Ch.4/ Inductions
Many people get induced so here is a breakdown of the process so you know what to expect.
So you’re being induced. There are a wide range of reasons for an induction and as of 2020, more than a third of labors in the US were induced (American Journal of Maternal Child Nursing). It’s a good idea to know loosely what’s going to happen at an induction so you can be prepared, know what to expect, and be able to make informed decisions in the moment.
Note: Procedures vary from doctor, hospital, and practice but this is a just general overview. Ask your care provider what an induction looks like under their care even if you aren’t currently being offered an induction since they may offer you one later on.
Often, scheduled inductions begin at night and they’ll have you come in around 10 pm. This is because once they induce you, it takes some time for things to get moving so they usually encourage people to try and rest over the night and then hopefully have their baby the following day. When you get to the hospital, they’ll admit you if they have a room for you. People arriving already in active labor will get priority over you so it can be a bit before you actually get admitted even though you have an appointment.
Doula Tip: Call the hospital when you’re about to head over and see if they have room for you. Of course, things could change by the time you get there, but getting some more sleep and rest at your home is always preferable to sitting in a waiting room.
Once you’re admitted, they’ll often do a cervical exam to see if you’ve started the labor process already and how far along you are. Many people are dilated 1 or 2 centimeters towards the end of their pregnancy. They’ll check you by inserting their gloved hand into your vagina and feeling your cervix to see how dilated you are and how thin your cervix is. This gives them information on how best to induce you.
There are 5 main ways they will induce in a hospital (note: most often, OB’s like to couple methods together so you will probably be presented with two of these methods at once):
Membrane Sweep – sometimes this method is offered in your OB’s office before you’re being officially induced and it’s the least invasive among the induction methods. Your provider will insert their gloved finger into your vagina and through your cervix. They will move their finger back and forth to detach the amniotic sac from the wall of your uterus. This releases chemicals that for some people, kickstarts their labor. It can be uncomfortable when they do this method so be sure to take deep breaths and hold someone’s hand.
Cytotec / Cervidil – these are two medications that can assist in cervical ripening, meaning preparing your cervix to thin and dilate. Cytotec is an oral medication that is taken to ripen your cervix and get contractions going. Cervidil is a medication that is inserted vaginally that mimics the natural chemicals released during labor that signal your body to start thinning and opening the cervix.
Foley Bulb Catheter – this is a catheter that is inserted into your cervix and then the bulb is filled with saline. This expands the cervical opening, causing your cervix to dilate. The bulb will fall out once you’re 3-5 centimeters since that’s about how big the bulb can get. The hope is that once you’re dilated that much, your body will naturally kick in and continue the progress on its own.
Pitocin – the hormone needed for contractions is oxytocin. The synthetic form of oxytocin is Pitocin. Starting with a low dose of Pit will start contractions but always know that you can ask for the Pit to be turned down or off to see if your body can take it from there. Contractions from Pit can feel much more intense than naturally occurring contractions and you’ll be closely monitored to make sure your baby is tolerating the sudden increase in contractions.
Breaking Your Waters – rupture of membranes is done with a little hook that looks like a dull knitting needle. They’ll put the hook up your vagina and through your cervix and pull on the amniotic sac until it breaks. It’s important to know the baby’s positioning before doing this to ensure that their head is right there and not the umbilical cord. In the very rare event that the umbilical cord comes out before the head, an emergency c-section could be advised because you don’t want that cord to get knotted, cutting off the air to your baby. Ideally, when the water breaks, the baby’s head will be right against your cervix, putting pressure against your cervix which encourages it to dilate and thin.
Once they’ve implemented one of these methods, or multiple, they’ll usually leave you in your hospital room to make progress and hopefully by the time the next day comes around, you’ve made some changes.
If you have a doula, it’s important to understand this process so you know when best to have them come support in person. Of course, you can call them whenever – that’s what they’re there for! But knowing what’s to come can help you best utilize them.
I always recommend clients to start with their induction on their own and keep me updated so I can provide support over the phone until I physically come to their birth location. I’ve had clients immediately have contractions get going after an induction so I went to meet them right away and then I’ve had clients where it took a little longer to get going so I met them in the morning.
Ultimately, your doula is hired by you to support you, so if you feel you would benefit from their in person support, then call them! Sometimes knowing the plan can help you prep better but you know your body and your experience best so please get your birth support there when you need them.
