7 Questions To Ask About Induction of Labor
When I was 40ish weeks pregnant with my first daughter, my doctor started to talk to me about induction. He stripped my membranes at just over 40 weeks – I didn’t know any better than to say yes. And nothing came of that strip other than me feeling violated and my husband shocked because it was so rough.
A week later, I went to my 41-week appointment crying because I was “so done” being pregnant and was that a good enough reason to be induced? My doctor cordially said, “Of course, that’s a good enough reason! Your baby has had plenty of time to grow and is ready whenever you are.”
But was that the truth? If my baby was ready, wouldn’t I have gone into labor naturally already?
Looking back, I wish my doctor had empathetically said, “I see you’re uncomfortable and I know that the end of pregnancy is challenging. But, you and your baby would benefit most from waiting for labor to come naturally. Induction comes with a lot of risk and unless you have a medical need to not be pregnant anymore, you should let your baby pick her birthday.”
But he didn’t.
He was ready for me to not be pregnant anymore and played into the narrative that induction is a simple process with little risk. But that simply isn’t the truth. And I was not given the opportunity to have informed consent because I didn’t have all the information available.
This story is all too common. Mothers nationwide are given very little information about the induction process and told “It’s not a big deal! You can meet your baby within the next few days if you get induced.”
While being induced doesn’t change who you are as a person or the love you have for your child, an induction can dramatically change how you and your baby start life together.
Do some women love their inductions and have great experiences? Absolutely. And chances are these women asked their doctor questions until they felt peace with agreeing to an induction. But too many women aren’t given all the information they need to make an informed decision and are left dissatisfied with their inductions.
So if you are facing a possible induction and you’re not quite sure which questions you should ask your doctor before saying yes to an induction, you’re in the right place! I’m going to discuss 7 commonly asked qQuestions To Ask About Induction. Then you can use this information to make an informed decision that is best for you and your baby.
So grab your notepad and a warm cup of tea and let’s get started.
What Is An Induction?
First of all, what is an induction? Labor induction is a process used to help your body go into labor so that you’re no longer pregnant. It can be used for a variety of reasons, both medically necessary and elective. And it can last anywhere from a few hours to a few days depending on your body's readiness for labor.
When the induction isn’t successful, meaning your body doesn’t respond to the pharmaceutical interventions you will need a cesarean section for your baby to be born.
Check out part 1 of this series to learn more about the risks of induction.
Medical Reasons For An Induction
In part 1 of the series, I discussed the medical reasons suggested for induction. But I’d like to go over them again just for a refresh.
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.
You can also ask for an induction, known as an elective induction, and it will depend on the doctor and your specific situation whether you can get induced or not.
7 Questions To Ask Your Doctor Before Labor Induction
All right, now let’s equip you with a list of questions you can ask your doctor if he or she prescribes an induction so you can have true informed consent and be at peace with your decision.
Why do I need to be induced?
This is the most important question and unfortunately, there are a lot of answers. Perhaps you have high blood pressure or uncontrolled diabetes and induction makes sense. But if your doctor doesn’t like the fact that you’re due on Christmas day or during his vacation, that is not a valid reason to be induced.
2. What evidence supports that reason for induction?
Evidence to support your doctor’s suggestions for induction is not only a good idea but it’s part of informed consent. Refer to the list above for the medically necessary reasons for induction. If you and your baby are sick and will both benefit from ending pregnancy early, then it makes sense to agree to an induction.
However, if your doctor says your baby is too big and needs to be born ASAP, the evidence doesn’t support that claim. Likewise, getting induced because you’re “done being pregnant” isn’t a safe reason either. I’ve been there and I wish someone had said that to me.
3. What is the plan of induction?
As I discussed in part 1, induction is a multi-step process with many different pathways. You have mechanical means of induction, pharmaceutical means of induction, or a combination of the two.
Your doctor will probably begin with a cervical exam to get an idea of how ready your cervix is for dilation and will assign a Bishop’s score, which simply assesses how ready your cervix is for labor. From there he can create a game plan with your consent, and to keep you involved in the process. The more involved you can be in the process the more likely you are to have a favorable outcome and less likely to experience trauma.
4. What are the risks associated with each step of the induction?
Each step of induction comes with risk so make sure you ask for medication inserts for each medication that might be used. Then you can go over it with your doctor until you have a clear understanding.
Also, it’s important to differentiate between absolute risk versus relative risk. Absolute risk is the actual probability that women in a similar situation might be subject to a specific risk. For example, how common is an episiotomy for women who undergo induction? Getting a specific number here can help you decide if that risk is worth it. Relative risk compares two groups, such as the risk of episiotomy in natural labor vs. induced labor.
You want to have the actual risk of women in a similar situation to make an accurate assumption of risk.
5. Are there alternative options?
There’s always another option. Whether you don’t want to start with Pitocin or you want to skip the Foley balloon and use Cytotec instead; understanding that there are many different avenues to induction can help you decide what’s best for you and your baby.
Additionally, options such as waiting a week or not inducing at all should be discussed.
It’s also important to note that if you had an induction before and you’re still dealing with trauma from that induction, it’s perfectly valid to ask about an elective cesarean section as an option. This isn’t ideal because c-sections come with just as much risk, if not more, but, your specific situation needs to be taken into account.
6. What happens if my body doesn’t respond to the induction?
It’s important to know what your doctor will do if an induction isn’t going according to plan. How long is he going to give your body and your baby to respond to the induction process? Will he allow a start and stop if you and your baby are doing well? Or will he suggest a c-section after only eight hours of induction?
At what point will your doctor need a different plan and what will happen if you and baby aren’t responding to the induction?
7. Can we stop halfway through and reevaluate?
This goes along with what happens if your body doesn’t respond to an induction. If there’s a chance the induction could be stopped halfway through and started another time you might be willing to move forward with an induction.
You need to understand that some interventions, such as your water being broken, can’t be undone. But, Pitocin has a short life and can leave your body pretty quickly. Meaning you might be able to take a break if it isn’t working. Understanding where the point of no return is, can help you make a better decision.
Inductions Come With Too Many Risks Not to Ask Questions
When you choose to be a part of the medical system and have your baby in the hospital, you consent to some risks that you would not have taken if you stayed home. And once you’re in the system they have a timeline. Whether it’s the schedule on the labor floor or your doctor's planned vacation, induction can often be used when it’s not in the best interest of the mother and baby.
Although an induction might be presented on a silver platter, you need to understand the short and long-term risks before consenting. If the benefits outweigh the risks, then go for it. But ultimately you can only make that decision once you have all the information available to you.
So keep asking questions, until you have an answer that you are at peace with. You are not an annoyance to your doctor. You are a mother, attempting to be fully informed before forcing her baby to be born before God originally planned. So ask your questions and go in peace.
