Tag: induction

5 Induction Truths

An induction is discussed with every pregnant person at some point, & these are 5 truths you may not hear anywhere else.

1. Sometimes Induction is Necessary.

High blood pressure, blood sugar control issues, protein in your urine, health concerns for the baby, and more can make it healthier for your baby to be better on the outside than on the inside. These are very valid medical reasons to be induced. Some providers prefer inductions to take place because of suspected big babies, low fluid, getting close or passing your due date, and other reasons. As we know from the evidence, these are NOT medical indications for induction.

2. You CAN Say No.

If everything is fine with you and the baby, then it is perfectly ok to say no to an induction. Even if you are in the hospital for an induction, you are STILL allowed to say no to anything that they offer, and you should be having a true informed consent and refusal discussion for each and every procedure. This includes breaking your water, starting medications, cervical exams, internal monitoring, the type of cervical ripening medication, and ANY TIME someone wants to touch you! Signing up for an induction does not mean you leave your autonomy at the front door. You’re still the boss applesauce!

3. Induction Increases Your Risk of Needing Cesarean Surgery.

Yes, there was ONE study that found that inducing everyone at 39 weeks reduces the cesarean rate, which actually was really problematic. I have discussed this previously along with a BUNCH of other scholars, however there is far more research that says the opposite. I really appreciate Dr. Sara Wickham’s resources on induction for help making informed decisions. This is something that needs to be discussed before you agree to any induction, no matter why it is being advised.

4. Induction Affects More Than Just When the Baby is Born.

Induction is forcing your baby and body to do something before they are ready to do it on their own. Most due dates are an estimate, and none are expiration dates, as babies keep developing even after they are born. Induction interrupts the hormonal physiology of birth, as Dr. Sarah Buckley has published on extensively. Interventions also affect breastfeeding, which can make feeding your baby more challenging after an induction. This needs to be part of the discussion when you are weighing the risks and benefits of whether to choose an induction.

5. Induction Can Take a LONG Time.

Especially for first time parents, induction can take a really long time. Locally most inductions start overnight with a cervical ripening medication and then proceed the next day. Will you be allowed to eat and/or drink during that time? Will you be allowed to take a shower? Will you be on the monitors the entire time? When are you allowed to get an epidural if you want one? Will your provider be there the whole time? What kind of time limits will they put on your progress? Will there be breaks? Can you bring your Fire Stick to keep watching your current favorite binge-worthy show? Ask questions to help yourself make the most informed decisions regarding your care!

The bottom line is this: If your provider is recommending induction, have an open and honest conversation with them using the BRAIN acronym:

  • Benefits–what are the benefits to this?
  • Risks–are there any?
  • Alternatives–what else could we try?
  • Intuition–what does your gut say?
  • Nothing–what happens if we wait?

Only YOU get to decide what is the right choice, and we want to make sure everyone goes into birth and parenting with their eyes wide open from the beginning. Want to do some more digging before making a decision about an induction? Asking for TIME can be the most empowering way to step away from what can be a high pressure feeling power imbalanced situation when you are sitting there with your pants off talking to your provider. We talk to clients about this all the time, so feel free to give us a call for a consult if you want a little help!

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. 

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.