To Induce or Not to Induce
What you need to know about induction of labour
“An induction usually comes down to making the decision whether you and your baby will be healthier if we deliver now instead of later”
For many women the thought of having an induction of labour is frightening and unwanted. We have this notion that a medically induced labour is unnatural, with many women not wanting to get induced or believe that it will be painful. This is understandable, but only presents a part of the story. This post is dedicated to explaining why health professionals induce labour, the process of induction and the most common induction methods used today. At Coach House our goal is for you to feel more prepared for any outcome, whether you’re getting induced or not.
Disclaimer: This post is meant for informational purposes only and should not replace information or medical advice provided by your primary health provider.
An induction of labour is defined as the artificial initiation of the labour process. This is done through either medication or equipment with the goal of persuading your body to get labour started. There are many reasons why your primary care provider will suggest an induction of labour. These reasons usually involve concerns about your health, the health of your baby, or both. What it comes down to is making the decision whether you and your baby will be healthier if we deliver now instead of later. Personally, I was induced at 38+6 weeks due to an aging placenta (Read Sam’s Birth Story). I was grateful to have an induction because the aging placenta could have been harmful to my baby and that made me anxious.
Below are some examples of why an induction of labour may be necessary:
You are past your due date (over 40 weeks pregnant)
Waters breaking with no signs of labour
Group B Streptococcus positive (GBS+) and waters breaking with no signs of labour
Women’s preexisting medical conditions or illnesses
Diabetes
High blood pressure (pre-eclampsia)
Uterine infection (chorioamnionitis)
Poor growth of the baby (IUGR – intrauterine growth restriction)
Large baby (over 90th%ile) based on estimated growth by ultrasound
Low amniotic fluid around baby (oligohydramnios)
Concerns for baby’s well-being
Twins/Triplets (multiples)
For the sake of helping explain this concept and process, let’s assume that you’ve spoken with your primary care provider, and for one of the reasons listed above they’ve decided to book you in for an induction. Your primary care provider will set up the induction booking and provide you with a time and place (the location where inductions are started varies between facilities). Some hospitals have an outpatient clinic or department which specializes in inductions and other pregnancy related outpatient procedures.
When you arrive at the hospital or clinic for your booked induction you’ll first need to register. Next, a nurse will take you to an examination room where a routine assessment will take place (vital signs, baby’s heart rate monitoring, etc.). A doctor will perform a vaginal exam to assess your cervical dilation. Based on all these assessments and your cervical dilation, your health care team will determine the most appropriate method of induction for you. They will discuss the risks and benefits of the chosen induction method before things get started.
Pro tip: bring your hospital bag with you (but leave it in the car for now). You may have been booked for an outpatient induction (see definition below) but after being assessed by the healthcare team they may decide to keep you as an inpatient. If this is the case, you’ll be glad you brought that hospital bag.
Below explains the most common ways to induce so that you feel more prepared walking into your induction:
Prostaglandins: synthetic hormones used to soften and thin the cervix. Prostaglandins come in several forms most of which are inserted vaginally:
Prostaglandin gel
Prostin tablets
Cervidil: tampon shaped
Misoprostol (given orally)
Cervical Foley: is long tube with a balloon on the end that is used to mechanically dilate (open) the cervix
1. The doctor will insert a speculum into the vagina and then insert a long tube (catheter) with a balloon on the end into the vagina and through the cervix.
2. Once the tube is through the cervix, the balloon is inflated with water putting pressure on the inside of your cervix allowing it to open and dilate.
3. The other end of the long tube will be sticking out of your vagina which will be taped to your inner thigh with some tension.
4. You might feel menstrual cramps during the procedure and for several hours later.
5. Your nurse will monitor you and baby for some time after the procedure is complete and then you will be sent home with instructions on when to return to hospital.
Pitocin (oxytocin): a synthetic hormone that is administered through an IV to bring on contractions. This method is often paired with a cervical foley or breaking your waters.
Artificially breaking the waters (Artificial rupture of membranes/Amniotomy): if your cervix is open at least 2 cm and your baby’s head is pressed against your cervix your doctor may choose to break your waters. During a vaginal exam, a small plastic hook is used to puncture a hole in the amniotic sac. You may feel a gush or trickle of warm fluid out of your vagina immediately after.
Please note: some of these methods can be paired together. For example, you might receive a cervical foley and oxytocin. All methods of induction are immediately followed by continuous monitoring of you and baby for a designated period of time.
How will I feel?
Since inductions are artificially initiating labour they are arguably more painful than going into labour naturally. Natural labour can have a slow progression over days to weeks with subtle changes that may be easier for you to cope with. The contraction pain associated with an induction can build up quicker resulting in more pain as your mind and body have not had as much time to adjust. The contraction pain often starts off as irregular menstrual cramps and/or back pain. Please remember that every body feels pain differently and has a unique tolerance to pain. When getting induced its wise to consider your plan for how you’ll manage the pain with contractions.
Inpatient vs outpatient induction of labour
It is important to note whether you’ve been booked for an inpatient vs outpatient induction. An inpatient induction means that you will be admitted to labour and delivery and once the induction starts you aren’t going home until the baby comes out. On the other hand, an outpatient induction means that the induction starts with the plan for you to go home and return to hospital at an agreed upon time.
Here’s what we recommend for your induction day:
Bring your hospital bag (you may want to leave them in the car until you know the plan)
Understand that inductions can take a long time (sometimes days) and this could mean a longer hospital stay
Expect there may be delays and wait times before and after your induction gets started
Bring entertainment and snacks
We hope that this clarifies what’s involved in an induction of labour and that you feel more prepared and knowledgeable going into one.