Everything You Ever Wanted to Know About Inductions

Induction of Labour

So, your doctor or midwife has told you that you need an induction to start your labour.

What does that entail?

Firstly, there are many reasons for induction, the most common one being post-dates. This is more than 41 weeks of pregnancy in North America. Other reasons can be because your baby is larger than expected on ultrasound or if you are medically unwell.

Unfortunately, induction has become too common in recent years. It is a medical procedure that is more likely to result in a cesarean section than when you go into labour naturally. The decision to induce should be taken seriously.

More from Babytalk: What to Expect When You’re Getting a Cesarean Section

Luckily, there is a way to know if your body is ready for induction, and you should ask your health care provider if you are. It’s called the Bishop score and is based on the status of your cervix.

BISHOP score

The higher your bishop score is, the more likely you are to have a vaginal birth. Below is the scoring chart (taken from Wikipedia) if you’d like to get technical.

Inductions. Bishop score to know if your cervix is ripe.


The lower the score, the less likely the induction will be successful. I made a free downloadable Bishop’s Score printable for you. Click on the image below to snag it! You can either print it out and take it to your provider, or just download it to your phone. Once you have had a vaginal exam, ask your provider to score you and talk about your options with them.


free printable bishop's score

If your Bishop’s Score is less than 6, ask your provider what you can do to increase your score before starting your induction. You are more likely to have a vaginal birth if your score is 8 or higher. Sometimes there is no need to hurry your induction and you can ask your doctor or midwife to keep using agents to soften your cervix before starting your induction. Sometimes this ripening stage can take days!

 

Induction Procedure

For all inductions, you will have to come to the hospital. Usually, you arrive at triage and the nurse there will get you started. Sometimes the care provider starts the process and sends you home, other times you will have to stay for monitoring. This all depends on your medical status and the hospital you are delivering at. There are different methods for ripening your cervix, all based on what the care provider deems necessary.

Ask questions about all the different options. With new research and time, a lot of the recommendations change. It’s really important to ask questions based on your personal care and what is important to you.

Foley Induction

This method basically entails filling a small balloon with water that lies in your cervix and mechanically opens it. For the procedure you will lie on your back with your feet in stirrups, sometimes the care provider will ask you to put your fists under your bum. This allows your cervix to be more visible. The doctor will use a sterile speculum and a light to have a good view of your cervix. 

The balloon used to open the cervix is at the end of a long tube (this is called a foley).  Once the doctor has found your cervix he or she will insert the tube into the opening. They usually have to use long instruments to place the tube in the right spot. Once they’ve found the right spot they inflate the balloon at the end of the tube with about 50-60 millilitres of warm water.

During this procedure, the nurse is with you to help the doctor and support you. This can be an uncomfortable procedure but usually doesn’t take long. I’ve seen women who barely feel anything! 

Every woman differs in regards to how long the balloon needs to stay in. It usually comes out easily once the cervix is dilated 3-4 centimetres. You might feel cramping after the insertion, but it is important to try to rest because labour and delivery are still many hours away (most likely).

Augmentation

Some doctors like to use a medication called oxytocin in conjunction with the foley. Others wait until after your water has broken (either on its own or artificially) to start that medication. Either way, it is a medication often used in labour. Even if you go into labour on your own, doctors will use it to augment the process.

The reason you go through all of this is to have your baby, healthy and happy after delivery!

Cervidil or Gel Induction

 This method uses medication to kickstart your cervix to dilate. Basically the doctor checks your cervix and then puts either cervidil (which can be pulled out with an attached string if necessary) or a prostaglandin gel close to your cervix.  This type of induction can cause immediate contractions, or you might feel nothing at all. It really all depends on your body. It might even put you in labour on the spot!

Artificial Rupture of Membranes

If your cervix is already a little bit open, the doctors can sometimes start your labour by breaking your water. They use a long crochet-like needle to nick the bag of waters that surrounds your baby. This is done during a cervical exam but is not painful for you or your baby. No, the water won’t run out and yes your baby can survive in there with less water. Actually the placenta will continue to make amniotic fluid until your baby is born.

amnio hook
Amnio hook used to break the waters

Oxytocin

In addition to all these methods, oxytocin is a common intravenous medication that is used to cause contractions. Usually, doctors will only use it once your water is broken, but that practice varies on birth location. Once you have an oxytocin (sometimes also called by its trade name Pitocin) drip going, the nurse will continually monitor your contractions and the baby’s heart rate. This is because every woman needs a different amount of oxytocin to get her labour going. It’s started with a low dose and increased incrementally until the right strength and timing of contractions are obtained.

More from Babytalk: How to Naturally Induce Labour Yourself. Four Incredible Tricks

Flexibility

There are so many different medical ways to get your body into labour. It all depends on your provider and your cervix. Sometimes you will know ahead of time what kind of induction you are getting, but other times your cervix will have to be checked first.

Women are typically called in for induction depending on the medical need of induction and the activity on the unit. You might have to be flexible, sometimes the timing doesn’t work out as planned. Have everything you need for the hospital ready to go so that you can come in whenever the hospital calls.

Don’t forget to think about babysitting if you have other children that need watching.

I’d really love to hear your induction stories, good or bad! Please send them along, I’d like to post some birth stories to help other women understand what lies ahead.

More from Babytalk: The Best Way to Cope With Contractions During Labour

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Find out what actually happens in hospital when you are getting induced - Babytalk

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