Thursday, March 13, 2014

Inducing Labor

What is inducing labor? One of the many questions I had during my pregnancy and delivery.  I never thought my delivery would go as it did, but then, that is the point about “What To Expect When It Isn’t Expected”.  I can not tell you exactly how your experience will go with an induction, but I can answer some questions that I have been asked about my own.  If nothing else it gives you a bit more knowledge.

What is an induced labor?
An induced labor is when your labor doesn’t start or progress on it’s own and you need the help of outside medications or methods to give birth.  
Is induced labor a guarantee?
No, in some cases inducing labor does not work.  If the baby is not ready to grace you with his or her presence, then an induction most likely won’t work.  When I was going through my induction I was very fortunate that each step went beautifully and the total process took 12 hours.  The girl in the room next to mine, unfortunately, had been going through her induction for a week and it was not progressing.  They were inducing her because of gestational diabetes but it was not terribly urgent for her to deliver as it was in my situation.  The poor thing was walking the halls and doing whatever she could to help the process.  It is important to know that know matter what, if the baby is not ready, the baby will not come naturally.

When is your labor induced?
There are a number of reasons and pregnancy complications that would lead you to an induced labor.
  • Having a pregnancy complication, such as, preeclampsia, gestational hypertension, gestational diabetes, or kidney disease.
  • Broken water with no contractions.  If you water has broken and labor does not follow you and your baby could be at risk of infection.  If there is a suspicion of infection, further testing will be done and your doctor or midwife will decide what is best for you and your baby.
  • Your baby has stopped growing at a proper weight or is very overgrown.  Any feeling that your baby is at risk will lead to an induction or c-section.
  • A lack of amniotic fluid around the baby.
  • A placenta abruption, deterioration to the placenta or an insufficient placenta.
  • Hitting the 42 week mark and no baby will usually lead to an induction.  You will be offered the option but some women do not opt for an induction which is totally fine as long as you and your baby are safe.  Waiting longer than 42 weeks can increase the risk of stillbirth or other medical problems so it is best to listen to your doctor or midwife and trust them.

How will my labor be induced?
There are a few different methods and medicines used for a labor induction.  I won’t lie to you, it can cause a bit of discomfort, but if it is what is best for you and your baby, you do what needs to be done.  The goal in an induction is to ripen the cervix, which means to get your cervix softened, thinned out, and beginning to dilate, and to begin labor.  Some methods and medication used to induce are: 
Prostaglandins -- If you are being induced but your cervix is not ripe, you'll begin the induction by having medication containing prostaglandins inserted into the vagina by the doctor or midwife at the hospital. This medication helps to dilate you and thin out the cervix.

Foley catheter -- You may have a catheter placed in the cervix.  The catheter has a small balloon that is not yet inflated at the end of it and is placed into your cervix. The balloon is inflated with water to puts pressure on the cervix helping the release of prostaglandins, this will cause the cervix to dilate and thin. When the cervix has dilated to about 5 cm it will fall out and be removed.

Rupturing the membranes (Breaking your water)-- If you're at least 4 to 5 cm dilated, but not showing much sign of progression, your doctor or midwife can insert an instrument that looks like a crochet needle through the cervix to break your amniotic sac. This looks like it will hurt and be uncomfortable, but it really isn’t.  It is no worse than having a vaginal exam.

Pitocin -- This is given through an IV drip to get contractions going.  In an induction once you have reached the point where you go down to the delivery room an epidural will be given if you decide you want one and Pitocin will be given through your IV.  For women who’s water does break but there is no progression, Pitocin is also given.  When your water breaks, most doctors or midwifes will want to deliver within 12 to 24 hours because the risk of infection for you and your baby increases the longer you go with a ruptured membrane.  The amount of Pitocin is adjusted as you start progressing.  I don’t want to deceive you, Pitocin will make the contractions come on very strong and they are painful.  In labor that start on it’s own there is a build, with Pitocin and it is WHAM! you are in labor.

In my own experience, all of these methods and medications were used together.  I was admitted and had the foley catheter done and medication also inserted to help in ripening the cervix.  Within a few hours the catheter fell out and I was having very strong contractions.  I was given some morphine for the pain to ease the contractions.  By this time I was in “inactive labor” for a week now.  This means contractions but no progression, going in I was about 3 cm dilated.  After the dose of morphine wore off I was brought down to delivery, given an epidural and the Pitocin started.  Shortly after, my water was broken, and a few hours later it was time to push.  I was vey fortunate and had a very successful induction.  It is so important to relax to help your body do what it needs to and help your baby relax.

Under what circumstances should my labor NOT be induced?
  • If there is an indication that the contractions would be too much for your baby then you will most likely be brought in for a c-section.  It depends on the test results.
  • Placenta previa, which is when the placenta blocks the exit for the baby.
  • Your baby is breech (head up, feet down).
  • You previously had a c-section. 
  • You have genital herpes.
  • You are having multiples.

I hope this helps inform you a bit about what inducing labor is and the procedure.  It can be scary, but I have to say, don’t be.  Most things about pregnancy and childbirth are unknown.  Whatever you endure is for your baby.  If you have any stories of your experience, questions or comments feel free to contact me at!

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