>My final few weeks of pregnancy can be some of the hardest weeks to get through with all of the aches, pains, lack of sleep, peeing all the time and anticipation of when the baby will arrive. Come the last month of pregnancy I am doing everything I can safely do to get this baby out. I know I am not alone in this desire to do just about anything to go into labor! As a birth doula I always discuss the different options that women have available to them at the end of the pregnancy to help things along. Too often though I hear women at the end of their pregnancy say “I’m so uncomfortable and tired of being pregnant, I am just going to ask to be induced”. Induction can be treated like a magic switch that once flipped gives you your baby in 12 hours or less! The reality of induction can be quite a bit different.
So what really happens in an induction?
An induction is an attempt to start your body’s natural labor process. The goal of an induction is to “kick start” the laboring process that your body is already preparing to do, not artificially replicate it. Labor is a very complex process and there is no guarantee that an induction will start it but there are a few steps that are taken to help ensure that, if you are induced, it will work.
Bishop’s Score
If you are looking at getting induced, either electively or because it is medically necessary, your healthcare provider will probably give you a rating between 0-13 on the Bishop’s scale. The score is based off of your body’s indicators (such as cervical effacement, position, dilation and frequency of contractions) and your medical history. A score of 0 means that an induction will almost certainly fail to stimulate labor while a score of 13 is as close to a guaranteed successful induction as possible. Scoring below 5 usually means an induction is not advisable.
Cervical Ripening
The first step in many inductions is to make sure your cervix is “ripe”. An unripe cervix is thick and firm while a ripe cervix is thin and soft. As your cervix prepares for labor (usually in the days and weeks prior to labor) it naturally begins to soften and thin out which allows it to dilate effectively. If your cervix is not ripe a cervical ripening drug will usually be administered vaginally for 12 hours or so.
Stimulate Contractions
The most common way to start inducing labor is by introducing an artificial form of oxytocin into your body (typically Pitocin). Oxytocin is the hormone that stimulates your uterus to contract. Your contractions and the baby’s heart rate will be monitored closely while receiving Pitocin to make sure that the baby can handle the intense contractions (and they can get intense!). The goal of Pitocin is to stimulate your body’s natural ability to contract so that as your contractions build and become more consistent you can be taken off of the drug and allow your body to take over and continue laboring naturally.
Pitocin contractions are not like normal contractions. Natural labor contractions will usually start off mild and further apart while slowly building intensity and coming closer together as labor progresses. While laboring naturally your brain secretes endorphins (natural pain killers) to help you cope with the intensity of the contractions. Pitocin, on the other hand, can often cause very strong contractions that are close together early on in labor rather than the gradual build up. Pitocin also does not cross the blood/brain barrier which means your body is not producing the endorphins it normally would in labor to help cope with the pain so the contractions can feel much more intense than they normally would.
As the contractions build your body will hopefully take over the laboring process and the Pitocin can be lower or stopped all together.
Artificial Rupture of Membranes (Breaking your water)
Another common way to help stimulate labor is to break the bag of waters around the baby. By breaking the bag of water it allows the baby’s head to move down into your pelvis putting more pressure directly on the cervix and can help to bring on stronger contractions and help you dilate faster. You must be at least slightly dilated for the doctor to be able to break the water. The risk of infection does increase once your water has broken so there is often more pressure for the baby to be delivered within a certain amount of time but this depends on your care provider.
Something to consider before allowing your water to be broken is the baby’s position. As your baby descends into your pelvis it needs to rotate clockwise to come out. The bag of water surrounding the baby can create a “cushion” of sorts to help the baby rotate more easily. If possible it is good to find out if the baby is in a good position before having your water broken to prevent complications.
Time
Being induced can happen quickly, especially if you’re already showing signs of early labor, but it could also be a long and tiring process. It is not uncommon for inductions to take a few days from the time you check in to actually having the baby. It is very important that if you are planning on having an induction to keep this in mind because your mental stamina will be just as important as your physical stamina to have a wonderful birth.
Overall, while inductions can literally be life-savers when medically needed you may save yourself a lot of time, pain and money by just waiting the extra few days or weeks for your baby and body to decide when they are ready for the birth!
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