Episode 6: Labor Induction (& how to have a successful labor induction)

Welcome to Episode 6 of your Free Weekly Brave Journey Birth Preparation Videos. Today we're talking about medical labor induction.

The topic of induction comes up for SO MANY birthing families.

The two most important things to know:

1. It is your choice whether or not to induce labor. If your medical care provider has scheduled you for an induction, you can postpone or cancel your appointment and take some time to check in with yourself and your body, check in with your partner, check in with the baby, and do some research. This time to process means that if you do decide to have an induction, you're in a good space and prepared for your brave birth journey.
2. Induction certainly changes the process away from the normal physiology of birth, but it doesn't have to be a negative experience. In this video I go through the typical labor induction process (knowledge lowers fear), and I include some tips for a successful induction - starting at about minute 9.

Transcript:

Hi, I'm Cara Lee. I'm a birth doula, childbirth educator and birth preparation coach. I equip birthing people and their birth partners with the knowledge, tools, and skills to bravely birth their own way. This is episode six of my weekly birth preparation series. And we're going to be talking about medical labor inductions.

If you'd like to receive these weekly videos directly into your inbox, please go to bravejourney.com and enter your email address. And I'll send them every time I release a new video. I don't send spam or sell your information. It's just so I can send these weekly videos. And I'll also let you know if you enter your email address bravejourney.com. I'll let you know when registration opens for my birth preparation program.

So, let's get to our topic today. We're talking about medical labor induction. I'm adding the word medical, because we're talking about the instance when a person is admitted into the hospital with the intention of inducing contractions with Pitocin. There are other practices sometimes called natural labor induction practices. And those are not what we're talking about today. So today. Oh yeah. I always have to have notes. So you'll hear ruffling papers. Thanks for your patience with that. It keeps me on track. So I don't go on and on.

So today, first I'll briefly touch on some reasons for induction, as well as some of the risks of induction. Two, we'll talk about the induction process from the birthing person's perspective, so it's not an unknown. And three, lastly, we will talk about how the fact that induction does inherently change a normal physiological process labor and birth - is into a medical process. However, it doesn't have to be a negative experience. So I'll finish with some tips for having a successful induction.

First: reasons for induction. One of the most common that I hear, reasons for uh, induction, is post-term pregnancy. So, you're approaching maybe two weeks post your due date and labor hasn't started on its own.

Usually, birthing by 41 weeks is the general recommendation. Some hospitals and nearly all birth centers will support a birthing person going to 42 weeks. Just a disclaimer, here, I can't talk about this without sharing that both of my babies were born post term, which means they were both past 42 weeks. It happened with my first and I really thought that with my second, it wouldn't happen, but again went past 42 weeks. I like to cook them long, I guess.

Another reason that labor induction might be recommended: occasionally a care provider will suspect a big baby. Um, there's a big margin of error with this. I'm not going to talk about it today, but it's really hard to know exactly how big the baby is from ultrasounds, but sometimes they will recommend it. That's just a fact.

Sometimes they'll recommend induction because your water has broken, but labor hasn't quite hasn't begun on its own.

Maybe if the estimated weight of your baby is actually too small, if they feel that inner uterine growth restriction is happening.

Maybe high blood pressure disorders or things like other medical conditions or high-risk categories, they may recommend an induction.

So there are some really good reasons for inducing sometimes, and sometimes there's not so good reasons. Um, but. That's for conversations with your medical care providers and doing your own research.

Induced labor does come with risks as well. So some of the risks: to be blunt I mentioned this earlier, the induction of labor turns a normal physiological process of labor and birth into a medicalized one. So induction does increase the likelihood of other medical interventions and induced labors tend to be more difficult to manage without pain relief Lastly, about 25% of people who induce their labor do end up giving birth via cesarean section.

In terms of induced labor as being more difficult to manage without pain medication. The reason is that Pitocin brings really effective, strong, long, intense contractions, which is good at bringing the baby. But also more difficult to manage because a normal physiologic labor that occurs spontaneously tends to have an ebb and flow of contractions. We'll talk about that a little bit later.

However, induction does not have to be a negative experience. I will include some tips at the end for how to have a successful induction, but first: the induction process. So inducing labor can take one to three days. Yes. Up to three days sometimes. Um, and spoiler alert at the end. One of the tips I recommend is bringing entertainment, bring movies on your laptop so you can enjoy your life while you're there before labor starts.

The first step of labor is usually softening the cervix.. So, um, birthing people will often check into the hospital in the evening and cervical or vaginal check will be done and a Bishop score will be given. So, the Bishop score is looking at how ready is the cervix for labor. Uh, so they're going to look at the ripeness of the cervix. How soft is it or is it still quite firm. Dilation? Has the cervix started open yet or is it still quite closed? Effacement. Has the cervix started to thin yet. Position? Has it started to move forward yet? The station of the baby is the station, is the baby still really high or is the baby lowered into the pelvis?

All of these are signs of labor progress. All of these are signs that the, that the body may be ready for an induction or for labor to start. And all of these changes to the cervix happen gradually over the course of the last few weeks of pregnancy So if the cervix isn't considered ready yet the medical care provider may start a medic administer a medication to soften or ripe in the cervix.

So I mentioned, you may check in, in the evening, they'll administer that medication and then let it work. Its magic through the night. This is common. Um, and then the next morning they'll check the cervix again. And if it's still not soft enough or ripe enough, they will again administer another dose of the medication.

So this is why it bringing entertainment is nice. Let's see, um, birthing people should try to rest off and on as much as possible through that first process, because the hope is, is that eventually contractions will start and labor will get intense. So resting more at the beginning can be really helpful.

Let's see. Sometimes once the cervix is dilated and soft enough, they'll insert a Foley bulb in for a Foley bulb Um, inductions, the foley bulb was like a deflated Basically a balloon that they'll insert up into the cervix and then they'll inject and fill it with, um, Not this big, but they'll fill it up with saline solution and then just give it time to allow gravity to let the weight of that saline solution balloon begin to put pressure on the cervix and invite dilation, um, and hopefully the cervix responds by dilating and then the foley bulb just eventually falls out.

And hopefully by that point, contractions have started, but if they haven't then the next step of induction, if the cervix is considered soft, enough And ripe enough and thin enough is for Pitocin to be administered, to start contractions. Pitocin is administered. It's an IV medication. So, uh, even with IV and IV pole and monitor straps, it's very possible for birthing people to stay upright and keep moving through their labor. It just means taking the pole with you everywhere you go. Um, and perhaps, uh, having to stay within a range of the monitors, um, because of the monitor straps, but it's still staying upright and leaning slightly forward and, um, is, can really help labor progress and help the induction process. So sitting on a birth ball, rotating your hips, standing and slow dancing and swaying, all of this can help in the early stage of contractions.

Where am I at? So I mentioned earlier, Pitocin tends to bring really effective, strong long contractions. The other side of that is that these contractions while effective at bringing baby can be more difficult to manage because a normal labor on a labor that starts spontaneously, there will be a super strong contraction, really intense at the peak.

You think you can't handle it. And then it goes away and you get a break and you get another super intense contraction, and then it goes away and you get a break. And then the next contraction comes on. It's weak and short and quick, and it goes away and you get another weak one. So then you get a longer break and then you get a super, super strong when it's so intense, you don't think you can handle it, but it goes away and you get a break.

So that ebb and flow is what makes labor manageable and makes it so people can find their rhythm and work with it. With Pitocin, they're just strong and intense and they are just peak every single time. And there's no break. So that can be really difficult to manage without pain relief. Um, it's just a fact.

So it's important to remember that a labor induction may be recommended by your care provider, but the decision of whether or not to induce labor or wait for spontaneous labor is yours. And even, if you've made an appointment for induction, you can cancel or postpone it a day or two. So it's important that you make the decision of whether or not to induce labor in collaboration and discussion with your medical care provider.

To be blunt though, some care providers can use heavy- handed tactics to pressure patients to choose, um, any medical intervention, but with induction, they often pull what we call the "dead baby" card, which sounds awful, but they'll threaten that if a patient chooses not to induce at that moment that their baby may die, which is terrifying. It's everybody's worst nightmare. So it's, um, a little heavy- handed because often the situation is much more complex than that. And usually waiting a little bit until the person feels ready to induce their labor is Extremely effective. So I've had many clients cancel appointments or postpone appointments until they feel ready.

And as you decide whether or not to induce labor, you can reflect, you can pray, prepare, put your hand on your belly and connect with your baby. Connect with your birth partner, connect with your body, your mind, connect with spirit, and really choose what feels right for you. And going into an induction with that mindset, having just taken a little bit of time to prepare and to get in a good place, can make it a, a much more positive experience.

So if you decide to have an induction and you're, um, you're going into it, let's make sure you're not afraid. So here's some tips to help you have a successful induction:

Bring entertainment. Inductions can take two to three days. So starting with the cervix softening, bring movies and TV shows and anything to keep yourself busy.

Encourage the birth partner to get good sleep and take good care of themselves. And let them be free. Let them bring earplugs and eye masks so they can sleep through all the people coming in all night. Encourage them to go run errands or go pick up some good -not hospital- food, take out and bring it back. Let them come and go. The first stage can be really draining and you want your birth partner to preserve their energy so they're there for you when things get really intense later on.

Stay up and moving around as much as possible. I mentioned that, but even with an IV pole and monitor straps, you can move around, stay swaying, stay up, sit on a birth ball, lean forward against the hospital bed. All of these upright and active positions are possible even with an IV pole, just takes a little maneuvering.

Pitocin should be slowly increased. So not given all at once, but over the course of an hour or two increased every hour, just a little bit. So this allows you to have an early labor experience and find your rhythm and find ways to manage labor, just like a normal, spontaneous labor, you can practice your coping strategies early on. And then when things get more intense, you've had a chance to do that rather than labor, just kicking into gear all at once.

And if your medical care provider suggests breaking your water earlier in labor, which sometimes they'll say that that can help stimulate labor contractions, you can have a conversation with them about the benefits and the risks. Because one of the risks with that is that you're put on a timeline. Most medical care providers have a policy that people need to have birthed their babies by a certain number of hours after their water breaking because of risk of infection once the waters are broken. So you can talk to your care provider about maybe waiting until labor is really firmly established until breaking your water, or waiting until even later. 

So that's the lowdown on inductions with a few tips. Let me know what you think. I'm so curious, leave a comment, send me a DM. Did you have experience with induction? Have you been facing a decision about maybe having an induction. Just let me know. I love, I love talking about these things.

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And let me know if there are any topics that you are curious about or you wish you'd known before you had a baby, or you're curious about right now, Because I'm always thinking about things to Talk about any tape. Any topic is on the table. Thank you very much.