This post was written by Labor & Delivery Nurse, Liesel Teen, also known as @mommy.labornurse on Instagram. Leisel is a member of the Juna Expert Advisory Board and monthly contributor to the Juna Blog.
What Happens During An Induction?
Spontaneous labor is great! But sometimes situations arise, and you may need to be induced for medical reasons, or you may choose to be electively induced!
Here are a few of the most common reasons why a medical induction may be warranted:
- You are overdue (most practices consider this to be past 41 weeks, but many nowadays wait even longer, up until 41 & 6 days) – this will depend on your practitioner!
- You have preeclampsia or gestational hypertension
- You have gestational diabetes
- Your baby has IUGR (intrauterine growth restriction)
- You’ve broken your water early in your pregnancy, and you’ve been hospitalized for it
- You have a history of stillbirth
- You have cholestasis
- You have another medical condition that puts risk on yourself or to baby to continue your pregnancy safely
Or, you may decide, after discussing with your provider, that you’d like to be electively induced. There was a recent study that came out in 2018 called the ARRIVE study, that actually showed induction at 39 weeks is linked to a lower rate of Cesarean compared to those assigned to expectant management (19% Cesarean rate versus 22%) and also showed a lower chance of developing pregnancy-induced high blood pressure (9% versus 14%). The ARRIVE study does not mean that elective induction at 39 weeks lowers the risk of Cesarean for every mom, however it’s recommended if this is of interest to you, to speak with your own provider about this findings. That way you both can come to a conclusion as to what is best for you!
At The Hospital
Let’s talk about what happens in the delivery room, if you plan to be induced. Typically you will not go through L&D triage, you’d just come straight to a labor room to be checked in by your nurse.
Your nurse will still ask all of the same questions, and do all of the same “check in” type things that she’d do if you’d come through triage, it’s just a little less rushed because you aren’t answering them in between contractions!
She will take your vital signs, have you change into a gown, have you provide a urine specimen, place you on the external fetal monitor, go over your health history & prenatal records.
Once you get settled in, your provider will come to see you and explain how your induction will go. You may also sign various consent forms – some hospitals still require moms to sign a written consent form allowing your provider to induce your labor.
Your provider will talk to you about the methods that will be used, the risks vs. benefits, and scan your uterus to see how baby is lying (let’s hope head-down!).
Next, your provider will check your cervix, and determine which method of induction is appropriate for you.
There are a few ways to induce labor, let’s go over the most common ones.
- • Pitocin: Pitocin is a medication that’s given to help get your labor started and it’s the most common method! It’s the man-made form of the hormone your body produces when you’re in labor…oxytocin. By giving you Pitocin synthetically, we are attempting to tell your body that you’re in labor. It’s given via IV, and titrated up or down, depending on how your body responds to it!
- • Breaking Your Water: Breaking your water is a form of induction, and some hospitals use this method FIRST, as a means to get labor started. However, breaking your water is something that is usually used in conjunction to being on Pitocin. It’s usually done later, after you’ve been contracting for some time, and baby’s head is low, and well-applied onto your cervix. This is typically when it works the best!
- • Foley Bulb: A Foley bulb is a little catheter that’s manually inserted inside your cervix to attempt to somewhat DILATE it manually. It also helps to release prostaglandins around your cervix, to soften and thin it up!
- • Meds: There are a couple different medications out there that can be used to induce labor! Most of them are inserted intravaginally and work similarly to Foley bulbs…in that they mainly work to PREP your cervix…instead of causing you to have rip-roaring labor contractions (like Pitocin will!).
If you’re a first-time mom, your provider may recommend that you come in at night to PREP your cervix, with either intravaginal medications or a Foley bulb. This is typically routine for FTM’s, because FTM’s generally don’t have super thinned-out, dilated cervixes going into their inductions. Second, third, fourth etc. time moms are more likely to be 2-4 centimeters dilated near the end of pregnancy, so prepping isn’t needed!
If you’re coming in overnight, and need a Foley bulb, or any other “prepping” medication, this is where your provider would do that part after you get checked in!
Once that’s done, your nurse will keep you on the monitor for a little while to make sure baby tolerated that Foley bulb insertion and/or medication insertion, and if everything is okay after about 20 minutes, you’ll get to remove the monitors and go to sleep (or rest…it’s hard to sleep in the hospital the night before you have a baby!).
Some practices even allow moms to go home, and sleep at home with Foley bulbs and/or intravaginal medications – ask your provider about this!
Alternatively, if you’ve come in for an AM induction, after your provider checks your cervix, your nurse will get your Pitocin started!
If you’re a PM labor induction, Pitocin would most likely get started in the morning…or sometimes in the middle of the night if your Foley bulb comes out early.
Pitocin?
Now, Pitocin isn’t a WHAM BAM THANK YOU MA’AM sort of drug. It’s already been referenced earlier, Pitocin needs to be titrated to a certain level to get you in adequate labor!
There is a WIDE range of dosages…
MOST women do not start feeling contractions AS SOON AS Pitocin is started…usually after about an hour, you may start to feel some cramping, followed by mild contractions, followed by stronger contractions that start to get closer and closer together.
However, some women start to feel contractions almost immediately after it’s started – others need 2-3 hours to feel anything – it all depends on your body.
Once you’ve reached an adequate labor pattern (PAINFUL CONTRACTIONS, 2-3 MINS TOGETHER, AND CERVICAL CHANGE), your nurse will STOP turning up your Pitocin.
Then, your body will continue to contract on it’s own, change your cervix, and eventually you’ll deliver!
Don’t be surprised if this is a fairly LONG time from when the Pitocin was first started. If you are a first-time mom, PM labor inductions typically don’t deliver until the FOLLOWING night…on night shift. It can take a LONG time (usually) for your body to get the idea that it’s time to have this baby!
But don’t stress, this is 100% NORMAL…babies can take a long time to make appearances when they are induced!
A Few Restrictions:
- • Continuous External Monitoring: When you are being induced, intermittent monitoring (aka, take your fetal monitors off routinely) cannot be done, and you must stay on the fetal monitor the entire time you are on Pitocin.
This helps your nurse determine how to dose your Pitocin appropriately, and also lets her know if baby is dipping his/her heart rate too low, and we need to turn down/off the Pitocin entirely.
- • Can you Eat? Most providers do restrict food consumption AFTER Pitocin is started…however your provider MAY say this is ok…or you may be allowed to have a clear-liquid diet. The use of Pitocin makes your labor a tiny bit more high-risk, and you may be restricted from food consumption, in case you need a c-section.
This practice will LIKELY change in the U.S. hopefully in the near future. The research on eating/drinking during labor is limited, BUT more and more providers are already beginning to allow full food consumption during low-risk births. Likely as induction becomes a safer and safer option, food consumption will become the norm!
- • Moving Around: Generally, as long as your nurse can monitor your baby, and your contractions with the external monitor, you shouldn’t have too many movement restrictions!
Many, many hospitals in the U.S. now have wireless monitors, so you’ll be allowed to move around as you please – in your room, or in the hallway.
Additionally, many hospitals have waterproof monitors as well, so you should be able to labor in the shower if you please!
The only restriction here would be if your nurse is REALLY having difficulty monitoring you. Sometimes with a lot of movement, it’s difficult to pick up contractions and baby’s heart rate. This data is critical to your nurse, as she needs to know this to titrate your Pitocin to a safe level.
That’s pretty much labor inductions in a nut-shell! Talk to your provider during your pregnancy if you have any questions regarding your induction!
