Before You Say Yes to Labor Induction Read This!
Prepare. Educate. Empower
While this in no way serves as medical advice, Serene Journey Births’ mission is to prepare laboring families with the tools they need to have an empowered birth. We educate families by providing evidence-based information on medical procedures and interventions during birth (especially in a hospital setting). The goal is to empower you to make an informed decision about your medical plans of care. This article will discuss the following components of labor induction:
Induction medications and how they are administered
The effects induction medications could have on the laboring person and the baby
What does it mean to be induced?
Let’s begin with some basics. What does it mean to be induced? Induction is when labor (uterine contractions) is brought about with the use of synthetic hormones or other medical interventions before the spontaneous natural onset of labor. Normally, in late pregnancy, a hormone called Corticotropin-Releasing Hormone (CRH) increases. CRH is a stress hormone that:
Prepares a mother’s body for birth
Prepares the baby’s body for life outside the womb by releasing other adrenal hormones that help us cope with stress (because labor is a strenuous activity)
As the body is preparing for labor, there are many hormonal changes that jumpstart the process. This is commonly considered a Hormonal Cocktail:
Estrogen increases to cause the uterus to become more sensitive to oxytocin.
Oxytocin (aka the “love” hormone) increases to produce contractions. *SIDE NOTE- this is why the feelings of safety and comfort are EXTREMELY important for labor to progress.
Prostaglandins increases to thin the cervix. This is also a component of sperm which makes sex a natural inducer (no fears- this can only happen in late pregnancy).
Relaxin relaxes the cervix, pelvic ligaments, and connective tissue to allow greater joint flexibility.
Melatonin is released when in a dark/relaxed environment and promotes the production of oxytocin.
Scientists have yet to discover the EXACT reason(s) why our bodies go into labor, but studies heavily suggest that babies release their own hormonal cocktail to let the body know they are ready to enter the world; the world’s most primal and instinctive process!
During induction, you are bypassing this natural process. Synthetic prostaglandins (hormone #3) are typically placed inside the vagina to soften and thin the cervix. These medications are called Prepidil (PGE2), Cervidil (PE2), Misoprostol and Cytotec (PE1); it is up to your provider which medication they use. Misoprostol can also be administered orally and prepidil can be injected into a vein. Once these medications are given to you, there is NO turning back.
Another medication commonly used is Pitocin, the synthetic form of oxytocin (hormone #2). This is given intravenously and it causes the uterus to contract. Pitocin is more effective at speeding up labor that has already begun than it is as a cervical ripening agent. Unlike the other medications mentioned, Pitocin can be turned off for labor to continue to progress naturally. With either intervention, your contractions and your baby's heart rate will be continuously monitored and your movement will be limited (which isn’t great for labor to progress).
Another option, which isn’t frequently used, is the insertion of a small tube (catheter) into the cervix with an inflatable balloon on the end. The balloon is filled with saline and rested against the inside of the cervix. This helps soften & thin the cervix. Naturally, the pressure the baby’s head places on the cervix cause it to open. Another method is rupturing the amniotic sac, also known as an amniotomy or artificial rupture of membranes (AROM), where your health care provider makes a small opening in the amniotic sac with a plastic hook (aka breaking your water).
Pro: Labor induction can lead to a successful vaginal birth. Con: 50 percent of inductions lead to a C-section/cesarean birth.
How do inductions lead to cesarean births?
Once these medicines are placed into the vagina, some birthing parents experience hyper-stimulation of the uterus. This means the medication works TOO much causing abnormal or excessive contractions. Hyper-stimulation of the uterus can cause a decrease in blood flow to the baby, which lowers the baby’s heart rate. A prolonged decrease in fetal heart rate (fetal distress) will lead to a cesarean birth. You are also more likely to request an epidural because induced contractions are more painful than natural ones. Complications from an epidural could also lead to a c-section.
Because you will need continuous electronic fetal monitoring, this limits your ability to move into positions that would allow you to labor more comfortably. This could lead to the request of pain medication to which you could have an adverse response. The birthing parent is at risk for developing a fever and experiencing a change in heart rate. There is also an increased risk of infection with AROM and bleeding/hemorrhaging increases after birth.
Don’t want to make this blog a book!
Overall, many inductions do lead to a safe delivery but we must take into consideration those births that don’t. If induction is suggested, inquire about the reason for this and if possible, considering waiting. There are several ways to induce labor naturally (read more here). If induction is something you think is best for you and your baby, make an informed decision by asking your provider which medications they use and which ones they think will work best for you! You should always ask for more detailed information about any provided medications.
As always, I invite you to reach out if you have any more questions, comments or concerns.
Donna the Doula
Let Your Birth Be Serene
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