So You're Being Induced (Induction of Labor demystified)

So you are being induced

So you're going to be induced, here is a non-scary, non-overwhelming explanation of the induction of labor process.

First on all, congratulations on your pregnancy. You are growing a human being inside of you! You are a hero.

Legal stuff: Everyone's medical situation is different. I do not know your medical situation. All information provided is for general education and does not contain medical advice. I am a registered nurse in the state of Florida, and I want to remain that way so I cannot provide advice without completing a thorough assessment and working with a provider (doctor or nurse practitioner) otherwise I am operating outside my scope of practice. Therefore, I direct most questions to your OBGYN or CNM (certified nurse midwife / nurse practitioner). Also this post contains affiliate links. If you click and buy something,  you support me in receiving a small commission to continue writing.

There are 2 general types of inductions: elective (by non-medical choice) and nonelective (for a medical reason). According to ACOG, American College of Obstetricians and Gynecologists, it is okay to have an elective induction once you reach 39 weeks and 0 days or later. Prior to 39 weeks and 0 days, there must be a reason that puts the mother's or fetus' life at risk to do an induction. Click here further information on ACOG recommendations.

Here you are, your provider has you scheduled for an induction in a few days.

You may have already been exposed to horror stories on google, you may have heard that cytotec is the "abortion pill," you may have "no pitocin" written on your birth plan, you may be anxiously worrying what happens if the "induction fails" and you end up having a c-section, a caesarean section. Breathe momma, I'm here for you. I can't speak for all providers or all hospitals, but I can inform you from my general experience, what yours may be like.

 

What to Expect when your Inducing

Induction Day:

0000 - 0700: You get 0 sleep because you are nervous and excited about your upcoming induction and meeting your little one.

0700: You arrive at the hospital. The staff are expecting you and greet you with a smile while handing you a sign in sheet. You fill out information about yourself, the father, insurance information, and plans for the baby. You sign a general consent for saying that you agree to be a patient, you are who you say you are, and that the hospital may treat you.

0710: Your nurse greets you in the waiting room and brings you back to your labor & delivery suite that has already been prepared for your arrival. You notice fresh linens and a delivery pack. You get a little nervous, but your nurse has written happy birthday baby on the white board and perhaps a sweet line like, "you've got this momma" on the mirror above the sink. You feel slightly at ease knowing that the staff are here primarily for the safety of both you and baby, but also care deeply about your comfort and hospital experience. (If your nurse doesn't do those little things, come visit me. My team goes above and beyond for every patient every time. We'd love to have you.)

After introductions the nurse will step out to give you your last moments of privacy before it seems like the whole world has seen your lady parts. She'll have you change into either a hospital provided hospital gown or let you wear one you've brought from home. Many of my patients have loved this one from amazon!

The nurse will likely ask you to perform a "clean catch" urine sample, which basically means washing your hands and vulva (aka lady parts) before peeing in the cup to make sure the only thing that gets in the cup is urine, not skin cells, not mucous plugs, and not blood. 

0720: The nurse comes back and sends the urine to the laboratory to check for signs of infection, dehydration, and kidney issues. Depending on hospital policy a urine drug screen may also be run, better to do it now than after receiving hospital administered pain medication.

Next, the nurse will hook you up to a fetal monitoring system to observe baby's heart rate and your contraction pattern. A fantastic nurse will give you a brief explanation of the monitoring system so you know what she is looking for and reassure you that baby is perfectly healthy at this point. If there are any issues, you will be informed promptly and the plan of care is eligible to change at any time, for any reason, and things can go South quickly so this "perfect induction day scenario" contains no emergencies, but that is not the case for every patient.

You'll sign more forms, likely more forms than if you were to buy a car. You're bringing home a baby! Get through the paperwork and we're about to start the fun part. Now the nurse will ask you 1000 questions, some focused on your particular situation, some that are about your general health, some about the pregnancy, and some that the law requires us to ask, but probably sound ridiculous. If I ask you how much cocaine or other illicit drugs you did during the pregnancy, I don't think you are using drugs, I have to ask because I like my nursing license and follow the law. With that send, it is 100% crucial that you are honest to every question in order for your baby to receive appropriate care. Even if some questions prompt shame or embarrassment be honest. I don't mind kicking out family members if it means taking the best care of you.

0735: Now that your interrogation, I mean assessment, is complete you'll likely have a peripheral IV started in your hand or forearm. A maintenance fluid like LR (lactated ringers) or D5 1/2 NS (dextrose 5% 0.45 normal saline) will be started to keep you hydrated and is a medication we use in emergencies for fetal resuscitation. It is better to have a working IV from the beginning and before you need it than having an emergency with no IV access and having a harmed baby.

0750: You'll receive a cervical exam to see how far dilated (0-10cm) you are. Beyond dilation the nurse assesses effacement, and position of both the cervix and the baby. Want more information on what exactly goes on during a cervical exam? An indepth post in coming soon! It contains drawings of uteruses and cervixes, woo!

Then the nurse will call the provider and get orders on what medications to use for the induction, such as cytotec or pitocin.

cervical exam explained

0800: Depending on the previous exam + the doctor's recommendations + orders, the nurse will begin the medication aspect of the induction. Since your body isn't currently in labor, we have to get it into labor, aka induce labor. What is labor? I think of labor as adequate enough (strong enough + frequent enough) contractions to create cervical change, aka dilation. Followed by descent of the baby through an adequate pelvis. Then, having a vaginal delivery with both a healthy momma and a healthy baby. In order to make that happen, the cervix needs to be soft enough to dilate, otherwise the contractions aren't going to create change and you're feeling painful contractions for no reason. Pain without gain? Pointless. When my patients question why I am starting with cytotec instead of pitocin, I tell them the following analogy.

Chewing gum analogy that will forever change how you chew gum:

Think of your cervix like a piece of unchewed chewing gum that you just pulled out of your pocket. If I told you, "no chewing! Blow me a bubble!" You'd say that you can't. The gum is hard and inflexible. No matter how much force you put into blowing or how frequently you try to blow, you'll never get a bubble. But if I let you chew first, the gum will get soft, moist, and flexible. Then you can easily thin it out a little between your tongue and the roof of your mouth. Then you can blow a bubble. And if you're really skilled maybe a 10cm bubble! ;)

During her exam, the nurse checked to see if you had a chewed piece of bubble gum or a hard piece for a cervix. If it is hard, cytotec was likely ordered to "ripen it" before the pitocin.

Every 4 hours (or so): The nurse reexamines your cervix, updates the provider on your progress, the fetus' health, and your health. The provider updates, changes, or continues the plan of care until delivery. 

Pain control

When you begin pitocin, the contractions are going to come quicker than before and more intensely! Yay the induction is working! But girl, it hurts! So do not feel like a failure if you need pain relief in the form of IV pain medication or an epidural.

Many people say "no epidural" on their birth plan, but from what I see, an epidural helps my momma's get some relaxation, perhaps even a nap. I know you didn't sleep before you came in! You're going to be up all night breast milk feeding or formula feeding, so get the sleep in now. If you are adamant about not having an epidural, your nurse will work with you to help create a serene(ish) environment. Although it would be more comfortable to walk around, comfort tends to come after safety. If baby is doing well and easily monitored while on pitocin, sure you can walk around at the bedside or use a birthing ball. Your partner is welcome to apply counter pressure. If baby shows any signs of stress, you will be more limited to the bed and placed in a position in which baby can receive the most blood flow and receive oxygen.

Baby

After delivery

Again I can't speak for all hospitals, but my hospital and its team of providers believe in following a patient's birth plan to the best of their ability while maintaining safety. Thus nearly every patient every time gets to experience delayed cord clamping, skin to skin contact, and delayed "eyes and thighs." A nurse will ensure that baby is breathing okay from the mother's chest and leave the baby there for an hour or longer in order to have the "golden hour" in which mom and baby bond and hopefully have a successful first breast feeding. Afterwards, the nurse will assist dad or mom in cutting the umbilical cord, weighing baby, measuring length, and administering eye ointment, Vitamin K, and the hepatitis B vaccine. 

Then typically baby falls asleep for a few hours. Mom is checked for signs of hemorrhage. And then it's a 24 hour (or more if there are complications) hospital stay to ensure that baby is feeding well and mom is doing well.

If any emergencies occur, the OR or NICU (if your hospital has one) is nearby and ready to assist!

Feel free to ask questions below or comment on your experience. If answering would be outside of my scope of practice, I will refer you to your OBGYN or CNM.