Inducing Labor

Dear Kathy,
 
My OB says should I not progress by my next appointment, she wants to induce labor. What does “being induced” entail?
 
Sincerely,
 
Ready to serve eviction notice

Dear Ready to Serve,
 
There are different ways of inducing labor, and the method chosen can vary based on the situation. Induction is being used more and more to prevent complications from being post-dates. Be sure you know the reason for the induction and have gotten all your questions answered before consenting to the procedure.
 
At Home Methods
 
If there is time, non-medical methods can be tried first. Increasing activity, such as taking long walks, can help. If there is a willing male partner, sexual intercourse can be effective because semen is packed with the hormone prostaglandin. Orgasms include uterine contractions, which don’t lead to labor if the body isn’t ready but they might help labor to get going at term, and are a fun way to try in any case! 

There are herbs that can stimulate labor. These should be used with the guidance of a care provider who is familiar with their use and dosages.
 
Castor oil is a laxative. Drinking it causes a few hours of uncomfortable cramps and diarrhea which can lead to labor. It’s not the most pleasant way to start labor, but it’s often used as a last-ditch effort before going to the hospital for medication. A soap-suds enema has a similar, but more immediate, effect and is sometimes used in the hospital right before starting medication.
 
Hospital Methods
 
Methods for inducing labor in the hospital include prostaglandins, mechanical dilation with a balloon, and Pitocin.
 
Prostaglandins are used to start the cervical softening and thinning process and can also cause some dilation. These usually have a slow onset and may require more than one dose. After administration, you need to stay resting on the fetal monitor for 2 hours, then you are encouraged to get up and walk around. You should gradually feel contractions start.
 
A balloon catheter is also used to prepare the cervix for labor. It involves inserting a catheter into the cervix and then inflating a small balloon which puts pressure on the cervix. This pressure causes the cervix to thin and dilate. Although it doesn’t make labor start, it helps the cervix be more responsive to contractions when they do start. You are free to move about during this process, which may take many hours.
 
Pitocin is a drug that causes contractions. It is often given after the cervical ripening methods described above. It is given through an IV that is attached to a pump that can give extremely small doses. It’s started at a very low dose, and increased by very small amounts, until contractions mimic the strength and frequency of normal labor. If managed well, contractions will follow a similar pattern to what would have happened if the body started labor on its own. During Pitocin administration, it’s important to stay on the monitor to make sure that contractions are not too close together and the baby is doing well. You can be sitting up in bed or in a chair near the monitor, you can be standing up, walking the hall, or soaking in the tub.
 
Many people feel that contractions are stronger with Pitocin than their own natural contractions, although that’s hard to measure because many people get Pitocin because their own contractions weren’t strong enough to dilate the cervix. Careful and responsible Pitocin administration should not produce contractions that are stronger or closer together than what is needed for a normal progression of labor.
 
Warmly,
 
Kathy


Maggie’s Doula Tips

​First, I want you to know that while an induction is likely a change of plans, it doesn’t mean that your original birth plan has to go out the window. However it unfolds, your birth belongs to you!
 
Below I’ll be providing some doula tips that will help you feel prepared, confident, and positive about your induction.
 
Questions for Your Provider
As with all matters in your pregnancy, birth, and postpartum experience, you want to be sure your care provider is someone with whom you feel safe and comfortable, and that you trust their decisions about your care. If you have any hesitation about their choice to induce, you always have the right to ask:

• Is it medically necessary to induce at this point? Are there any alternatives to medical induction that I could try? What are the risks of waiting, or are there any?

 
If you’re already set to be induced and you feel confident that this is the best option for you, I first applaud you on making an important decision for yourself and your baby! As you approach your induction date, here are a few questions you can ask your provider:

• What method of induction will you plan to use, and how will we proceed if that method is not effective?
• May I have food or drink until active labor starts?
• How much will my movement be restricted during the induction process? Is there a point at which I could be intermittently monitored or get up and move around?

 
Preparing Your Mind
 Once you’ve spoken with your provider and are well-informed of the medical aspects of the process ahead, It’s common to feel a mix of emotions as you await the “big day.” You may have heard stories from friends or family about their induction experiences that make you feel anxious, or perhaps you are simply full of excitement that you will meet your baby soon, or maybe a mix of both! Take note of how you’re feeling, and let that guide you in your preparations. The experience of labor and birth is unique for everyone, and induction or not, it requires self-love, intention, and determination.
 
In my experience, inductions can be long. Though it is of course possible that yours will not be, it’s good to keep in mind that it could take a while. Be kind to yourself and your body leading up to your induction date. If you’re a few hours into it and things are progressing more slowly than you expected, don’t be hard on yourself. If necessary, take some time to reset. Wash your face, brush your teeth, do whatever helps you feel refreshed and invigorated. Affirmations can be helpful in all stages of labor, but I’ve seen them work wonders to turn things around for clients who are feeling tired, discouraged, or disappointed.
Here are some that  you can repeat or write down to read if things start to seem long and arduous:

• My body knows how to give birth, and it works with my baby(ies) to bring them here safely.
• I allow myself to relax and work with the tools given to me to start my labor; I am contracting, dilating, and getting closer to my baby every minute.
• I am in control of my mind and my body. I choose to be calm, hopeful, and positive about my birth.

 
Preparing Your Body
As Kathy mentioned above, there are some natural ways to try and induce labor at home. The evidence points to sex and nipple stimulation as the most effective, but there are some other ways you can nurture your body and smooth the way for labor:

• Chiropractic care
• Acupressure/acupuncture
• Induction massage (with an experienced & qualified massage therapist)
• Eat date fruit
• Rest (it’s especially important to try and get a full rest before going into the hospital for induction. If your induction is scheduled at night, bring things from home that help you feel relaxed and ready for sleep - your pillow, a sleep mask, lavender pillow spray, etc).
• Eat a big, nourishing meal before going to the hospital. Think protein, carbs, and vitamin-rich veggies.

 
What to Bring
By the time you learn that you’re going to be induced, you may have already packed a birth bag - which is great! Depending on your preferences and needs, I’d like to suggest a few extra items to have on hand:

• Laptop or tablet for entertainment
• Headphones (having these could be especially helpful in a semi-private room or to help cancel out hospital noises)
• Coloring book
• Playing cards
• Books or magazines
• Snacks & drinks (If you are not allowed food during labor, these could also be helpful for a partner or support person attending with you)
• Your birth plan (If you've hired a birth doula, have them help you come up with a birth plan that fits your desires for labor with consideration for the induction process. We’re here to help!)

 
Even if you haven’t hired a doula, I encourage you to find people who help you feel powerful, supported, and confident throughout the end of your pregnancy and your labor experience. Inductions can be tedious, but when approached with loving support and mindful preparation, they can also be joyful, in line with your vision for your birth, and even downright magical.