The Induction Process: What to Expect

When labor doesn’t start on its own, or a care provider recommends it for medical reasons, an induction may be suggested to help get labor underway. The induction process is multifaceted and often involves several steps, making it a longer experience than many anticipate. Understanding each part of the process can help you feel more prepared and informed. This blog is a continuation of my previous blog explains why and when induction is used. This is a great tool to help you understand what the day of induction might look like.

The Bishop Score: Assessing Readiness for Induction

Before induction begins, your care provider will often assess your cervix using the Bishop Score. This scoring system evaluates:

1. Dilation: How open the cervix is. This is measured in centimeters, starting at 1 cm and ending at 10 cm.

2. Effacement: How thin the cervix has become. This is measured in percentages and the end goals is 100% effacement. Your cervix can’t dilate until it begins thinning so while this often overlooked, it is an important step in the process.

3. Station: The baby’s position in relation to the pelvis. Your care provider will describe this in numbers from -5 to +5.

4. Cervical Consistency: Whether the cervix feels soft, medium, or firm. Your cervix starts at the consistency of the tip of your nose and will end up as soft as your lips.

5. Cervical Position: Whether the cervix is pointing toward the back (posterior), middle, or front (anterior). Your cervix starts out pointing all the way towards your back and will slowly move to point towards the front.

A higher Bishop Score indicates that the body is closer to being ready for labor, which can make the induction process smoother. If the score is low, your care provider may start with cervical ripening to prepare your body for labor.

Cervical Ripening Methods

When the cervix isn’t quite ready for labor, the first step in induction is often cervical ripening. This process helps soften, thin, and open the cervix. This process is crucial to the success of the induction, but can take a very long time. Methods for ripening the cervix can be categorized into manual and medical approaches:

Manual Cervical Ripening

1. Foley Balloon Catheter: A small balloon is inserted into the cervix and then inflated to put gentle pressure on it. This pressure encourages the cervix to soften and dilate.

2. Cook Catheter: Similar to the Foley balloon but with two balloons, one on either side of the cervix, to provide additional pressure.

Medical Cervical Ripening

1. Prostaglandin Gels or Suppositories: Medications like misoprostol (Cytotec) or dinoprostone (Cervidil) are placed in or near the cervix to soften and ripen it.

2. Oral Medications: Misoprostol can also be given orally to help prepare the cervix.

Stimulating Contractions

Once the cervix is ripened, the next step is to stimulate contractions. This can be done using one or more of the following methods:

Pitocin:

Pitocin is a synthetic form of oxytocin, the hormone that naturally triggers contractions. It is administered through an IV, and the dose is gradually increased until a regular pattern of contractions develops. Pitocin can make contractions feel more intense, so many people opt for additional pain management options during this phase. This does not mean that a plan to go unmedicated goes out the window though, it just means you will want to plan appropriately to cope with the stronger contractions.

Artificial Rupture of Membranes (AROM):

Also known as "breaking your water," this procedure involves using a small hook to rupture the amniotic sac. This can sometimes kick-start labor or intensify existing contractions. While effective, AROM is typically only done once the cervix is dilated enough and the baby’s head is well engaged in the pelvis to reduce risks. It is important to not though that this often starts a clock as to when the hospital wants the baby out.

Hospital Policies Surrounding Induction

Hospitals often have specific protocols and policies for inductions. Here are some common practices:

1. Monitoring: Continuous fetal monitoring is usually required to track the baby’s heart rate and contractions, especially if Pitocin is used.

2. Time Limits: Some hospitals set time expectations for labor progression after induction begins, which can sometimes lead to additional interventions if progress is slow.

3. Dietary Restrictions: Eating and drinking may be restricted, particularly once Pitocin is started or after your water is broken.

4. Support Restrictions: Policies on who can be with you during the process may vary, so it’s good to clarify this ahead of time.

The Length of the Induction Process

One of the most important things to know about induction is that it can be a very long process, especially if your body isn’t already showing signs of readiness for labor. Here’s what to expect:

1. Cervical Ripening: This step alone can take several hours or even a day or more.

2. Contractions: Once labor begins, it may progress slowly, especially for first-time parents.

3. Rest Periods: Sometimes, care providers may pause the process to let your body rest before continuing.

It’s crucial to approach induction with patience and flexibility, as every person’s experience is different. Bringing items to keep yourself comfortable and occupied, such as books, music, or comfort items, can make the waiting periods more manageable.

Key Takeaways

• The induction process is often a multi-step journey involving cervical ripening, contraction stimulation, and careful monitoring.

• It’s important to understand hospital policies and ask questions about your options throughout the process.

• Induction can be a marathon rather than a sprint, so preparing mentally and physically for a potentially long experience is essential.

With the right preparation and support, you can navigate the induction process with confidence and empowerment. If you have any questions or concerns about what to expect, your care provider or doula is there to guide you every step of the way.