Medical Induction of Labor 101
Inducing labor has become so common that random people, friends, and family might ask you unassumingly when you’re getting induced. It’s almost as common as people assuming that your baby will come right on their due date, which we know only happens for less than 4% of babies.
The truth about a medical induction of labor is that it comes with enormous risks. Yes, it can be life-saving. But, what we’re seeing today is far beyond the range of normal. Over one-third of women in the United States are getting induced every year, which has more than tripled since 2009.
The vast majority of births are uneventful and not a medical event. God created your body to work and gave you everything you need to grow, birth, and then nourish your baby. Though, in some cases, a mother and baby might benefit from a medical induction of labor. So thank God we can give women that choice.
When is a medical induction of labor required? What are the risks and benefits? Are you fully aware of the steps involved in an induction? All of this is part of informed consent, which your doctor is responsible to discuss with you. But, if he doesn't have time or you have further questions, this is the resource for you!
I want to give you the 101 on induction – from the perspective of a nurse who helped facilitate them and a mother who underwent one, all while giving you the up-to-date stats and research to support it. And because induction is a big topic, this is part 1 of the series.
OK, I hope you brought your notepad! Let’s dive in.
What is a Medical Induction of Labor?
A medical induction of labor is when we intervene in a natural process and encourage labor to begin with pharmaceutical or mechanical intervention.
If you need an induction, you should be as close to term as possible. If you're not close to term, your doctor will perform tests that check your baby's readiness for birth. An induction usually requires multiple interventions to get labor going. If your body doesn't respond to the interventions, you will need a cesarean section to birth your baby.
Induction is not a simple 5-step process where the body responds and the baby is born and everyone is happy. Can this happen? Yes! But often the process leaves mothers feeling out of control and babies forced out before they are ready.
Inducing labor goes against the natural sequence of events and often “fails” because the woman’s body and baby are not ready. It must be used properly so it can be a life-saving intervention.
Medically Necessary vs. Elective Induction
If we take a look at the guidelines by all of the major bodies of research supporting pregnancy, the World Health Organization, ACOG, and the National Library of Medicine, as well as the research, they all say the same thing — induction should only be used for medical necessity. But what does this mean?
What situations are emergencies or almost emergencies? Would an induction save the life of the mother or baby give a better outcome than allowing spontaneous labor to occur? And if there are only a few reasons to induce, why are more than a quarter of women induced today?
Your doctor’s busy schedule, the “possibility” that your baby is too big, or the mother’s discomfort, simply are not reasons to induce. If you desire an elective induction, you must seriously consider the risks involved in the process and what harm you may cause to you and your baby.
Ultimately, an induction is only a benefit when waiting for spontaneous labor could potentially harm the mother and/or baby.
Medical Reasons for Induction
Current research and guidelines offer only a handful of medical diagnoses when an induction may be necessary.
Oligohydramnios
Less than average amniotic fluid for the baby’s gestational age.
Intrauterine Growth Restriction (IUGR)
Smaller than average baby for gestational age (how many weeks pregnant you are)
Uncontrolled Hypertension
High blood pressure that is uncontrolled can cause complications for both mother and baby.
Preeclampsia
Preeclampsia is a sign of organ dysfunction. High blood pressure, protein in urine, fluid retention, and seeing spots, are among the most common symptoms. It can progress to full Eclampsia if not caught early and that causes seizures and organ failure.
Uncontrolled Diabetes
Either type 1, type 2, or gestational diabetes can all influence the health of the pregnancy. But this is in cases of uncontrolled diabetes. Controlled diabetes can usually be treated like any other uncomplicated pregnancy.
Preterm prelabor rupture of membranes
When the water breaks before term and there is no start of labor.
Abruptio Placentae
When the placenta separates early from the wall of the uterus, which is only meant to happen after the baby is born.
Chorioamniotis
This is an infection of the amniotic fluid and can cause infection in both mother and baby.
As you can see these are serious diseases and dysfunctions of pregnancy. For the majority of women, these issues will not be present in your pregnancy. So if your doctor says you have to be induced you can ask what the medical indication is for and if you are not satisfied with his answer, keep asking questions.
These diagnoses should not be taken as the end-all answer. Asking “why” the current situation is happening needs to happen before jumping into an induction.
For example, why might the baby grow behind the standard schedule? Does it have to do with parental genetics? The mother’s nutritional intake? Or is the baby truly at risk and his placenta is not able to function anymore? Questions like these can be answered with time and investigation.
If you have a medical indication for an induction, it’s still likely not an emergency – or you would be rushed back for an emergency c-section – and asking questions and taking more time to investigate is in the best interest of both you and your baby.
Complications of Labor Induction
Your doctor should have an in-depth discussion with you if he or she is suggesting an induction. But just in case he hasn’t, here are the risks to both mother and baby that can result with an induction. Keep in mind that there may be other complications that are not discussed here. Just like birth, every woman and baby will respond differently to the process.
Risks to Mother
Higher rates of the following risks than women who are not induced:
Use of an epidural and pain medication
Cesarean sections
Instrumental birth – using forceps or vacuum to help the baby out of the vagina
Episiotomy
Postpartum hemorrhage
Rehospitalization after going home
Risks to Baby
Higher rates of the following risks than babies who are not induced:
Admission to the NICU
Asphyxia – trouble breathing
Birth trauma
Any form of resuscitation
Respiratory disorders
Rehospitalization after going home
All of the above has multiple repercussions associated with them. It’s not just an epidural or an episiotomy. It’s what results from that intervention. The cascade of interventions is a slippery slope and it can be hard to stop once started.
What Happens During an Induction?
So if you have a medical indication, you’ve asked for further testing, required in-depth answers from your provider, and you feel at peace with moving forward, here is what you can expect from the process of an induction.
Your doctor will need to start with a cervical check. This will help decide what route to take in your induction. Your doctor will use the bishops score to calculate how favorable your cervix is for induction. A number greater than 8, usually gives the best outcomes, while a score less than 5 is much more likely to end in a cesarean section.
There are multiple ways to start an induction:
Medication on the cervix – cervidil or cytotec
Medication orally – cytotec
Medication through the IV – pitocin
Mechanical opening with a foley bulb
Membrane stripping
Manually breaking the water
A combination of a few of the above options
All of these steps can individually start and sustain labor or all of them may be necessary. At each step, there is associated risk to mother and baby, which I will discuss more in depth in a later blog.
Once labor has started and a normal contraction pattern is established, there may not be an need for further intervention. But keep in mind, once you’re in the system and on their timeline, you’ll likely be moved along and any sign of labor slowing will result in an intervention to speed it up.
A “successful” induction of labor ends with a healthy vaginal delivery. If the woman’s body doesn’t respond to the induction or the baby becomes distressed and can’t recover, the baby must be born via cesarean section.
Some inductions I witnessed only took a few hours – more common for a mother who’s had a baby before. While other inductions can be days long. You just never know how your body or your baby will respond to the process.
Final Thoughts on Part 1 of Labor Induction
If you need a medical induction of labor, information is your best bet at a successful induction. With information you’re able to ask questions and stay involved in each step of the process. There is research that shows that the more women feel in control during their births and participate in decision-making, they are less likely to have trauma after birth.
If you need an induction, use this information to ask your doctor questions. Keep asking questions until you’re satisfied with the answer. Stay involved in the process and keep Christ at the center of your decision making. Follow the peace of God and trust that He will never lead you astray.
And stay tuned for part 2! I will discuss what specific questions to ask your doctor before an induction and how you can stay involved in the induction process.
Share this blog with a friend who might have been told they need an induction! Start the conversation so we can have better outcomes for mothers and babies.
