Induction: why and how to get labour going

Okay Kiddo, time for the eviction! Hilary from Pulling Curls gives us the scoop on how and why we sometimes need to give the weeble the boot.

My first son was nine days overdue – he was over 10lbs when he was born so you can image what kind of treat was like in those last few days.

When my OBGYN gently suggested that she might have to induce me I was thrilled and didn’t really listen (or care) how it was going to happen. Frankly, you could have taken a melon baller to me and I wouldn’t have batted an eye.  

So I asked my lovely Hilary, from Pulling Curls, to give us the scoop on induction so that we’re all a little more in the know about how the eviction notice plays out. Some are good reason and some sound like a thinly veiled attempted to make a tee off time. So whether you’re eager to get the party started, or disappointed that the baking can’t continue, it’s never a bad thing to be informed.

– Amy 

Induce.  It’s not particularly a pretty word — right?  It certainly doesn’t roll off the tongue, but the thought of induction makes some ladies drool with anticipation of no longer being pregnant.  It makes others irate at the “un-natural” ness of the whole moment.  Induction: it means the process or action of bringing about or giving rise to something. In labor, it means we are doing something to start your labor. If you are IN labor, and we speed it along, it’s called augmentation.

First we’ll go through WHY someone might get induced:

1/  Post Dates

Ladies, this isn’t counted in minutes, more and more it’s counted in weeks. Many hospitals will not induce someone for “post dates” until they are 41 weeks.  More and more studies are saying that babies need to cook til’ they’re good and ready. Although, I personally, prefer less-done brownies. I guess this doesn’t transfer to newborns.

2/  Low Amniotic fluid

(called oligohydramnios – oligo for short) Your doctor will perform a test called an AFI (amniotic fluid index) via ultrasound. They measure the pockets of fluid in your uterus.  If it is low, they may induce you. Less fluid gives less cushion for the ever-important umbilical cord. If it’s kinda low, they may just watch you and have it re-measured.

3/  Diabetes

Diabetics tend to grow larger babies, and their pregnancies are more complicated in general, for various reasons. They used to try for much earlier on diabetic patients, but even now they’re allowing these babies to head to term.  Fully cooked, baby!

4/ Previous large baby

However, if you’ve HAD a previous large baby, that means you have a tested pelvis (aka, you can shove watermelon out that thing). This is being less and less of a reason.

5/ Measuring big

Again, this needs to be done with an ultrasound — or, at least it should be.  A baby that’s too big can be a reason to end-up in a c-section. However, inducing before your cervix is ready, can also end-up a c-section. Catch 22. Durn it.

6/  Measuring small

(also called IUGR – intra-uterine grown retardation – retardation being used because it means the baby has slowed its growth) This one, surprisingly, is even more important to keep an eye on than measuring big. This can mean the baby isn’t getting the nutrients they need. The doctor will usually take a look at how the baby is measuring over time. If you just have a small baby, that’s different than a baby who was measuring normal and is now measuring small. Again, this would usually be checked with an ultrasound (but often they would find an indication for the ultrasound by when they measure your belly at your Dr’s appointments).

7/ Previous stillborn

Again, this a touchy one.  Everyone’s hopes are extra high when you’ve had a devastating lost in your past.  But, it can be a reason.

8/  Pre-eclampsia

(I said that just like the Doctor on Downton abbey – he says it much cooler than we do here in the good ol’ states!) or, eclampsia (which is usually seizing, in which case you’d have a c-section).  This is when your blood pressure is high, you’re swollen and a few other factors that we find out through blood tests. It’s pretty rare, but is probably the #1 thing we watch for in pregnant moms (it’s part of why they check your pee at each visit).  It can be REALLY scary, just like it was on my beloved TV show.

9/  Other illness

Be it a serious flu or something big. They may consider getting the baby out.  Honestly, if it’s something REALLY big they might consider a c-section if your life is danger.  Being gravely ill with a baby inside is VERY hard on your body.  Getting the baby out improves everyone’s prognosis.

10/  Your water is broken, and you are not contracting

The majority of people go into labor on their own after their water breaks, but frequently your uterus just could care less it just lost all its fluid.  Thoughtless of it, but we have ways to combat your stupid uterus.  Most often the doctors will give you a few hours to start contracting on your own, and if you don’t they will push hard to start some Pitocin.

11/  Whatever the heck your doctor wants

Sometimes they come-up with the strangest things.  If you’re alert you’ll notice nursing giving looks to other nurses.  But that’s why they have the MD behind their name and I just have RN, BSN, BESTNURSEINTHEWORLD behind mine. 🙂

12/  Elective

That means it’s just something you want to do.  Mom’s in town, husband’s leaving town, your uterus is touching your knees, whatever.  Those are all considered “elective”.  It’s entirely between you and your doctor, but important to note that elective inductions do go at the bottom of the pile of inductions.  We have had 4 or 5 inductions on hold before, and electives come in last.  If there’s no medical indication for the induction we need to take people who have a reason first. The end.

Now, if you’re still with me – we’ll go through HOW they might induce you.

1/  Medication

It can go in the va-jazzle, in your mouth or even crushed and under your tongue or by your gums (wow, that sentence sounded kinda bad!). Really, the options are endless. The three I have used most often are Cytotec, Prepadil and Cervidil. There are pluses and minuses for all of them. Most doctors tend to have a favorite and just kind of stick with it. These tend to “soften” the cervix. Most are given when your cervix is less than 2-3 centimeters. If you’re past that point they will move on to….

2/  Oxytocin

(also called Pitocin, Oxytocin is the generic) — this goes in your IV. It is just a synthetic derivative of what your body produces naturally to get you into labor.  We start it slowly. Each hospital has a policy to increase it carefully, while monitoring your uterus and your blood pressure.  We usually increase it until your contractions are 2-3 minutes apart, or your cervix is actively opening.

3/  Foley Bulb Induction

It’s basically a little balloon that they fill up that gently pushes your cervix open until it falls out (because your cervix is large enough it won’t hold it in anymore).  Usually, it is followed-up by Oxytocin afterwards, although sometimes people head into labor on their own.

4/  “strip your membranes”

That means that when they check your ol’ cervix they take their finger and ring it around between your cerivx and your bag of waters.  That releases hormones to shove you into labor.  Personally, I think this gets it going if you’re already going into labor soon. If you’re not — it’s just a little pain with no gain. This is uncomfortable, but it’s quick and low-risk.

5/  Doctors can break your water

Sometimes they just have you come in, and then they break your water. The baby’s head needs to be well applied to the cervix to make this low enough risk for them to do it. This most often works well on women who have had previous babies and are fairly well dilated. BUT, once they start this, there’s no going back. With each of the other ways, you could stop and go home if the induction doesn’t work. If they break your water, you are committed. Just something to keep in mind.

As for what YOU can do to get the ol’ labor juices going….

I have no idea.

If I had a nickel for every time a friend begged me for ideas (I’d have a real nice set of sterile gloves)…. and frankly, I just don’t know. I just know I’d never take castor oil. I’ve seen the by-products and how LONG they continue and I’d steer clear of that one. BUT, Pregnant Chicken has a great post on just such a thing right here.

Now, before you ladies freak out with all this induction talk. There are REALLY reasons that people need to be induced. I think we can all agree with that. I am a big fan of going the full 40 and even beyond if your baby and uterus can’t agree {I personally went 12 days over}. Pregnancy is hard. Pamper yourself, enjoy that baby on the inside because soon enough that wee one will be screaming their lungs out in a car seat and you might even think it was easier when you were one and the same.

Unlike me, Hilary is a nurse who has worked in various medical fields for the past 14 years, however, none of the information on this blog should be substituted for the care of a physician. You’re smart. You get it. Call your doctor if something seems weird.

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6 Comments

  • Another possible reason to induce, though I understand it’s extremely rare (hey, I had it, so I’m gonna mention it): Cholestasis of Pregnancy. http://www.icpcare.org/ Almost fits the stillbirth or "other illness" categories, but not exactly. The only symptom YOU might notice is itchiness, or it might make sense to just call it another illness. (No rash, itchy all over, worse in the hands and feet, worse at night.) But there’s a risk of stillbirth if you have it, so it’s serious stuff. The risk is the highest at the end of the pregnancy, and there’s no cure except giving birth, so the main treatment is to induce around 37 weeks.

  • According to ACOG and many other organizations, you are not post dates until after 42 weeks.

    Suspected "Big Baby" or "Low amniotic fluid" are not research/evidence-based reasons to induce.

    There’s a really great organization called Childbirth Connection that offers evidence-based information on induction (and more). http://www.childbirthconnection.org/

    • Yes, ACOG also says "After 42 weeks, the placenta may not work as well as it did earlier in pregnancy. Also, as the baby grows, the amount of amniotic fluid may begin to decrease. Less fluid may cause the umbilical cord to become pinched as the baby moves or as the uterus contracts. For these reasons your doctor may recommend delivery BEFORE 42 weeks of pregnancy."
      I’m all for letting things happen naturally, but cord compression and meconium aspiration are nothing to mess with.

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