A doula’s guide to Induction: Part 2
This is Part II in a 3 part series on Induction, where I discuss how they are done, and what to expect and plan for when you’re heading in for an induction of labor.
In Part I, I talked about what induction is and how to decide if it’s right for you.
Next, in Part III, I share lots of tips and tricks for a positive, autonomous induction experience.
So now that we’ve discussed what induction of labor is and whether it is the right thing for your circumstances, it’s time to discover just what it is that happens during an induction. How are they done? What can you know to expect ahead of time? One of my doula mantras that I always share with my clients is knowledge = power. The more you know, the more you can make informed decisions about your care, and the more your autonomy is protected. So let’s learn about how inductions are done.
MEDICAL & NON-MEDICAL INDUCTION METHODS
You have probably heard of at least one or two ways to “get things going” naturally if your labor hasn’t kicked off yet. What you may not realize is that these methods are actually also a form of induction. Remember that the term induction simply means to artificially start labor - so anything you do, medical or otherwise, to try to kick start your labor is considered a form of induction.
NON-MEDICAL INDUCTION METHODS
There are many, many things that birthing people through the ages have used to try and get labor going. Some are quite solidly backed in science, and others are more old wives’ tales, though there may be anecdotal evidence.
◇ Sex. In this case there is a lot of benefit. Semen contains prostaglandin, the hormone that softens the cervix, and of course any situation involving oxytocin (the love hormone) will help to get things going.
◇ Walking/bouncing/climbing stairs. This is more a matter of getting baby into an optimal low position than it is to get labor started, but won’t hurt to try.
◇ Particular foods: pineapple, chilli, dates, red raspberry leaf tea. Spicy food is a myth; pineapple core has an enzyme that is said to soften the cervix (but, like many natural remedies, this hasn’t been backed by science); dates are great for ripening the cervix and shortening labor (and there is a study on this); and RRL tea tones and prepares the uterus for a smooth delivery.
◇ Body balancing exercises. These are beneficial all the way through pregnancy, but ramping up the exercises at the end, such as a routine like the Spinning Babies’ Fantastic Four or the Miles Circuit, can really encourage baby to get into an optimal position and signal that it’s time.
SUPER IMPORTANT: DON’T TRY THE NEXT TIPS WITHOUT DISCUSSING WITH YOUR CARE PROVIDER FIRST!
◇ Castor Oil or herbal remedies. Castor oil causes a strong reaction in the body - usually vomiting and diarrhea - that can trigger contractions. Some herbs can also do this - ask your midwife what they suggest (don’t try to self diagnose!)
◇ Acupuncture/acupressure. There are some great effective points on the body that can be utilized to give your uterus and cervix the hint to get going.
◇ Nipple stimulation. This can be done yourself or by your partner, or by using a breast pump. Direct stimulation to the nipples can be effective in getting contractions started if your body is ready.
◇ Membrane sweep. This is a procedure done by your care provider. The membranes surrounding the cervix are stretched and “swept” with the fingertips, to loosen and encourage the cervix to begin dilating. The research on membrane sweeping doesn’t show a whole lot of evidence that it’s effective - it’s hard to pin down whether you would have gone into labor anyway, without the sweep being done.
REMEMBER: IF YOUR BODY AND YOUR BABY AREN’T READY, NATURAL INDUCTION METHODS PROBABLY WON’T DO MUCH.
Consider this: at 37 or 38 weeks, your baby may not be ready to be born yet. Trying to get them to arrive quicker may just be a waste of your time and energy.
MEDICAL INDUCTION METHODS
If you are admitted to hospital for a formal induction, there is a process to get your body started off. This varies depending on the hospital policies, the staff looking after you, your preferences, and your cervix’s readiness.
First, your cervix will be checked via a vaginal exam. Depending on how your cervix looks, one of several methods of induction will be suggested to start you off.
◇ Synthetic Prostaglandin- drugs to soften and ripen the cervix.
Cytotec, Cervidil and Misoprostol
◇ Synthetic Oxytocin - drugs to cause the uterus to contract.
Pitocin, Syntocinon
◇ Foley balloon/foley bulb/balloon catheter - inserted into the cervix and
inflated, to stretch the cervix to a maximum of 4cm dilation.
◇ Artificial rupture of membranes (AROM) - a small hook instrument
is used to pass through the cervix and break the bag of waters
If your cervix is closed (not dilated), thick (0-20% effaced) and hard:
Cervidil may be suggested to ripen and thin out the cervix. This is a suppository, similar to a tampon, which contains a slow release of the synthetic prostaglandin. This is not always suggested and sometimes skipped over in favor of misoprostol. This is not because it is less effective, but because it is more expensive for hospitals to administer. It is a good way for your body to have a chance to realize what’s happening and “catch up” with the process - and perhaps start contracting on its own.
Foley bulb or balloon catheter – this is inserted in the hospital, and sometimes you have the opportunity to go home and rest while it does its work, which is a great option. It can be anywhere from mildly uncomfortable to very painful to have it inserted - this varies greatly with each person.
Misoprostol is sometimes given at the same time as the foley, to encourage the cervix to soften and thin out. It is given in pill form.
Once your cervix is partially dilated, softening and thinning:
Sometimes your contractions will start on their own. Hooray! This means all your body needed was a little push to get started, and there is no need for further medication.
BUT IF NOT…
Pitocin is usually started, via the IV line. They usually start with a low dose, to see how your body responds, and gradually increase the dosage until your body is contracting in a regular pattern. Pitocin contractions sometimes begin straight away, and sometimes take a while (and a number of dosage increases) to get started. The contractions are known to be more intense and painful than a natural contraction; some people describe them as “sharper” and harder to deal with or endure. Sometimes, Pitocin gets things started, your body gets the message, and takes over doing it’s own work. In this case, the Pitocin can be switched off.
Artificial Rupture of Membranes (AROM) - breaking the waters is not always done, but in certain cases it is suggested to bring baby down and kick off contractions. It can only be done once the cervix is partially dilated.
HOW LONG DOES AN INDUCTION TAKE?
Induction is an unpredictable and lengthy process. Each step has a fluid time frame. Here is a rough guide of what to expect. Keep in mind that sometimes these things are done at the same time, or can overlap.
Any non-medical method: could give results anywhere from 2-48 hours after
Cervidil: usually works over the course of 2-12 hours
Foley catheter: usually works over the course of 6 hours - overnight
Misoprostol: usually works over the course of 4-12 hours
Pitocin: once administered, dosage is usually increased every 1-2 hours, until your body is contracting in a regular pattern. This can take anywhere from several hours to a couple of days.
As you can see, with multiple methods and each one having a non-specific timeline, it’s hard to estimate exactly how long an induction might take. It could vary from half a day to up to 3-4 days, depending on how your body responds, your baby’s tolerance of it all, and how you feel.
The duration of an induction is often the hardest mental challenge for a birthing person.
REMEMBER THAT YOUR BABY WILL BE BORN AT EXACTLY THE RIGHT TIME.
Your preparation and learning will help you to manage expectations for timing. Labor always shows us, no matter how it starts or progresses, that having a baby is a lesson in relinquishing control and embracing the unknown.
In the final part of this Induction Series, I’ll share my doula wisdom - lots of suggestions and ideas for making your induction experience as autonomous and positive as possible.
Part I (What is induction, and is it right for you?)
Part III (Tips and Tricks for a great Induction experience)
Please note! I’m not a doctor. I’m not here to offer medical advice. The information in this post is to help you build a well-rounded knowledge of inductions so you can make the right decision, along with the advice and guidance of your doctor or midwife.
Illustration by Mercedes DeBellard - here’s her instagram and her website
