The Induction Process

Induction will should only be done if medically necessary.

Before you are induced your doctor will need to make sure your body is ready for an induction. This will hopefully involve assessing whether or not your cervix has begun to dilate, efface, soften, and/or move to the anterior (forward-facing) position, or whether or not your baby has started to descend into your pelvis.

If you are induced when your body isn't ready to be induced, you may have to be induced again - not a fun walk in the park. Induction is a process and sometimes it can end up being a very long process.

If your labor is induced, the chances that you'll need an assisted delivery with forceps, a vacuum, or a c-section are increased. The chances of a c-section increase by 50%. Those chances further increase if this is your first birth, your cervix isn't favorable for induction, or if you're being induced early. The reasons for these interventions is that your labor ends up going too slowly or it can't seem to start at all, despite all efforts, or your baby's well being is in question.

Some reasons for induction are:

• Your baby isn't doing very well in the womb anymore and it would be in everyone's best interest if you were induced early.
• You were diabetic before you became pregnant (reason being: there is a higher likelihood of stillbirth in women with pre-existing diabetes and the risk increases as your due date passes).
• A stress test or non-stress test shows that the placenta isn't functioning properly anymore and it would be better for the baby if you were induced as soon as possible.
• Your membranes ruptures (aka - your water broke) over 24 hours ago, but your labor hasn't started.
• You've developed pre-eclampsia or some other serious medical condition and induction is necessary for the safety of both you and your child.
• You have a history of rapid labor that puts you at risk for an unplanned home birth (usually this is only done if you live too far from the hospital and you may not be able to make it there on time once labor starts).

So what happens during an induction?

One of the following (or all) will take place. Be aware that once one thing happens, usually a domino effect of other things will likely happen.

• Prostaglandin E suppositories or gel - these are used to ripen the cervix. In 50% of cases the woman will go into labor on her own within 24 hours. If your cervix is already dilating (mine was not - so I wanted to start with this) then you will not need any of this and you will move along to the next step. Sometimes a second dose of this will be administered if the first dose didn't start to work. If your cervix is starting the process, but contractions haven't really begun, you will move on to the next step.
• Artificial rupture of membranes (amniotomy - aka: the doctor will break your bag of waters) - something that looks like a crochet hook will be inserted through your cervix to tear a small hole in your amniotic sac if it is still intact. Backing up for a moment; some doctors will do a process called "stripping the membranes" first, which is when they swipe their finger across the membranes to release prostaglandin. Either way its done, the procedure can be quite painful if you're less than 1cm dilated (and can be pretty pain free if you're past 1cm). If your induction fails after your membranes have been ruptured there's no turning back...now you'll be given pitocin.
• Pitocin - the synthetic form of oxytocin (which is the natural hormone that produces contractions) is injected (by IV drip). If your cervix is not dilating you may be given a few rounds of this drug. Some women feel that pitocin makes their contractions extremely painful; reason being, their contractions weren't able to build slowly. Instead they seem to have just come quickly and with more pain than someone who hasn't had pitocin. This makes the chances of being able to tolerate the pain less likely, which usually results in the need for an epidural. Pitocin should be used with caution and care because it can cause excessive contractions that can reduce your baby's oxygen supply during labor. Once you've hit the pitocin stage, you'll be constantly monitored (as well as your baby). They'll be making sure that your contractions aren't too long or powerful. If that happens, the rate of infusion can be reduced or the process can be stopped. Once your contractions are happening, the pitocin can be stopped or decreased and your labor should progress just like it would if you hadn't been induced.