All About Inductions

Almost anyone who has ever been pregnant will tell you that at a certain point you get tired of being pregnant, and just want the baby out.  If you go to your appointment and your doctor or midwife says something along the lines of "You know, we can induce and get the baby out today..." or "How would you like to meet your baby today?" it is so tempting to agree just to stop being pregnant, and the incentive of getting to hold your new baby for the first time is very enticing.

Legally, hospitals are required to talk about the risks along with the benefits of any medical procedure, this includes inductions.  Unfortunately, there are far to many moms who aren't given a break-down of what to expect, or are made to focus only on the good things.  It is important to go into any medical procedure knowing what to expect, both good and bad.

So, what exactly is an induction?  There are a couple of things that hospitals may try to induce your labor.  

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Prostaglandins

One method of induction is using medications designed to soften and dilate your cervix.  There are several different kinds, so you may hear words like Cervidil, Prepidil or Cytotec.  Basically these use prostaglandins to soften the cervix.  Cervidil is similar to a tampon, it is inserted and can be removed by pulling on the attached string.  Prepidil comes as either a suppository or a gel that is smeared on the cervix.  Cytotec is a tablet that is placed on or near the cervix.  Cytotec has not been approved by the FDA for use in induction of labor, and may pharmacies refuse to release the drug for use in obstetrics due to the high numbers of negative side effects including uterine rupture,hemorrhage, and death of the mother and/or baby.  The use of a prostaglandin to induce may cause the uterus to become overstimulated, at which point more medication will be given to slow it down, or if possible such as with Cervidil, it will be removed.

Pitocin
Another method is putting you on Pitocin.  Pitocin is a synthetic form of the hormone Oxytocin.  It will cause your uterus to contract.  Unlike natural contractions, you won't have that wave-like effect where you feel it coming on, it hits its peak, and then tapers off.  Many women find that contractions while on Pitocin are stronger and more painful.  This usually leads to other interventions in the form of pain medications such as IV narcotics, or an epidural.  Pitocin also tricks the brain into thinking that the body is producing Oxytocin and stops producing the hormone naturally. Oxytocin helps to increase uterine contractions and promote loving feelings toward your new baby.  This doesn't mean that you won't love your baby, but many people report that it seems harder to bond right away.  Pitocin also causes fluid retention which means that you and your baby may have a bit of swelling.  You should also read this new study by the American Congress of Obstetrics and Gynecology (ACOG) about the potential negative impact of Pitocin on the baby.

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Amniotomy
The last method that I will talk about is an amniotomy, also called an artificial rupture of membranes (AROM) or breaking the bag of waters.  For an amniotomy, your doctor or midwife will most likely use a long hook that looks similar to a sharp crochet hook.  Basically they just hook a part of your amniotic sac, and it breaks.  This can be a very effective tool to jump start your labor, and is often even used further in to move things along more quickly.  When you have an amniotomy, it is still very possible to continue with a natural birth without the introduction of any medications, however it is also important to note that once they break your bag of waters, you can't change your mind.  If Pitocin or prostaglandins don't work, you can still choose to go home and give it time as long as the membrane is intact.  An amniotomy is like the point of no return.  

So... are inductions good or bad? 
The answer is yes.  It is a really good idea to wait for the baby to be ready to be born so that they get a chance to fully develop.  However, there are times when induction becomes the best course of action.  If your pregnancy has gone for more than 42 or 43 weeks, it is time to start talking about induction.  The number of weeks may vary depending on your provider.  You should never be induced before 40 weeks, unless for medical reasons.  If your water breaks but you aren't having labor contractions, some care providers will give you 24-48 hours to start labor on your own before induction, others will choose to induce right away.  If your care provider suspects a medical problem they may choose to induce.  This includes things like suspected uterine infection, placental abruption, high blood pressure or preeclampsia, or diabetes.  Basically, if your doctor or midwife is growing concerned about the safety of you or the baby, they will start talking about induction.  Here is an article from the Mayo Clinic about when to induce.

Some reasons that are given that are not good reasons to induce are things like your "baby seems to be getting big.  Let's get him out before he grows anymore.", tired of being pregnant, or your doctor is at the hospital that day.  A good rule of thumb is that if you and the baby are not at risk, you shouldn't induce.

I also feel that it is important to note that although you may have someone say "We can induce and then you will meet your baby today." chances are, you will not meet your baby today.  Inductions can go on a long time and often stretch out over a day or several.  You should also note that only about 60% of inductions are successful.  The other 40% wind up as Cesareans either because it just never took, or serious complications arose.  Considering the number of births in our country, 40% is a lot. 

If you are unsure, or feel like you want to know more, you are allowed to ask for more time to think about elective procedures.  Most inductions are not emergencies, and it is perfectly acceptable to say something like "I would like to sleep on it, and perhaps revisit this suggestion in a day or two."  That gives you time to go home, discuss the idea with your partner, and research the procedure, it's success rates, and the potential side-effects.  

Here is a handy little card that you can print out and keep in your wallet which has a list of important questions to ask when presented with a medical procedure.

Here is a great blog with more information on inductions.