Induction of labor has been a very hot topic in the birth world, most especially since a huge study published in August 2018 seemed to say that if we just induce everyone’s labor, it will help reduce the cesarean rate. If you are a super geek like me, you can read the actual study here, along with Henci Goer’s full critique and dissection here, and the California Maternal Quality Care Collaborative message about how to apply this study to medical practice here. Long story short: no, that is not actually what that study said and the circumstances that those included in the study had are NOT what most people are looking at when it comes to induction. I know academic discussions are not everyone’s cup of tea, and that is not the purpose of this post. I want to talk about ways that you can approach the induction discussion with your provider.
I would be remiss if I didn’t start with a little information about induction. There are 2 basic reasons that people choose to be induced: Medical and Elective. A medical induction means that there is a medical reason that it would be better for your baby to be born instead of continuing your pregnancy. There are plenty of important reasons that induction exists for the safety of parents and babies including high blood pressure, high levels of protein in your urine, blood sugar issues due to gestational diabetes, and many more. Some people choose to be induced for all kinds of reasons like family flying in from out of town, pain from the end of pregnancy, a history of very fast labors, and many more. Induction is forcing your body and baby to get the process started before they are ready, so it isn’t always fast, ESPECIALLY the 1st time. There are all kinds of ways to induce labor medically, though providers typically have a way that they like to get things rolling depending on what is already going on with your body.
What I really want everyone to do, is to have an informed discussion with their provider about induction. The old saying goes that if you don’t know your options, you don’t have any, and that is also true for induction. I always encourage everyone to have an open and honest conversation with your provider, ask great questions, know your options, and know the evidence for those options.
Here are 6 questions that might help you start the induction discussion with your provider:
- Why are you recommending induction?
Some providers recommend everyone be induced at 39 weeks. Some providers only recommend induction for medical reasons. Asking why is a great way to start the conversation and communicate your preferences about whether or not you want to be induced.
2. Can you tell me what my Bishop Score is?
A Bishop Score is used to help rate the readiness of your cervix for induction of labor using five different measurements. How open is your cervix (dilation)? How soft is your cervix (consistency)? Is it pointed toward your back, middle, or front (position)? How thin is it (effacement)? How far down in your pelvis is baby right now (station)? All of this adds up to the score that will tell you how likely it is that you will deliver vaginally if induced. A score of 8 or more means you are favorable for induction. (Please note: this score is NOT a guarantee!!!)
3. What is your recommendation for how this induction will start and proceed?
Most inductions start with a medication to soften your cervix and get it ready. There are 2 medications that they use for this. Cervidil is essentially like a tiny tampon (with a string and all) that they place next to your cervix. Cytotec is a tiny pill that is cut into smaller portions and can be given three different ways: placed next to your cervix, swallowed, or allowed to dissolve under your tongue. You can read more about these drugs here and here if you would like.
After your cervix is ripe there are different options to proceed, and you may want to discuss things like: a foley bulb for opening your cervix mechanically, your feelings about artificially breaking your water, pitocin for getting contractions going. These are all options that should be considered beforehand so you can be an active and informed participant in your care.
4. Are there alternatives to what you are suggesting?
As with most things, providers have a way that they normally do things, this is their job after all. Sometimes there are alternatives that are not always presented. For example, some people get their contractions going using nipple stimulation for a release of natural oxytocin. This is something that you will want to talk to your healthcare provider about before you just start trying to do it at home though. Not everyone wants to know all the options, so providers sometimes shorthand the discussion. By asking this question you show that you are curious and trying to have an open conversation with them.
5. Will you be there?
You spent 9 months getting to know your provider, and some people honestly choose to be induced to ensure that their provider will be the one who is present at delivery. I completely respect that. I think that part of the induction conversation always should include knowing who is going to be there and what their schedule looks like. (BTW: one of the nice things about having a doula is that no matter if you get induced or not, you will know and have spent time with at least one of the people in your birthing space.)
6. What kind of timeline are we looking at for this?
Scheduling things is great, and managing expectations for induction is also important. What I see most often locally is people admitted to the hospital in the evening for cervical ripening and then the active portion of the induction starts in the morning. If you don’t need cervical ripening, then often you are asked to arrive in the morning to begin the process. Induction can be quick, but it isn’t always. You will want to know what happens if your provider goes home and who will be overseeing the induction and possibly the delivery then. If they break your water, do you have a deadline for delivery? Will you be allowed to eat and drink at all during your induction?
As with every decision regarding your care, you will want to use your B.R.A.I.N. as a starting point for any interventions. Talk about the Benefits, Risks, and Alternatives. Also check in to see what your Intuition is telling you, and don’t forget to ask what happens if we do Nothing! Induction doesn’t have to be scary and you also shouldn’t be afraid to say no if you don’t want to do it without it being medically necessary. Only you can decide what is right for your situation, and I promise that as your doula I only want you to have the best information to make an informed decision and I will support you unflinchingly and with all the encouragement you require.