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Induction {What To Expect}

By: Jessica Bower, IBCLC, Certified Doula

It's likely that you are hoping to avoid an induction of labor for your birth. Most of our clients want their labor to start spontaneously for a variety of reasons. If you haven't already, check out our blog post on ways to avoid an induction. However, if you find yourself in the position where inducing labor is the best option for the health of you and your baby, we want you to be equipped and prepared for what to expect.

Some reasons why your care provider might recommend induction:

- You have preeclampsia, gestational hypertension, or HELLP syndrome

- You have Gestational Diabetes

- You are diagnosed with Intrauterine Growth Restriction (your baby isn't growing to a normal weight in pregnancy)

- An ultrasound or non-stress test show concerns (these are ultrasounds and fetal montioring that are sometimes done at the end of pregnancy - you can ask your provider if/when they may want to do these tests on you)

- Other health condition for you or your baby

- Your pregnancy lasts longer than 41 or 42 weeks (talk with your care provider about when they prefer to induce labor based on passing your due date - many midwives do not routinely recommend induction until closer to 42 weeks. This is always an important conversation between you and your care provider)

- Your provider is expecting you to have a big baby. If induction is suggested based on the suspected size of your baby - please know the facts on induction for big babies

Anytime an induction is recommended, it should not occur before 39 weeks unless it is for a medical reason. Sometimes the benefits of delivering a baby before 39 weeks outweighs the risks to the mother, baby, or both of continuing the pregnancy. Usually, however, it's best to have your baby after 39 weeks. Once you reach 39 weeks, you may be able to have an elective induction if you desire. This means that you can decide that you would like to be induced without a medical reason anytime from 39 weeks on. Some reasons why people might want an elective induction would be because they have a partner who might be deployed soon and they want to be sure that their partner will be with them. Other reasons could be because you are struggling emotionally or physically and would like some control in the situation and you decide that you would like to be induced. While I know that most of our clients don't want an induction (for good reason!), I want you to be informed of all your options. Elective inductions are becoming less common at 39 weeks because our hospitals do not have the staff to support lots of elective inductions. Some hospitals will not even consider elective inductions until moms reach 41 weeks in pregnancy.

Length of Labor

The timing of how long it will take from the time you get to the hospital to when your baby is born varies greatly from person to person. It will likely be different if this is a first full term vaginal birth or if you've had a prior vaginal delivery before. It also depends on what your cervix is doing. You can ask your provider if your cervix is favorable (soft, open, thinning) or unfavorable (long/hard, closed, thick) for an induction. If your cervix is favorable then it's likely that your induction will be shorter than if your cervix is unfavorable. In general, expect the process to be long. For most moms, it takes awhile for the process to get started. The longest part of an induction for most people is the early stages - getting the cervix thinned and effaced. Once you get to about 4-5cm, labor tends to get more intense and progress happens faster. It's possible for it to take 24-36 hours just to get the cervix to 4cm or so. Know that it's normal and common for this to take place. We can't emphasize how important it is to be patient with the induction process. In most instances, time is on your side. If you are healthy and your baby is healthy, we have time. Telling your body to start labor before it wants to can take awhile, but you have to be patient. On the other hand - it's possible that your body is ready for labor and just needed a small bit of encouragement to get labor started. In some instances, inductions can be as short as 4 hours from getting to the hospital to having a baby. Just like a rapid spontaneous labor, this isn't that common, but it CAN happen. So if this starts to happen, let your doula know ASAP and we will be right there with you through your rapid induction!

Rest and Nourishment

Rest and eat just like normal for as long as you possibly can. Just like with early labor in a spontaneous (not induced) labor - early labor can take awhile and it's so important to rest and eat in the early stages. For rest, bring in your own pillows and blankets to help you rest better. Turn off all the lights in the room. Bring your own music or sound app to play to drown out background noise. If you are being induced in a hospital, most midwives will encourage you to eat in an induction like normal (depending on your unique circumstances of course). Many doctors will say that you should not eat solid food in the early stages of labor. They usually say "clear liquids only" which includes things like broth, jello, Italian ice, sodas, and water. This is an important discussion for you to have with your care provider. Many clients do not do well when they are on day 2 of eating nothing solid. If you feel like you will do best eating in the early stages, then you need to make a conscious decision about that and talk to your care provider about your hopes and goals for rest and nourishment in the early stages of labor. You can ask your provider to explain to you the benefits and risks of eating during the early stages of an induction to help you decide what you'd like to do also.

One Intervention at a Time

Talk with your care provider about the induction process. Based on your history, your hopes for your birth, your reason for being induced, and what your cervix is doing when they start the induction will help your provider know the best way to start the induction. Inductions commonly include drugs like cytotec or cervadil to thin and soften the cervix. Some providers use a balloon catheter to manually dilate the cervix. Artificially rupturing your membranes (breaking your water) can be a useful tool. And then of course Pitocin is often used. You and your provider likely won't know all the tools that they will use in your induction at the beginning of an induction. They will use one intervention at a time, see how your body and your baby respond, and reassess. This blog post will not go into all the pros, cons, and questions to ask with each of these interventions - we encourage your to take a childbirth class and/or have us as your doulas to help you be informed and best equipped for each of these interventions. But you can always be sure to ask about the benefits, risks, and consider how you feel about each of the interventions. One aspect that we like to emphasize is for you to take each step of the induction as it comes. When you realize that you're going to be induced, you don't need to think that all of your hopes and dreams of an intervention free birth are out the window. You simply just take it one step and a time and see how things go. We will be with you every step of the way!

Doula Support For Your Induction

Just like with a labor starting at home, we are with you every step of the way. The day before your planned induction, we have a phone conversation with you to discuss the beginning phases of your specific induction (remember - how the inductions starts and what methods are used liekly depend on where your cervix is). In the early phases of an induction, you are arriving to the hospital, going through the admissions process, asked lots of questions, and then you and your provider decide how to start things. It's usually 1-3 hours before you get any medication to start induction once you arrive to the hospital. Once they give medication, it can take a long time to feel anything or to feel anything more than being crampy. For this reason, the doula does not join you immediately. We join you just like we would in a spontaneous labor - when contractions are getting closer together and more intense and you are ready for that next layer of support. We do this for two reasons:

1. So that you can priortize rest. We know that you are more likely to rest when there are minimal distractions in the room. Clients want to talk to us (and of course we love that too), but we NEED you to sleep. Clients who sleep in the early stages of an induction or laboring at home in the early phases are able to manage the later stages of labor so much better.

2. We want to be 100% when we join you so that you can ideally have one consistent doula through the process. Our goal is to be with you through your entire active labor time so that we don't have to swtich with another doula. This consistency in a doula is key. If we joined you immediately when you got to the hospital, we'd almost always have to switch out to a fresh doula at some point in the labor. Of course there's always the possibility that we are with you 18-24 hours anyway and need to switch out. But we try to avoid this if we can. We see the consistency in a doula be very beneficial to our clients time and time again.

Another Resource

I want to leave you with a wonderful podcast that we encourage everyone to listen to if they are preparing for an induction. Listen to it here.  

At the end of the day, remember:

- Be sure to have open and clear communication with your care provider about why inductions is best for you and your baby

- Know that your doula will be with you every step of the way. Communicate well with us through the process before it's time for us to join you. Just like spontaneous labor - text minor updates and CALL if you want to chat with us and when it's time for us to join you!

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