Pregnancy-Should I have my labor induced?

With today's medical advances, many women are having their labor induced for different reasons, and there are different methods in which this can be done. Reasons that labor is induced include both elective and medical. A woman must weigh the benefits vs the risks when deciding if induction is right for her.

Ultimately, the decision belongs to you, even when your doctor tells you that you need to deliver. Now, if you have a problem, like high blood pressure, diabetes, etc. then you should take your doctor's advice. However, if your doctor just doesn't want to be interrupted during the Sunday football game- and you really wanted to go as natural as possible, then stand up and tell her- I'd rather not be induced, but thank you for offering.

Induction of labor- A process in which you are given medication to promote labor.

Elective

Elective induction, also may be called social, is the most common "reason". Defined as being induced between 38 and 41 weeks of pregnancy for no other reason than to be delivered and there are no medical issues. Ideally, an elective induction will take place after 39 weeks, and also should not be done before 38 weeks. This is due to the fact that although a pregnancy is considered term at 37 weeks, there can still be lung maturity problems at 37 weeks, especially since dates can be off up to 2 weeks.

Many times an elective induction is done because the mother has asked to be induced. She may be tired of being pregnant, or has had a rough pregnancy and is just ready for it to be over. Many times induction is done for maternal convenience, such as family is going to be in town, or the father may only be there for a limited time (especially if he is in the military!). Sometimes she may ask to be induced for something as simple as childcare arrangements.

Often times, however, induction of labor is done for physician/provider preference (or convenience). I especially see more of this around the holidays. Some doctors induce everybody.

I also see a lot of elective inductions scheduled once the mother reaches 40 weeks. This is becoming a more common practice to keep the mother from reaching 41 weeks. Your provider may tell you that you need to be induced because your past your due date. Technically, a  pregnancy is not considered post-dates until after 41 weeks, and, prior to this, induction is still considered elective. However, statistics show better outcomes for both mom and baby when delivered before 41 weeks.

Medical

A medical induction is when a mother is induced for a "medical" reason.

There are many medical indications for induction. Diabetes, high blood pressure, low amniotic fluid, small baby, large baby, thyroid problems, bleeding problems, post dates are among the numerous medical diagnoses.

Medical reasons also include previous pregnancy problems, such as a history of a large baby, or previous stillbirth.

Something to keep in the back of your mind is that some medical problems can spring up over a short period of time, especially high blood pressure in pregnancy. I have seen moms that have come in on a Tuesday with a blood pressure of 180/108, and the day before it was perfectly normal.

Most importantly about medical diagnoses: DON'T PANIC! The best thing you can do for your baby is to stay calm. It's okay to be a little anxious, but the more anxious you become, the less blood flow to your baby, and blood flow is more important to your baby now, than ever before. What I like to tell my patients is "You're not allowed to panic until I panic". Your nurse has seen it all, and knows what is BAD. So, relax, and give that baby the oxygen and blood flow it needs. 

Methods of induction:

There are 3 different methods of induction. Which one your doctor decides to use depends on how favorable your cervix is, and of course doctor preference.

Pitocin

The most common and well known of induction medications. Pitocin, a synthetic hormone of the natural hormone called Oxytocin, is infused through your IV. It is started at a slow rate and increased slowly. How frequently it is increased and how much is determined by your doctor.

You may also be given this medication to augment your labor.

While on this medication, it is necessary to monitor your baby and your contractions continuously. This is due to the necessity to see how effective the medication is so the dose can be adjusted accordingly. Also, sometimes baby doesn't always tolerate your contractions, and the dose may need to adjusted, or even shut off temporarily. And if your baby does not tolerate the pitocin, it does not automatically equal C-section, your baby just might need a little breather.

You will not be allowed to eat or drink during this part of the induction process, this includes hard candy and gum. It will be ice chips only, or the occasional popsicle (if your provider allows it).

You will also receive a bag of pitocin after delivery as well. The first bag is usually infused very quickly, and a second bag may be hung, which will be infused at a slower rate.

Cervidil

Cervidil is used when your cervix is not "ripe" for labor, meaning- your cervix is not soft, thin, or dilated. This medication is highly effective at ripening the cervix, however is quite costly. Your insurance will cover this, but if you are part of the growing population self-pay patients, this is important for you to know.

Cervidil is placed behind your cervix by way of manual exam (you'll have to get used to this anyways!), and is left in place for 12 (yes, twelve!) hours. Where the medication is absorbed off a small flat wafer that is attached to a long string. Depending on who places it, part of the string may hang out of the vagina and if you get up to the restroom, it is important to not pull on this. You may or may not have an IV in place during this part of the induction process.

After the medication is pulled, you will be started on pitocin thereafter after about an hour. This would be a good time to shower if you're allowed to.

Again, it is possible that the baby may not tolerate this medication, in which your nurse will pull it out early. Other reasons why the cervidil would be pulled early- your water breaks or you go into labor (yeah! and yes, it is possible), you start contracting too much, or your doctor has ordered it to be pulled early. 

Because of the amount of  time for this medication to effectively work, this type of induction is typically scheduled overnight, meaning you will need to be at the hospital in the late evening. This allows both you and your provider a good night's rest before the real action begins. If your provider orders a sleeping pill, I highly recommend taking it. You will probably have contractions while this medication is in place, and they can be fairly uncomfortable. Don't be afraid to ask for pain medication if you need it.

Cytotec

Cytotec is another medication that is used to ripen the cervix for labor. This works in an entirely different manner than cervidil, but also very effective.

This medication is in pill form, and is usually placed behind the cervix, although occasionally it is ordered to be taken by mouth. A dose is usually placed every 4 hours, and typically does not take more than 3 doses to achieve desired results.

This type of induction is also scheduled at nighttime, so that pitocin may be started in the morning.

This medication is also given for heavy bleeding after delivery, although in a much larger dose than for induction of labor.

If you are scheduled for an overnight induction, it is wise not to bring the entire family at this time, as you can safely figure that nothing will be happening that night! You will also want to bring some activities to keep you busy such as a book or movies, even your laptop!

Your provider will decide if you are allowed to eat or drink during a cervidil or cytotec induction. So discuss with him/her ahead of time about this. But bear in mind, even if you are allowed, if any issues arise, or you start laboring, then you will no longer be allowed to. 

The benefits of having your labor induced can be great, especially if you have medical problems. But it is also important to keep in the back of your mind that induction of labor can be a long, tedious process, I have seen it take up to 3 days in some instances. Your labor may be more painful. It also slightly increases your chance of needing a cesarean section due to:

• Your body is just not ready yet, trying to force your body into labor can back fire, even if it is for a medical problem and despite using ripening agents.
• Medications increase the strength and intensity of your contractions, sometimes babies don't tolerate those stronger contractions.
• Occasionally, induction can exacerbate certain medical problems.

If you had a cesarean previously, and are planning to attempt a vaginal delivery this time, your labor can be induced, but you must be watched very closely throughout the process. Discuss with your doctor your options.