How to Have a Mindful Induction

By Christine Ghali, Certified Doula, Childbirth Educator, Birth Mentor, Birth Coach

 

Induction of labor is the artificial start to the birth process through medical support or other methods. It is something that happens for many varied reasons. Sometimes it is known about well in advance; sometimes it is a decision that happens more quickly; and sometimes it is something that requires mindful decision making and a process of informed consent or refusal. According to the American College of Obstetricians and Gynecologists (ACOG), “labor should be induced only when it is more risky for the baby to remain inside the mother’s uterus than to be born.”

 

 

“What are some reasons for inducing my labor?”

Every birthing person is unique, including their individual medical history and how their body and their baby might respond to a labor induction. While we will never be able to list every single circumstance that may lead to or result in an induction of labor, here are some of the most common reasons for labor induction:

  1. Elective inductions due to the birthing person’s preference

  2. When a complication develops such as hypertension, preeclampsia, heart disease, gestational diabetes, bleeding during pregnancy, or uterine infection like chorioamnionitis

  3. Placental complications or suspected deterioration of the placenta

  4. The amniotic sac has ruptured (bag of waters has broken) but contractions haven’t started within 24-48 hours

  5. 42+ weeks gestation (concerns of low amniotic fluid levels and/or placental complications)

 

“So…what should I do if an induction is required?”

First, be sure you understand all facets of your labor induction including:

  1. Why your provider is making the suggestion including the likelihood of the proposed induction method to be effective

  2. What happens if the induction is NOT effective

  3. What comes along with an induction both medically and emotionally

  4. Your options for alternatives to the induction method that is being suggested, including any self-induction methods and how and when to effectively try the alternative methods

  5. The timelines you can realistically expect each proposed induction medication to take effect

  6. How you feel about consenting or refusing any proposed induction method, or what your intuition is telling you

  7. What to consider if you refuse the labor induction, or do nothing/wait

 

 

“I’ve heard about natural inductions. Should I try?”

Always check with your medical provider about possible alternatives. Only you and your provider know your extensive medical history and can decide if you are a candidate for a natural labor induction.  Even natural labor induction methods carry some risk. Some natural labor induction methods can include:

  1. Sex

  2. Orgasm

  3. Nipple stimulation

  4. Membrane sweep

  5. Artificial Rupture of Membranes (AROM)

  6. Castor Oil

  7. Optimal Fetal Positioning exercises (e.g. Spinning Babies)

  8. Old-wives tales like walking, spicy foods, pineapple, eating dates throughout pregnancy

 

 

“What should I expect the induction to look like?”

If, for whatever reason, you find that you are indeed facing a true medical induction, it can be helpful to understand what that might look like.

Often, a medical induction that is planned in advance includes the administration of a medication called Cervadil, a prostaglandin, which is inserted vaginally overnight to soften and ripen the cervix, making the next day’s induction more likely to be successful. This typically requires the birthing person to check in to the hospital in the evening and spend the night under observance. Expect many distractions throughout the night as your nursing team does their job to monitor you and your baby, take your vitals, and make notes in your chart.

Another option is the insertion of a Foley catheter, or Foley bulb. This is a small tube with a balloon on one end that your doctor or midwife inserts into your cervix. The balloon is then inflated with a saline solution. This puts pressure on the cervix and encourages cervical dilation. Much like Cervadil, the Foley is often inserted overnight and removed in the morning. Sometimes it comes out on its own, if the cervix has dilated to around 4cm.

In the morning, Pitocin is often started through an IV at a low dose. Pitocin is the synthetic version of your body’s oxytocin which is partly responsible for labor’s progression. Often, the dose of Pitocin is increased slowly every hour, to stimulate contractions. Sometimes, the dose will need to be lowered if contractions become too close or too powerful. The use of Pitocin almost always requires the birthing person to be monitored with external fetal monitors. Be sure you understand what this involves and any other procedures that come along with Pitocin by having a detailed conversation with your provider prior to the induction.

In some instances, your provider might suggest rupturing your amniotic sac (Artificial Rupture of Membranes, AROM) as a means to speed up labor. Be sure to understand the considerations involved in AROM in advance, before offering your consent (non-head presentation, prolapsed cord, timeframes required from AROM to birth, etc).

 

 

“How long is this going to take, anyway?”

Sometimes medical inductions are lengthy, especially for a first labor. They often are even longer prior to 39 weeks gestation. It’s not uncommon for any medical induction to take 24-48 hours.

It’s important to be realistic about your medical induction’s likely timeframe so you can practice self-care in the hours leading up to active labor. Active labor is when the cervix reaches 4-6 centimeters and labor is often described as difficult. It can realistically take 12-24 hours to reach active labor during a medical induction. Plan ahead for how you will spend early labor in the hospital and communicate any expectations you may have regarding how you would like your partner to support you during that time.

If you have a doula, she will be available to you remotely until active labor is established (4-6 cm). This allows her to stay rested and to be her best support to you when you really need it (the last 12 hours of labor!) This is a guideline and NOT a rule. You will know when you need the professional support of your labor doula! Doulas are quite instrumental during induced labors as these labors often are accompanied by the unexpected, including heightened sensations during strong Pitocin contractions which require intense moment-to-moment support during each contraction, physical support, and often support to make decisions regarding pain medications and more.

 

 

“What can I do to cope through an induced labor?”

Remember that labor is hard, no matter how it unfolds. It’s important to prepare mindfully for labor’s intensity and to communicate in advance with your support team (partner, doula) regarding your birth preferences and how you’d like to be supported. Remember what you learned in your Birthing From Within class; now is the time to use your Breath Awareness, Non-Focused Awareness, vocalizations, visualizations, birth affirmations, mantras, Spinning Babies, position changes, shower, water, food, heat, ice, massage, acupressure, hip squeezes, counterpressure, meditations, and more…and trust that both you and your baby have your own unique journeys and to allow space for their divine unfoldment. Epidurals often accompany labor inductions, due to the strength of Pitocin-induced contractions as well as maternal fatigue from a lengthy labor.

 

 

 

Compiled using information from the following sources:

Mayo Clinic Guide To A Healthy Pregnancy.  Harms, Roger W., M.D., et al, Part 4. Planning Your Pregnancy and Birth Third Ed. The American College of Obstetricians and Gynecologists, Ch. 8. Lamaze International, http://www.lamaze.org/, http://americanpregnancy.org

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