Considering a labor induction? Top 10 things to know.

I didn’t want to induce my labor, but I’m glad I did. And I’d do it again if it felt necessary.

I was more than 41 weeks pregnant and chose to schedule a medical induction. Because I had no major medical concerns but was full-term, I was on the list to receive a call to get induced when there was a space available at the maternity center. During my wait, I went into 13 hours of natural labor – until my contractions stalled out. It was 5 a.m. after a sleepless night when I got the call that the labor and delivery team at Novant Health Presbyterian Medical Center was ready for me.

I hesitated. I still really wanted to experience natural labor and I had consumed so much online content that bashed inductions for leading to a cascade of medical interventions including cesarean sections. But I was frustrated. I was exhausted. I woke my husband up to start the car. It was time to meet our stubborn little girl.

Dr. Rachel Katzmark, a Novant Health OB-GYN hospitalist who focuses largely on labor and delivery management, took the fear of induction out of me. She confirmed I was 3 cm dilated, educated me on my options, and helped me select my induction plan – Pitocin, manual breaking of water if needed, vaginal delivery.

Then she left me to bounce on my birthing ball, watch comedy specials with my husband (come on, natural oxytocin hormone!), eat snacks and opt for an epidural until it was time for her to break my water and coach me through to the finish line. It felt long, it felt tough, but I felt grateful to stay on course with the plan, and to have such a positive birth experience.

In the United States, roughly 20 to 25% have a birth that starts with induction. Thinking about scheduling an induction, too? Here’s what to know, according to Katzmark.

10 things to know about inducing labor, from an OB-GYN

10. Medical and elective inductions follow the same process, but the reason for each is different.

If we have a reason that we think it’s healthier either for the patient or for the baby to be delivered, meaning the risks of ongoing pregnancy are higher than the risks of being born, we may recommend on the medical side that the patient be induced.

Talking through the rationale and the “why” with your doctor is really important. An elective induction means mom and baby are perfectly healthy with no issues, but we are choosing to move forward with an induction of labor to deliver the baby as opposed to waiting for spontaneous labor or for labor to start on its own. You’re a good candidate for an elective induction if you are at least 39 weeks pregnant, you want an induction, and your baby is head-down.

9. Induction of labor around 39 weeks may actually reduce the risk of a lot of complications – and of C-section.

As ob-gyns, our No. 1 goal is to have a safe mom and a safe baby. Our second goal, the vast majority of the time and if aligned with patient wishes, is a vaginal delivery if at all possible. That is the ultimate, safest and healthiest thing and prevents complications associated with surgery.

8. Inductions are designed to mimic the body’s natural course of labor. That’s why they follow three main steps: cervical ripening, stimulating contractions and breaking water.

• The most straightforward way to induce labor is to start with cervical ripening (preparing the cervix for labor and delivery) using medications or a Foley balloon,
• Then transition to Pitocin, the synthetic version of the oxytocin “love hormone” to stimulate contractions,
• And break water as close to the removal of the balloon as possible.
  

That has been shown in research to be the most efficient way to induce labor while reducing risks such as infection, hemorrhage, NICU admissions and C-section.

Where alterations to that plan come in are either if the patient has a medical reason to avoid a certain medication or if they have a personal preference to avoid a certain intervention. Then we can try and maneuver that process a little bit to help align with patient wishes.

7. Cervical ripening involves medications or devices that get the body ready for labor.

For cervical ripening, we either use medications like misoprostol or Cervidil, or devices like a Foley balloon, which is inserted into the cervix and inflated to encourage the cervix to open. This prepares the body for labor so it responds to oxytocin the same way your body would if it spontaneously went into labor.

To determine if cervical ripening is necessary, we use a scoring system based on a cervical exam that takes in dilation, effacement, how low the baby is sitting in the pelvis, the consistency of the cervix and some other metrics.

6. To stimulate contractions, the care team administers Pitocin via continuous IV drip.

When someone is in labor spontaneously, the body starts producing a small amount of oxytocin and then gradually increases as time goes on. With induction, we do the same thing. We start with a tiny dose of Pitocin and then slowly, over time, we increase it a little bit, by a little bit, by a little bit.

Pitocin is fast-acting and the dosage is adjustable, so we can find each person’s effective dose. There is definitely a rumor that Pitocin is more intense than spontaneous labor, however this isn’t necessarily true. A lot of it comes from the fact that when someone has ineffective labor (cervix isn’t dilating) and we add Pitocin, it gets more intense. But this makes sense because the labor is becoming strong enough to allow progress. It’s remarkably uncomfortable either way!

5. It’s time to break water when you are contracting regularly and the baby’s head is nestled well against the cervix.

There are many people who do break their water spontaneously during an induction. If your water does not break on its own, we use a tiny plastic hook to snag and open up the bag of water to let it drain out. The bag of water does not have nerves in it, so that process is not painful for mom or baby.

When timed appropriately, it can dramatically decrease the total amount of time for labor and for induction by releasing additional hormones naturally that make the body more sensitive to contractions with Pitocin. But once the hormones release, labor does become more intense. That’s true whether Mother Nature breaks the water or a physician breaks the water. Having a doctor break your water does not increase the chance for C-section.

4. Even if you and your doctor are aiming for vaginal delivery, interventions can become necessary during an induction.

We’re choosing an intervention when it’s reducing the risk of C-section or reducing the risk of harm to a patient and her baby. When something is problematic, we are going to start taking the least-invasive things we can out of our bag of tricks to try and do everything we can to steer ourselves back on course.

This applies to spontaneous labor as well as induction; our goal is always to intervene as little as possible, but we are willing to do interventions if the benefits for mom and baby outweigh the risks of not taking action.

3. It’s important to be patient with the process.

We always joke that we’ve got nothing but time when it comes to an induction. For a normal time frame, if you’re coming in for first-time labor, my hope is that it takes between 24 and 48 hours. But we’re not trying to rush. We want to do it in a way that the body is ready for each step along the way. If you’ve had previous deliveries or are arriving dilated, this can lead to shorter induction times.

2. Even if you get induced, you still have autonomy over your birth setting, your coping mechanisms and your pain management.

Our recommendations are from the labor progression side. This has nothing to do with your choices about your setting, whether you use a birthing ball, or what pain management you want, like an epidural. We want you to make those choices and have your experience be what you’re aiming for – it helps to review birth preferences during a prenatal visit prior to coming to the hospital.

1. Bottom line: Induction of labor can be incredibly positive.

Knowing what to expect is a huge part of that. If you have questions or concerns about inductions, or a more detailed list of birth preferences, talking about those preferences and questions with your doctor in the office before you come in for your induction is absolutely essential. That is going to allow you to have the most seamless experience in labor and delivery, and help you decide if an induction is the right thing for you from an elective side.