Category: birth

The Induction Discussion

Ask good questions & know your options!

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: 

  1. 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. 

Things Doulas Know

Unsolicited advice is not my style

I have stopped giving random advice to pregnant people that do not ask for it, essentially for two reasons. The first reason has to do with other people and the second because of me.

  1. Everyone seems to feel entitled to give pregnant people advice, and I do not want to add to the mostly annoying cacophony.

I do not know what it is about pregnancy that makes everyone feel like they need to give you advice and tell you what to do. I know that most everyone really means well, but holy moly it can be really exhausting to be constantly bombarded by people who think they know better than you about what you should do. I won’t even get started on the horror stories that people feel obligated to tell you like they can’t stop the flow of awfulness spewing from their mouths. I have a strict no spreading trauma policy when it comes to speaking to pregnant people, and I highly encourage all clients to tune out any and all negative messages surrounding birth and parenthood, especially while you are extra vulnerable and pumped up full of hormones!

2. I know way more than most people about pregnancy, birth, babies, etc than most people, and I have a tendency to go on and on about it.

I know a ton of really specific and sometimes seemingly random things that can really help people who are navigating pregnancy, planning for their upcoming birth, and getting prepared to take care of a new tiny human too. I am happy to talk about all these things all day long, and I do quite a bit, BUT not everyone wants to hear that. I respect people’s wishes and only expose my super birth geek side when requested.

As a doula and childbirth educator, I have extensively studied pregnancy, birth, and postpartum. I know where to find great evidence-based and unbiased information. I know different comfort techniques to get through labor and delivery. I make sure to keep up on all the local resources for new families in our area including great breastfeeding support services, chiropractors who specialize in the Webster technique, prenatal yoga classes, which physicians will provide parallel care for home birth, support for victims of abuse, stores that sell green baby products, and more. I am seriously committed to life-long learning and I want to help everyone be better connected with the resources and information that they need.

I never want people to feel afraid to ask me questions. I would rather my clients ask me anything rather than sit around worrying or wondering. I make an effort to not overshare or overwhelm people. I am always happy to answer questions, especially for my clients. BUT, I can’t send you answers that you don’t ask for, and I won’t, not because I’m protecting the information, rather because I know it is really hard to sip from a fire hose and it has taken me YEARS to gather all this information that you are trying to digest in 40-ish weeks.

What was the worst unsolicited advice you ever received about birth?

My Goals as Your Doula

As a doula, I listen and follow your lead.

  1. Support you and your family how you want to be supported.

End of list.

Yes, seriously.

As a doula, I listen and follow your lead. If you want information about anything pregnancy or birth related, I am happy to help you find great and unbiased information about all your options. I love answering pregnancy and birth questions, but make a big effort not to inject my opinion into any of it. That is because my opinion about what you should do is pretty much irrelevant. I do not tell people what to do, and completely understand that there is no one right way that works for every birthing family and every situation.

Most people only think of the physical support a doula can offer, and that is certainly part of the job description, but it definitely is not all of it. I hold space for my clients to give them room to think things through and listen to their gut without an audience. I talk through tough decisions and help you get to the root of your desires for your birth. I am an empathetic ear when you are frustrated, excited, anxious, worried, elated, exhausted, etc. I also don’t have ALL the answers, but I am really great at helping people wade through the sea of information out there to find excellent sources and resources too.

In my 5+ years as a doula, my practice has certainly changed, but my #1 goal has always been steadfast, and I don’t ever imagine it will change! I have no agenda for your birth; I only want your family to feel fully supported as you would like to be. I truly strive to check any bias I might carry and leave it outside of the space of your blossoming family.

Would you like to have an extremely knowledgeable, experienced, and compassionate person in your contact list and at your birth? If you said yes, then I would love to talk to you about birth doula services!

Doula? A do what now?

Midwives and doulas have very different jobs!

One of the most common misconceptions that I run into as a doula is that people think that we are the same as midwives. While I have worked with some really great midwives in my time as a doula, and LOVED having midwives catch my own 2 babies, I do not want to be a midwife or be confused for one. Doula care can compliment midwifery care very well, but we certainly do not replace a midwife.

As a doula, I do a whole lot of things that can improve your pregnancy, labor, delivery, and immediate postpartum. I help you ask more (and sometimes better or more specific) questions prenatally and think through all those decisions about what you want for your delivery before it is actually the big day. I help you practice different comfort techniques and even help you know exactly what things you actually need to have for your birth and immediate postpartum period either at the hospital or home. I hold hands and help people move around, sometimes with all kinds of wires attached to them. I push on your lower back, squeeze your hips, and massage your hands during labor. I help you to the bathroom and comfort you through the challenges of labor and deliver with all kinds of affirming words. I will let you squeeze my hand and listen to the changes in your voice and demeanor for clues on how I can better help you. I do not doula the same for any two births, as each one presents its own unique set of circumstances.

Midwives provide care for healthy pregnant people prenatally, during labor and delivery, and postpartum. They approach birth differently than an Obstetrician, but essentially do all the medical things an OB can do other than surgery. Midwives view birth as a normal process and often practice watchful waiting while expecting everything to be perfectly normal and fine instead of trying to prevent things from going wrong through action. It can seem a very subtle difference in philosophy, and not all midwives take this approach, but this is the midwifery approach generally to pregnancy and birth.

  • A short and completely non-comprehensive list of things a midwife can do that I do not as a doula:
  • Check your vital signs like blood pressure and temperature
  • Order labs
  • See you for in-office prenatal visits (monthly, biweekly, then weekly)
  • Check your cervix
  • Catch your baby
  • Give you stitches
  • Check your fundal height after delivery
  • Order and administer medication

If you want to learn more about midwives, this link is a good place to start.

If you would like to learn more about doulas, you can read about us here. I would also LOVE to talk to you about my services! You can contact me through this website, via email, phone, or message me on social media–whatever you are comfortable with is fine with me. You can read reviews from previous clients and check my availability at this link as well if you would like.

I love helping my clients navigate pregnancy, birth, and postpartum, and have more than five years of experience as a doula at both hospital and home births. I have worked with some amazing midwives and OBs too. I have been to 8 different hospitals as a doula and learned all about their policies and who has which equipment. I know which cabinets have the towels and where to find the emesis basins. More than that though, I support my clients however they want to be supported, because each one is different and each situation demands different techniques and approaches.

Someone once asked me what the #1 most important quality is for a good doula. That was easy for me to answer: EMPATHY! What I may lack in midwifery clinical skills, I make up for in compassion and listening skills. Midwives and doulas can work really well together and there is definitely room for both in your chosen birthing space!

Ask Questions!

As humans, we like to ask questions. As patients, we are often not encouraged to do so. That is a problem. You are in charge of your body. You are in charge of what happens to it. That means that nobody gets to do things to you without you saying yes; that’s bodily autonomy. You deserve to be given true information to make the best decision possible for you and your family. As a doula, I encourage my clients to inform themselves as best they can and find a provider that they trust to be able to have open and honest conversations about your care.

Misinformation can spread like wildfire, and you have to be mindful about who you are getting your information from, even when you might trust the source for other things. Just because your mother gave birth 25 years ago does not mean that she is up on all the latest evidence regarding birth practices. Just because your neighbor had a fantastic planned cesarean does not mean that committing to major surgery is what is right for you or guarantee that you will have similarly easy outcomes. The point is this: question the source and motives of anyone giving you information!

This is a short list of things I often hear about that are NOT TRUE:

  • Once a cesarean, always a cesarean. (VBAC is an option!)
  • Everyone should be induced at 39 weeks. (Nope)
  • If they think your baby is big, you have to schedule an induction or cesarean surgery. (Nope)
  • Induction is no big deal. (Not always)
  • Laying flat on your back is the best pushing position. (Not according to the evidence)
  • You are in “active labor” at 4cms. (Not since 2010)
  • There are no risks to getting an epidural. (Not true)
  • Doulas are judge-y jerks who only help people who want to go without medication! (not me) I could honestly write a whole post about ideas about doulas that are wrong, but that is for a different day.
  • Home birth is not a safe option. (There is plenty of evidence to say it is.)

The truth is that everyone you ask for their advice is informed by their own knowledge and experience. Your great-grandma may have LOVED being asleep for the birth of her children, but that just isn’t how most people choose to birth anymore. Your doctor may have had a string of 3 traumatic deliveries that they attended in the week before your appointment. Your sister may have had a medical condition that necessitated her induction. You need to make sure to temper any opinions you get with unbiased information too, and then figure out what you would like to do using the BRAIN method:

  • Benefits–Why are you suggesting this intervention?
  • Risks–Is there anything negative that could happen?
  • Alternatives–Are there other options available?
  • Intuition–What is your gut saying you should do?
  • Nothing–What happens if you do nothing?

That last one is REALLY important to remember. If nobody is in danger, it is perfectly prudent to ask for more TIME! Sometimes doing nothing is a perfectly reasonable option, and you are well within your rights to say no to interventions being offered in a non-emergent situation. Even when a non-emergent intervention such as a cesarean needs to be done, it is also perfectly ok to ask for a few moments to gather your thoughts and prepare your mind for what is to come. Though some do, not all necessary cesareans need to RUN to the operating room, and a massive shift in plans can be a bit easier to stomach if you have a moment to wrap your head around it before it happens.

The Rights of Childbearing Women is a great place to start when thinking about what you might want to question. You are not a bad patient for asking questions! Some people prefer to have a provider who tells them what to do, and that is ok too by the way, but if you prefer to have a provider who is open to communicating with you and explaining their reasoning for recommendations, I HIGHLY recommend checking out your options and knowing that you may have the option of switching providers for any reason and at ANY time. Providers all have different styles, and finding one who fits with your style is a GOOD thing. Not all providers are created equal, and sadly there are providers who are less than honest in their recommendations. Trust your gut! Don’t be afraid to speak up, ask questions, and switch if you feel like your provider is trying to push you into something you are uncomfortable with and isn’t necessary, including using coercive techniques to persuade you.

If you want to do research, here are some trusted sources for good information that I send to my clients:

If you are a childbirth professional and you want to learn more about your clients’ rights in childbirth, you can check out Birth Monopoly’s Know Your Rights course designed specifically for us in mind.