The Induction Trap

Around 38 weeks pregnant, most women start to feel totally done being pregnant.  They want the baby in their arms, they feel big, they are tired, they are done. Most OBGYNs are happy to schedule an induction for their patients at 39 weeks.  Due to the ARRIVE study, they can do this with "evidence" behind their decision. This new study found that being induced at 39 weeks decreased your rick of cesarean by 3% and decreased the risk of developing hypertension after 39 weeks.  Providers will justify the induction at 39 weeks for advanced maternal age (over 35), "big baby" on scans (these scans are often wrong by quite a bit), maternal discomfort, provider convenience (going on vacation, having plans over the weekend), and pretty much any other reason you can think of.  When you are told you can have an induction, it is so exciting!  You will meet you baby soon! Unfortunately, there are so many things about induction that moms don't realize. 

There is a standard induction pattern that is followed by most providers and hospitals. Here is the rough outline: 

1.  The mother comes in (usually in the evening) and has an induction agent placed near her cervix.  This is usually Cytotec or Cervidil.  This agent is supposed soften the cervix which triggers the body to start contracting. For some women, this works really well.  They go into labor and have a successful vaginal birth.  
2. In the morning, the mother is assessed for dilation and progression.  Usually Pitocin is started at this point.  Pitocin is an IV induction agent that causes a women to contract.  It is the synthetic version of the endogenous hormone oxytocin.  Pitocin can be turned up to create stronger and more consistent contractions. Augmented contractions can be very painful and most women opt to get an epidural at this point, even if they had previously been set on a natural labor. 
3. The epidural is sometimes placed here.  See my post on anesthesia considerations. Once it is placed, the patient is no longer able to get out of bed.  A foley catheter is placed in the urethra because you cannot get up to pee. Moving around during labor is essential to progression for most women.  
4. If the patient is still not making progress at this point, the provider will usually suggest breaking the bag of waters.  They will say that you are not dilating because the baby's head is not placing pressure on the cervix.  This is a critical step. Everything that has happened up to this point can be taken back, even the epidural can be taken out.  If you consent to breaking your water, you are on a clock and if the baby is not delivered in 24 hours (36 in more progressive places) you will have a cesarean section. You are able to leave. You don't have to stay if this induction is not working.  You can give your body and your baby more time (if baby still looks good and hasn't been stressed by the induction at this point).
5. After the water is broken, if you are still not progressing over the following 24 hours, your provider might place a foley balloon catheter inside your cervix to help place pressure if baby's head has not descended. 
6. If you still don't have an epidural at any point in this process, they will tell you that the epidural will let your body relax and labor can do its thing.  Message: you are too tense, it is your fault the baby is not moving down.  This is the last ditch effort for the natural-birth set mama before she has a cesarean forced on her. 
7. Good nurses will help roll you back and forth (you can't move yourself with an epidural and you can't get out of bed once your water is broken even if you don't have an epidural) on a peanut ball to try and help baby get in the birth canal.  
8. If you have not progressed in a fashion acceptable to the provider at any stage of this induction, they will suggest a cesarean section.  The common phrases are "your pelvis is too narrow for the baby to descend", "baby is just not coming out vaginally", "this is the safest thing for baby since your body is not responding to labor appropriately".  It is pitched as safety. An emergency.  The truth is that this emergency was created by the provider and the unnecessary induction. 
9. If you have not delivered vaginally, you are taken for the cesarean section. See my post on what happens during a cesarean section. 
10. After the surgery, you are told that there is no way the baby would come out of your vagina and you should probably have cesareans with all of your future children.  All one of them because only two sections are "safe".

I know this seems pretty biased.  Unfortunately, I see this happen very very often at the hospital, with my friends, and it even happened to me.  Inductions can be successful and so many women end up having great vaginal births after induction. There are a few things you can do to avoid this process above.

1. Know your bishop score.  This number can help determine how successful an induction would be for you. This is just another tool that can also be wrong but it can give you an idea about how ready your body is for labor. 
2. Have activities planned for the last few weeks of pregnancy.  It is so easy to say yes to an induction during this time because you are so done being pregnant.  Keep yourself busy.
3. Talk to your provider about not wanting to be induced without favorable conditions (like a Bishop score over 8).  Tell them to please not bring it up in the last few appointments unless it is medically necessary. 
4. Get your body ready for labor with positioning exercises.  The above algorithm did not work on me.  Spinning babies and the Miles Circuit worked like a charm for me. See my post on getting baby positioned for labor. 
5. Try natural "induction" techniques.  See my post outlining some gentle ways to help your body be prepared for labor and maybe even nudge it in that direction. 

I GET IT.  Being so pregnant is hard.  I have tried to induce my labors with each of my five babies in very different ways.  It is easy to be convinced to do something that may not be in your best interest. This post is just another perspective on what can happen during the induction process. 

Important consideration!

Medical inductions for actual medical indications are life-saving.  If you are being induced for pre-eclampsia, gestational diabetes (with indication), Intrauterine growth restriction (IUGR), kidney disfunction, placental disfunction, or any other medical reason that precludes you from continuing with your pregnancy- please take your doctor's advice and get induced.  This post is not about doing dangerous things, it is the opposite.  We have this amazing tool of induction that is being used in cases when it should not and resulting in cesarean sections for people who should not have needed them.  Let this tool serve its purpose when necessary.