Guide to Inductions: Understanding Your Options

Co-written by Deja Ramos, a Certified Doula (DONA), ICCE, and Co-Founder of The Birth Companions and Anna Morales, Co-founder of Mila Support

Induction is the medical term for starting labor artificially. While spontaneous labor has many advantages, induction is an alternative to surgical birth when there is a reason to birth baby ahead of spontaneous labor. Knowing what to expect and what choices you can make along the way gives you the opportunity to personalize your care to meet your values.

Why Inductions Happen

Inductions may be recommended by your provider when:

• You reach 41 weeks pregnant (some providers recommend induction at 40 or 39 weeks)

• You have gestational diabetes or high blood pressure

• Baby is measuring small or not growing well

• Your amniotic fluid is low or high

• Your water breaks after you are full term but labor does not start on its own within 12-24 hours (PROM)

Some people also choose elective induction for convenience, scheduling, or anxiety about going past due. These are less common unless you're already full term (39+ weeks).

What are Your Options

You can choose to wait longer for spontaneous labor. Talk to your care provider about the reason for the recommendation to induce and the risk of waiting. You can also ask about additional monitoring while you wait for spontaneous labor.

• You can go home and review your options with your support people. Inductions are rarely an emergency, because they take so long themselves. Taking a few hours to come to your own decision can have a powerful effect on your experience of induction.

• You can ask for your Bishop Score and how that score impacts your chances of having a successful vaginal birth with induction. If the score is low, you may be increasing your risk of c-section and that may fit with your values.

• You can request a more conservative (slow) or a more aggressive (fast) approach. Giving each step plenty of time and maybe repeat attempts to be effective before moving on to the next step in the process. Choosing physical methods over chemical methods. Delaying AROM or Pitocin.

• You can incorporate non-medical methods into your induction. Try nipple stimulation with AROM. Use the setting to boost your natural oxytocin.

• You can pause or even abandon an induction that is not leading to cervical change. As long as your waters are intact, you can choose to leave the hospital and try again another day.

• You can say no. You have the right to opt out of a recommended induction if you don't feel it is the right or safest path for you and your baby.

Methods of Induction

Your Induction Pathway

Your induction process depends on your cervical status at the beginning. You join this road at your own starting point and go from there.

What Induction Feels Like

• When you arrive at the hospital for your induction, you will go through the process of admission. They'll take your vitals and ask you a bunch of standardized questions. Then your care provider will discuss the reason you're being induced and the plan. This is where you can express your preferences for your induction.

• It may be several hours between your arrival and the initiation of the first step in your induction. Many of the early tools for induction are given 12-hour windows to do their work. Most inductions are started in the evening so you can sleep for the first stretch of this. You and your baby will be monitored through the whole process, which can be disruptive, but try to get as much rest or sleep during this first night as you can.

• The care team will evaluate your cervix at each junction to determine whether you are ready to move on to the next tool, or if repeating a tool is warranted. It may be a full 24 hours or more before your body is ready for pitocin and you feel like you're actually in labor, depending on where you start your journey. And from there, it may be another 24 hours before you meet your baby.

• Pitocin does not cross into the brain from the blood, so it doesn't help with the hormones that help you cope with labor. Because of this, contractions from pitocin often feel more painful. Additionally, the pattern of increasing pitocin until "adequate contractions are established" means you may get to an active and intense labor pattern quickly and spend a lot longer in that experience than someone who's labor is spontaneous. Because of these two features of pitocin, epidurals are much more common in inductions than spontaneous labors. Don't be afraid to use that tool, it is there to help you birth your baby.

Tips for Induction

• Eat well - have a nice meal before you go in and bring or order delivery of foods while you're in the hospital. When the labor picks up, your appetite will wane.

• Pack for a couple nights away - pack clothes and pjs for a weekend and plan to keep your morning/evening routines until labor is established. Waking up, taking a shower, and changing clothes in the morning can go a long way in offsetting the same-ness of being in the hospital for these extra days.

• Bring creature comforts - pillows, snacks, and bingeable TV to help you while away the long hours. Make the space your own with some twinkle lights and music.

• Get out of bed - it is easy to get mentally "stuck" in the bed, but sit in the rocking chair or on the sofa to eat dinner or watch some TV.

• Don't forget this is still labor - once contractions get going, pull out your coping tools. Movement, breathing, showers are all effective in inductions, too.

Final Note

It can take hours, or even days, to go from the start of an induction to active labor. Your body still needs to do the work of preparing for labor and that take time. Be patient and kind to yourself. Inductions can be empowering when you understand your decision to be there and you know your options. Whether planned or unexpected, understanding the process helps you stay calm, involved, and confident. Remember, you are still in control. You can ask questions, pause, or request changes.