Preparing for a medically necessary labor induction
Labor induction is increasingly on the rise, however, even ACOG has a limited statement on what is a defines medically necessitated labor induction. This is generally defined as gestation or chronic hypertension, preeclampsia, eclampsia, diabetes, premature rupture of membranes, severe fetal growth restriction, and postterm pregnancy (postterm dates are defined generally after 42 weeks gestation though protocols and practice style is often after 41 weeks). There are varying opinions in the birth world of what is truly medically necessary so always research your options and need.
Induction is not a panacea, it only sometimes works, is more challenging than naturally occurring labor and is often long. I hope my suggestions and information can help you be more well equipped when it is the best solution for you and your baby.
So you do need to be medically induced, how can you prepare? Do you need cervical ripening prior to the induction as well ?
Start with the type of induction you need.
Ripening is for a cervix that is not ready for using pitocin for induction purposes (see Bishop’s score below). Ask your care provider what your score is. If he or she does not use the Bishop scoring ask for the particulars of each of the five categories then you can use the table yourself. The position category denotes the position of your cervix.
If you need a ripener prior to the induction, you have two common options (Cytotec or Foley Catheter) though there are more available (Cervidil or Prepadil), they are not widely used any longer.
Foley Catheter ripening is a mechanical ripening method that requires no medicine therefore has very little negative consequence related to the usage. The catheter is inserted in the cervix, then filled with saline to fill the end of the bulb and mechanically opens the cervix up to approximately 4 cm’s while the foley is in place. The mother will go home until the catheter falls out or will remain in the hospital overnight. The pressure from the foley catheter promotes continual prostaglandin release that encourages the effacement and works in conjunction with the mechanical dilation to open the cervix. When the catheter falls out, unless it prematurely dislodges the cervix is ripe and ready for induction (pitocin usage). Sometimes the mother is already in early labor and may not require pitocin or require less. For more information and studies regarding foley cather ripening view my blog page http://prepforbirth.com/2009/07/20/foley-catheter-ripening-versus-medication-studies.html.
The most common yet riskier method of cervial ripening is the use of Cytotec (Misoprostol). Cytotec is used in an off label manner for ripening the cervix. ACOG has this to say in the revised new guidelines that include seven recommendations based on “good and consistent scientific evidence” — considered the highest evidence level — including one that sanctions 25 mcg of misoprostol as “the initial dose for cervical ripening and labor induction.” The recommended frequency is “not more than every 3-6 hours.” Though this drug has been shown to be successful for ripening it is not without concern, consequence, risk or controversy. Please do your research ahead of time prior to allowing this drug to be used on you and your baby.
Here are some helpful links:
Your cervix is ripe for induction
The most common next step is the use of Pitocin to induce labor contractions. What to expect: an IV with fluids running, continuous monitoring, and limited mobility. The increased pain and stronger than usual contractions over a longer period of time associated with Pitocin use often leads women to ask for epidural anesthesia. There are varying protocols, but the low-dose protocol is most often used today. Induction is not fail safe, you may or may not respond to “tricking” your body into labor. Your baby also may not respond favorably. In the event the induction fails or causes maternal or fetal distress or host of other complications, a cesarean delivery is the next step.
Here are some helpful links regarding Pitocin.
Rethink how you pack your birth bag
Considering the length of time that you will be at the hospital considering adding the following items to your birth bag.
- Movies (make sure your hospital provides DVD players or you will want to bring one of your own)
- Puzzles of all types
- Laptop Computer
- Extra changes of clothing
- Extra food for husband, partner or labor support
- Extra cash
- Ear plugs and eye covering to make sleeping easier
- More comforts from home to be soothing
Points to think about
- You are having a baby and need to do the work of labor completely at the hospital. ONLY allow those who can help you keep the chaos and interruption to a minimum. This is not a party.
- Turn of cell phones.
- Keep room comfortable, peaceful, and stress-free.
- Having your water broken artificially does not mimic it naturally breaking.
- Use the space provided and get on the birth ball, stand near the bed and sway, use rocking chair, have equipment moved closer to bathroom so you may sit on the toilet, use as many positions as possible to help baby negotiate and to help dissuade a mal-position.
- Induction increases the risk of a cesarean delivery becoming necessary whether from the induction failing (fooling a body into labor isn’t as easy as it sounds), maternal/fetal distress or another complication may arise. Here is a sample cesarean delivery plan in the event it becomes necessary. sample-cesarean-plan
My closing thought to you is take a deep breath and know when medically necessary an induction is a reasonable step.
My hope is for you to be well informed, be confident to ask questions, be strong to make your own decisions, and thrive to a successful birth even when Plan A isn’t an option anymore.