer all of your questions.