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During the holidays, talk of induction inevitably comes up. Either from accounts online warning you about higher rates of induction before the holidays, or from providers bringing it up. An estimated 40-60% of all labors in the U.S. are induced. If you find yourself scheduled for an induction of labor, I've got everything you need to prepare.
What is Induction?
Induction of labor (IOL) is the process of augmenting labor with medication in order to start labor before it starts on its own. There is an infamous study that came out in 2018 that showed that inducing labor at 39 weeks of pregnancy reduced the rate of Cesarean. Unfortunately, when providers cite that study they don't mention that the informed consent was so thorough that only 27% of those asked agreed to participate.
The most common protocol I see in Chicago area hospitals is to begin with a cervical exam. If the cervix is closed, usually you start with misoprostol (a tablet usually inserted in the vagina). Once the cervix is open to about 1cm, then providers typically place a foley balloon. Some people experience mild discomfort, while others report that the balloon was the most painful part of the whole process. Usually when the balloon falls out, your cervix is at about 4cm. Doulas call this "the false 4," because the balloon opens your cervix manually and often it takes quite some time for your body to catch up to the process. This cervical ripening process could take a couple of hours to a couple of days.
After all of the cervical ripening, providers usually want to begin pitocin (unless you are contracting on your own at this point, but most people are not). You are not in active labor until 6cm, which means that you may begin to feel active labor contractions - aka long, strong, and close together - before you are actually technically open enough to be considered in active labor. I see many people work incredibly hard for several hours to cope through contractions before asking for a cervical exam and an epidural. Often, my clients feel disappointment if they are at 6cm after working so hard. Remember, induction is different!
After some time on pitocin, and depending on how low your baby is in the pelvis, your provider will likely want to break your water.
I generally encourage my clients to use the acronym BRAIN in order to decide if they are ready to consent to have their water broken. Here is an example, but you can use BRAIN for any intervention.
Benefits: move labor along, doesn't require additional medications
Risks: puts you on a bit of a time clock, baby could get wedged in a funky position
Alternatives: position changes, acupressure, essential oils
Intuition: ask for time alone with your team to see what your gut says
Nothing: ask what happens if you do nothing for an hour or 2
Even if you feel confident that you know the answers to the above questions, I strongly suggest you go through the process and ask all of your questions to help build trust and rapport with your doctor.
Once you are in active labor and your water is broken, it's a waiting game. Just like spontaneous labor, it is all about position changes and encouraging the baby to move down. Once you're at 10cm it's time to push! That part is the same :)
Are there Natural Ways to Induce?
If there was one magical way to induce labor without medication, everyone and their grandmother would be selling it. So, no, there isn't. There are some ways to nudge your body in the right direction.
Acupuncture: research shows that it may help with cervical ripening but more high quality research is needed
Anecdotally, the acupuncture induction protocol requires multiple visits over several weeks; all of my clients who have had success are going frequently not at the last minute or as a last ditch effort
Dr. Courtney at Willow + Elm Wellness is a witch and does very good work
Red Raspberry Leaf tea: will not put you in labor! But it does tone and strengthen your uterus. You can read more in depth on my blog post here.
Nipple stimulation: has a long history (since at least 700 BCE), but all the research we have on it requires 1-3 hours of stimulation per day; think less of a fun little tweak and more of a marathon breast pump session
Date fruits: 5-7 large dates per day from 37/38 weeks onwards probably does soften your cervix but will not induce labor!
Sex: most effective when you have access to semen, which contains prostaglandins that can help ripen the cervix, or when it includes nipple stimulation and/or orgasm
Penetrative sex is not recommended after your water breaks
There are also some myths! Eating spicy food and curb walking are the ones I hear most often. Spicy food might work because giving yourself diarrhea might also kickstart labor if you are already really close. Curb walking isn't going to do anything other than potentially get your baby in a better position.
How to Prepare Your Body for Induction
Many people focus on what they could possibly do to induce labor and forget the basics. Any labor, regardless of how it starts, is a marathon of hard work. In order to best prepare yourself you need to pour into yourself. One benefit of induction is that you know when it is happening so you can schedule and plan to care for yourself. This list is not exhaustive. It is meant to get you thinking.
Book a prenatal massage, foot massage, or pedicure for the day before your scheduled induction. If anyone offers you a gift or support, ask for a gift card for some body work and then plan to use it right before. You can find providers who will come to your home.
Eat a nutritious and filling meal. Order a favorite food. You will likely be on a clear-liquids-only diet for the duration of your induction. You will get hungry. Even when my clients get told that they need to go in right away for an induction due to medical reasons, I recommend they ask if they have time to grab food first (and the answer is almost always YES!).
Talk a long luxurious bath or shower. Ask your partner for a foot rub. Do a sheet mask. Whatever grooming and hygiene makes you feel like you and your body feel like yours, do it.
Go for a walk in nature. You'll be inside for the duration of your induction plus 2 days of recovery for a typical vaginal birth. If you love the outdoors, take advantage of an intentional walk outside before your go in to your induction.
Bring in an aspect of your spiritual practice to help ground you. Light a candle with your intentions for your labor. Pull a tarot card for guidance. Ask your community to pray for your in whatever format feels authentic to you.
STAY OFF THE INTERNET. No panic searching Reddit for other people's experiences of labor. No scouring blogs for what to pack at the last minute (if that is how your found this post, get outta here!). Stay off the clock app.
Get a good nights sleep. Do whatever you need to do to feel max-relax and go tf to sleep.
7 Things to Pack to Make your Hospital Stay More Comfortable
Prepare yourself for a longer hospital stay. Best case? You over-prepare and your induction goes quickly. That is much better than relying on your best friend's cousin who said their induction went quickly and yours will, too.
Glowy things: LED candles, twinkle lights, I just had a client bring 2 of these lamps
Snacks!! Clear liquid protein shakes if you are trying to stick to the rules, but also the research shows very clearly that "Nothing By Mouth" policies are out of date and in serious need of updating.
Eye mask and ear plugs (or noise cancelling headphones)
Slippers, flowers, comfy labor gown - anything that helps you feel like yourself
Labor comfort measures: TENS machine, massage ball, labor comb
Distraction: TV, movies, a favorite show
Reconsidering Pain Medication Preferences
Regardless of what you were planning for pain management prior to your induction, you will need to revisit your preferences to update them for a new scenario. Many of my clients who were previously planning an unmedicated labor go into their induction planning to forgo pain medications. If and when they ask for pain medication, they feel disappointment or a sense of failure. Inductions can be long and grueling. You are getting medicine and the best way to work with that medicine (pitocin) is often more medicine (epidural). That is not what anyone wants to hear, but I do think it is worth saying. Use of pain medication during any prolonged labor is a wise and compassionate use of drugs.
Final Note
Take a nice deep breath. Relax your jaw. Babies come out most easily when the birthing person is relaxed. Easier said than done, I know. No matter what, you get to meet your baby soon. Your induction might be slow but it won't last forever. Labor is never easy, and I know you can do it!
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