Know Your Options: Induction

Welcome to the first post in my Know Your Options series! Okay, ready? Let's jump right in! 

What is induction? 

According to the American College of Obsetricians and Gynecologists (ACOG), induction is the use of medication or other methods to bring on labor. Augmentation is when methods are used to speed up or slow down a labor that has already started.

A labor can be medically augmented even if it began naturally. However, having labor induced does increase the likelihood the labor will be further augmented. Augmentation also increases the chances of further interventions.
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Additional Tidbit: This is known as the "cascade of interventions" and doesn't just apply to induction, but to all kinds of common interventions administered during labor.

Almost 1 in 4 women have their labor induced in the U.S. A labor may need to be induced or augmented for a number of reasons. However, approximately 19% of inductions occur for no medical reason. In one survey, 15% of pregnant people said they felt pressure to induce from their medical providers. Not to mention the pressure that may come from family members or the calendar as the looming  (estimated!) "due date" appears. It's important to understand that induction comes with risks.

So, how you do know if the benefits outweigh the risks in your particular case? And what other options do you have besides the "standard" medical induction method of a Pitocin drip through an IV? Let's start by defining the terms and laying out all the options. ​
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Medical Induction and Augmentation Terms

"Stripping" or "sweeping" the membranes - a procedure were the caregiver inserts a finger into the cervix and carefully separates the bag of waters from the uterus. 

Prostaglandins - drugs used to ripen/soften and thin out the cervix, a process that needs to happen for the cervix to dilate/stretch in order to birth. This could be a gel, suppository, or tablet.

Synthetic Oxytocin - a drug, such as Pitocin, which is given through an IV to bring on and strengthen uterine contractions. 

Amniotomy - or AROM, is the artificial rupturing of membranes, commonly called "breaking the water" can make contractions stronger if labor has already begun.

Bishop Score - a scoring system physicians use to determine whether or not your cervix is favorable for induction. It ranges from 0-13 and at least a score of 6 is required before induction can take place. 
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Knowing is half the battle!

It's important to understand what each term means when talking to your care provider about induction. This will help you ask better questions and understand the answers your provider gives you. Now that we understand the terms, we can talk about the risks. 

Induction poses an increased risk of:

• Stress on baby which results in changes in the fetal heart rate
• Pain for mother
• Umbilical cord problems 
• Infection in the mother or baby
• Baby born prematurely
• Baby needing intensive care
• Uterine rupture
• Increased risk of cesarean birth

Sometimes these risks will be outweighed by the benefits. Which is why it's so important to have a discussion with your care provider and ask informed questions! The following are a few scenarios where induction may be a better option than waiting for labor to begin on its own:

• You’re showing few signs of labor by 42 confirmed weeks of pregnancy
• You have a medical disease that is not responding to treatment
• You have certain medical conditions such as preeclampsia
• Your labor isn’t starting on it’s own after your water breaks and you have a 
  ​Group B Strep positive culture
• You have a uterine infection
• Your baby’s growth has been slow for his or her age

Induction can be temping as your due date nears. There may be outside pressures to induce. Here are some common reasons given for induction that are, simply put, not good reasons to induce labor:

• Controlling timing of the birth to plan around holidays, vacations, relatives 
  ​visting from out of town
• Controlling the timing of the birth to match with the doctor’s schedule
• Ending the discomfort associated with full-term pregnancy
• Worry that baby is growing too large

​Wait! What about my "natural" options?

"Natural" Induction Methods:

First things first, induction is induction. Whether you’re medically or naturally 
trying to stimulate labor, you can become more susceptible to further interventions and complications. Don’t take any form of induction lightly.

For more information on some of these methods, I've cultivated a YouTube playlist of videos on the evidence as well as how to do some of these methods. Each of these "natural" options come with their own benefits and risks. Making yourself familiar with these will give you more options when discussing your decision with your care provider. 

**Always weigh the pros and cons with your care provider before trying anything at home. **
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Ways to bring on labor "naturally:"

• Sex
• Relaxation/Visualization+
• Acupuncture*
• Acupressure*+
• Chiropractor*
• Evening Primrose Oil (EPO) 
• Nipple Stimulation+ 
• Castor Oil 
• Raspberry Leaf and other herbs*+
• Spicy Food/Curry
• Induction Massage*+
• Homeopathy*+
• Eat Date Fruit 

​*Make sure all professionals are qualified to do prenatal care.
+ Can be used as either induction or augmentation.

​Important: Please Remember...

• Get as much rest at night as you can; treat natural induction like early labor and make rest a priority.
• Walk both during contractions and as exercise during pregnancy. 
• Stairs are a great way to help baby get into a good position and get labor going. 
• Use gravity! Upright positions help baby move down and work with your contractions. 
• Keep yourself busy: Plan some fun, but restful, things to do in your last weeks of pregnancy. Take your mind off the anticipation of labor.
• BABY WILL COME WHEN BABY IS READY. If there are no signs or symptoms of a medical problem,  let baby choose his/her birth date.

​Now what?

So know that we know all this, what do we do with it? Start by talking to your care provider. Your situation will be as unique as you and your baby are! There are lots of factors that go into making these kinds of decisions so it's time to gather information on your own situation.

Ask Your Provider: 

• Is there a medical reason to induce labor?
• Are there non-medical alternatives I can try to speed labor along?
• Am I in immediate danger if I don’t go into labor now?
• Is my baby in immediate danger if I don’t go into labor now?
• How ready is my body for induction? (Ask about your Bishop score)
• What does the research say about the risks for induction?
• Do I need to make a decision now or can I wait?

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Want to take this information with you? Click the button below for a free printable PDF version!

Induction of Labor (PDF)