Inductions- The Play By Play.
All too often we hear that a client is facing induction, either by choice or medical necessity. Mom is ready for baby to get here, the nursery is finished, you had an awesome baby shower, your sister is watching the dogs. All ready to go to the hospital. But, what actually happens when you get there? What is the step by step process of labor induction? Most of the mothers we hear from need to know more about the actual process. Are you planning an induction? Has your provider suggested one?
Want to know how it usually works? Read on.
So Our hospital bags are all packed, we are on the way to the hospital, we even remembered to install the carseat. but what is actually about to happen?we know this is our last car ride without baby… what we don’t know is what happens once we get to the hospital…
**Pro tip- eat a good meal before you are admitted, you will need that energy and hospital food typically isn’t all that and a bag of chips.
Step 1… Admissions.
Once you get to the hospital, you will be admitted into the Labor and Delivery Unit. This typically involves paperwork, an insurance card, and your driver’s license if you haven’t already pre-registered prior. Sometimes- even if you have you will have to do this. You will be given the typical hospital arm band and shown to your room. Be patient. Depending on how busy the Labor and Delivery Unit is that day- it can take a little while. Once you get into your room, you will be asked to change into your hospital gown (or a labor dress if you have one- they are seriously awesome! highly recommend one!)
Step 2… The Medical Stuff Begins.
Now that you are settling into your room, typically if you haven’t already been asked for one, the staff will request a urine sample and check basic vitals: your temperature, blood pressure, pulse, etc. and get an initial monitoring strip on the baby to check baby’s heart rate and your contractions if you are having any. In most cases an IV with fluids will be started and blood drawn. Next, your provider will come in to discuss your given induction protocol, typically do a cervical exam (and a Group B Strep Swab if you haven’t already been tested this pregnancy- more on Group B Strep Here: https://doulainmississippi.com/blog/groupbstrep ), and place the initial “doctors orders” for the induction process. Once all of this is complete, the actual induction begins. Typically at this point, if she hasn’t already, your doula will be allowed to join you in the room.
Step 3… The Actual Induction of Labor.
There are multiple ways a woman’s labor can be induced. I will discuss the most common methods here and how they work. Side note: due to the risk of uterine hyperstimulation among other things, with all of these options except the Foley/Cook’s Catheter, once an induction has begun- continuous monitoring is almost always required. Every mother and every baby responds differently to an induction. Because of this, monitoring ensures baby and mother are both tolerating the process well.
1) Cervidil- often times a Cervidil induction is started at night to allow mom to rest during the early induction process. Believe it or not, many moms are able to sleep for a portion of the night while the meds start to work. With this method, a vaginal insert is placed up against the cervix to allow it to soften (thin/efface) when the cervix is not dilated or only slightly dilated. The insert stays in place for up to 12 hours. After 12 hours, an exam is done to assess any progress that has been made IF labor has not already begun. If the cervix has softened, but contractions have not yet begun, Pitocin is often administered. More on that below.
2) Cytotec- Similar to Cervidil, Cytotec is a pill inserted vaginally against the cervix to allow for softening (effacement/thinning) of the cervix when a woman is less than 2-3cm dilated. Cytotec dissolves unlike Cervidil so there is no need for it to be removed. After a few hours (typically 3-5), an exam will be done to assess progress that has been made if labor has not yet begun. If the cervix has softened, but contractions have not yet begun. Just like above- Pitocin is often administered.
3) Foley or Cook’s Catheter- With a Catheter induction (Foley or Cook’s), your provider will insert a catheter into your cervix. One side of the catheter is left deflated. Once inside of your womb, the provider inflates the balloon with a saline solution. This puts pressure on your cervix and encourages dilation. The catheter will fall out once your cervix is about 3cm dilated. This method can be used along with prostaglandins such as Cervidil, Cytotec, and Pitocin or by itself. If you are in active labor once the catheter falls out, no more intervention may be required. If not, this may be another situation where Pitocin is administered.
4) Pitocin- While Pitocin often gets a bad rap among the birthing population. It is a widely-used and fairly effective method of induction.Pitocin is administered via IV drip. The dose typically starts low and is increased every so often to get the best effects. Oftentimes, like other induction methods- it can take a while for Pitocin to “kick in” so a lot of the process is being patient, watching TV, scrolling through Facebook or any other distraction to pass the time until the real event kicks in.
Important note at this point- it is very very common for inductions to take time! this is something you should expect and plan for. bring things with you to keep you distracted. and try to be patient. know that this is normal and a part of the process. your patience will be rewarded with the greatest reward on earth! your new baby in your arms!
Step 4… Hurray! You are in Labor!
If the above methods worked as prescribed, or a combination did- you are now in labor facing the typical labor process to have your baby! If your doula isn’t already with you, be sure to text or call her as soon as possible. This is where the real show begins!Soon you will have your baby in your arms. Congrats- you made it through the induction!