Induction Information
As usual, this is not meant as medical advice. This is just information with a lot of links so you can do more research! Then make the best decision for you after talking with your care providers!
Everyone wonders why the cesarean rate is so high, I think a huge reason is all of the inductions happening today. Over 40 % of mother’s Care Providers try to induce them and over 47% receive pitocin during their births. I think inductions are something moms really need to be proactive about, because it carries many risks. Hopefully this article will help some moms who are being offered inductions, figure out if it is the best choice for them and their babies!
1. It may not work.
If your body is not ready to have the baby, an induction most likely will not work, which increases your chance of ending up with a cesarean. A good way to tell if your body is ready is to find out your Bishop’s Score! If it is over 9 an induction will probably be successful (if all goes smoothly) if it is below a 9, odds are you will end up with a cesarean. Either way, make sure there is a GOOD reason for an induction.
2. It can cause stress for the baby, which can lead to other interventions and possibly a cesarean. (Usually due to the medications they are using to induce)
3. It can exhaust the mom.
They often have moms come in at midnight, put in cervidil and then in the morning start pitocin. So even before active labor begins, mom is tired. Then the contractions can be so strong and powerful for so long, mom is tired and this leads to #4.
4. Since the pressure waves tend to be more intense than natural waves, moms may want to get an epidural which can lead to other issues.
5. An induction can be the first step down the road to a very intervention filled birth and is more likely to end in a cesarean, than a birthing time that starts because mom and baby are both ready!
1. Ask questions to your care provider from early in your pregnancy, to see where he/she stands on these issues. The answers may raise some red flags and you may choose to change care providers.
How often do you induce your moms?
When do you suggest induction?
What happens if I am still pregnant at 41 weeks?
How do you do inductions? (what medications do you use, etc)
2. Take an Independent Childbirth Class to learn about normal birth and educate yourselves on your choices before and during birth.
3. Trust your body and baby and your instincts!
4. Refuse late term ultrasounds. If your pregnancy has been low risk, there is no medical need to do one. Care providers often use the results to “suggest” inductions. Your baby looks big, etc.
5. If an induction is suggested, ask questions, do your research, see if it is really MEDICALLY needed. Know that you are in charge, it is your body and your baby!
5 things to do if you choose to get induced
1. Ask - What is my Bishop’s Score?
2. Ask - What will happen during the induction?
Knowing what to expect can help you feel more prepared.
3. Ask - What medications will you use?
Make sure you are ok with the medications they are planning on using (if they say cytotec/misoprostol/miso do some research on that)
4. Stay upright as long as possible during your birthing time
This can help the baby move down and get in a good position for birthing.
5. Watch the nurses each time they come in the room.
They tend to up the pitocin quickly and every time they come in, without telling you. So watch them. Tell them to go slowly, this isn’t a race!
5 different things care providers use for inductions
1. Cytotec aka Misoprostel aka Miso – very BAD! Dangerous for mom and baby. Go to this link to learn more. Know that if your OB tends to use this you have the right to refuse it and I would put it in writing!
2. Cervidil – There are some minimal risks…. but it helps to soften the cervix in starting an induction, usually this is the first step, followed by Pitocin.
3. Foley Bulb – use a “balloon” to help open the cervix, it will fall out when mom dilates to about 3 to 4cm. As far as I know there are no risks to this.
4. Pitocin – Man made oxytocin to help contractions to start and or to strengthen contractions. These contractions tend to be very strong contractions which can lead to some different issues. Discomfort for mom and stress on the baby. A key is to WATCH what the nurses do when they come in. They like to up the dose each time, ask them to do it 1 at a time (many do it 2 at a time) if you have a good pattern going, ask them to stop turning it up! They will up it without asking so you MUST WATCH!
5. AROM – Artificial Rupture of Membranes (Care provider breaks your water) In most cases this puts you on the clock. Once your water has broken most care providers want to see the baby born within 24 hours. It also increases your chance of infection and can cause added stress on the baby. Without the cushion of water around the baby, they may experience some stress. In recent studies they say it doesn’t prove that it speeds things up. So you may choose to keep your bag of water intact!
5 Good reasons for an Induction
1. Pre-eclampsia/Toxemia – This can be a serious risk to mom and baby. You just want to be sure it is really pre-eclampsia and not just a few elevated blood pressure read. There are many different things a care provider will look at. Before agreeing to an induction you would want to do a 24 hour urine collection and a liver panel, to confirm the diagnosis. The link explains more. Many times with elevated blood pressure they will put mom on bedrest and monitor her closely. Many will not tell mom that if she ups her diet in protein and adds more calcium and magnesium, that can help with her blood pressure as well.
2. IUGR – Baby is not growing as quickly as expected.
3. Low Fluid – This certainly can be a legitimate reason if the fluid level is below 5. Sadly I have seen 3 moms in the last 6 months told your fluid is low go to the hospital right now. Their levels were all below 10 but above 5. While it is something to watch, if baby is doing well (typically they measure fluid in conjunction with a NST) another more expectant management approach is to send mom home to drink 2 liters of water and come back later and have the fluid re-measured. It very well may have gone up! If not then an induction is still an option. But again, if it is above 5 it may not be urgent if baby is doing well. Maybe to help circumvent this, if you are going in for NST drink a LOT!!!
4. PROM – If moms water breaks before her birthing time starts most care providers are anxious to have the baby out within 24 -48 hours. It is pretty standard for them to want to start an induction within 12 hours of moms water breaking. If mom and baby are not showing signs of infection it may not be necessary. (click here and scroll down to #4)
5. Postdate (42 weeks pregnant) – The risks to mom and baby increase after 42 weeks gestation (more so in high-risk moms). So you may choose to get induced at this point. But it is still your choice.
5 Questionable Reasons for Induction
1. 40-42 weeks
Increasingly I am seeing moms feeling pressured into inductions at 41 weeks or even 40 weeks. Why is this? Statistically there are not BETTER outcomes for moms who induce at this time. Some OBs will cite a study that says the risks of induction don’t increase if done at 41 weeks, but when the study was reanalyzed, they found that not to be true.
If you are a mom who is wanting a natural childbirth, it is much easier for you and the baby if you wait for your birthing time to start on its’ own. If you feel good about waiting, your intuition says all is well with baby and if your care provider says all is ok with you and baby then you can say no to the induction! Wait until your body and baby are ready! Statistically first time moms don’t even start their birthing time on their own until after 41 weeks! Most care providers will want you to do kick counts and Non Stress Tests to reassure them all is well.
2. Big Baby – This one is really common today. Even ACOG says it isn’t a good idea to induce for this reason unless they think the baby will be over 11 pounds.
3. “low” fluid and PROM – These are listed above as good reasons. I think they usually are, but you should ask a lot of questions and trust your intuition.
4. Mom tired of being pregnant – Babies need to grow until they are ready to be born. This leaves a 5 week window of normal 37-42 weeks, so be willing and ready to go the distance! Some moms who are uncomfortable at the end of their pregnancy are just grateful to have a date when the baby WILL be here, they may not be informed of the risks that inductions are to them and their baby. Again, make sure you know your Bishop’s Score. Waiting another few weeks is a lot less risky and comfortable than ending up with a cesarean.
5. OB heading out of town/ Big Football Game/ Convenience
5 NO risk alternatives to inductions
1. Hire a care provider who trusts birth! They are less likely to suggest an induction, unless it is truly medically necessary.
2. Patience
3. Hypnosis – Hypnobabies has a Baby Come Out CD
4. Sex – (As long as your water hasn’t broken). The old adage, what got you into this can get you out of it. "Enjoying" it is one aspect (not always easy at 40+weeks) but also the semen has prostaglandins that can help soften the cervix. Try laying there with your bum on a pillow for 20 minutes, to let your cervix soak in the prostaglandins. (Didn’t work for me, but it can’t hurt, it could even be fun.)
5. Patience
5 more good links about inductions
What Doctors can learn from Midwives regarding inductions.
Citizens for Midwifery – some good links regarding inductions.
Christian perspective on trusting God and birth and inductions.
5 Ways to Avoid a Cesarean – Induce when medically necessary is number 1.
L&D Nurse point of view on slew of inductions.