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So You Want To Be Induced

So, you go to your 38 week OB appointment.  You feel fat, the waddle has started, and you are waking every 30 minutes to pee in the middle of the night.

At your appointment your blood pressure is perfect, all your tests are normal, you don't have any medical issues and your pregnancy would be considered boring by doctor standards.  The OB does a vaginal exam and your cervix is still thick but it's 1cm dilated.  You express to your doctor how tired and big you feel and that you just aren't sleeping well.  So, your doctor looks at your chart and says "We can schedule an induction for next week?" And begins to write things up.  The induction carrot is dangled within your reach and because you can't stand being pregnant any more you grasp it.  But do you really know what that means?

Your induction is scheduled for the next Thursday at 6 pm.  But that doesn't mean you are having your baby then.  You go into the Labour and Delivery Unit and they assess your cervix.  There has been no change since your appointment so they decide to put in a foley bulb.  This is a rubber tube with a balloon on the end that is inserted into your cervix and the balloon is blown up with saline water.  This is meant to put pressure on the cervix to encourage it to open.  You are monitored for a couple of hours and sent home to rest.  The cramping begins and while it isn't painful, its enough to make sleep quite difficult.  Ask your doctor if you can take Tylenol and or Gravol to aid in sleeping in this early stage.

The instructions you are given is to get rest and come back in the morning unless the foley falls out before then or contractions become intense and in a pattern.  The morning rolls around and you've had a terrible sleep but the foley is still in so back to the hospital you go.  When you get there, you wait around for a couple of hours and are finally seen to be told that your cervix hasn't changed and the foley is reinserted. Thus, you are sent home again and told to come back at 7 pm.

You go home and the cramping continues.  Getting rest and trying to wait out this early stage is difficult but you distract yourself with a hot bath, a movie and more Tylenol. Later in the day contractions seem to have started and you head back into L&D to get checked.  After waiting a couple of hours you are seen and checked and discovered to be 2-3 cms and your cervix is thinning out.  Baby is still high so they opt to start Pitocin and leave your waters intact.

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Pitocin is a synthetic form of oxytocin which is the hormone that aids in uterine contractions.  Oxytocin starts slow in your system, being released from your pituitary gland and is also known as the love hormone and is a key hormone in bonding with baby and breastfeeding.  With Pitocin, it is started at a really low rate and then is slowly increased over the course of the rest of the labour.

The drawbacks of Pitocin include stronger, more difficult contractions that are hard to manage without pain medication, such as an epidural. The baby can react negatively to these harder contractions, which may mean that the medication will have to be slowed down or stopped periodically to allow for a vaginal birth.  Given this risk, you will have to be continuously monitored and that may mean being stuck in bed until the end.  A larger drawback would be that the baby does not recover from stopping the Pitocin and a cesarean birth is required.

The Pitocin is started, an epidural goes in, and now you are stuck in bed.  But this is helpful because you haven't slept in two nights so the relief from the increasingly intense contractions is heaven sent and you and your partner sleep for a few hours.  It's now 1 am on Saturday morning and the on-call resident comes in to check your cervix.  You've been on Pitocin for 4 hours and its time to check for any progress.  You've dilated to 4 cms and baby has moved down.  So, it's time to break your waters to move things along.

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The benefits of breaking the water are that it will flood the cervix with a hormone called prostaglandin which can help the cervix get softer and stretchier to thin and open easier.  On the negative side, the water that was released was acting as a cushion for baby and they can sometimes react negatively to having your waters broken.  Once the waters are broken you are now left to wait again.

Several hours later, during lunchtime on Saturday, you are checked again and you've dilated to 6cms.  You are moving forward but the progress is slow.  After resting, updating family and watching another Netflix comedy special, you are resting again but the bed is uncomfortable and your partner is working hard to keep your spirits up.

Its 8 pm now on Saturday and the next shift of doctors are checking you and you are almost fully dilated but the baby is still a bit high.  Baby is doing well still so more time is given.  So, you rest again.  At 1 am on Sunday you are finally feeling pressure, fully dilated and pushing starts.  After a couple of hours of pushing the baby is finally born in the wee hours of Sunday morning.  You are exhausted but relieved for it to finally be over.

Now, this is just one scenario.  It's entirely possible that your induction won't be as long, and your body will just respond quickly. However, it's also entirely possible that your body will not be convinced to let go of the baby and your induction fails and ends in a C-section.  And this is the key. While deciding to have a planned induction for a non-medical reason is entirely your choice and will be supported by your OB, your body may have a different plan.  The body doesn't always buy into letting the baby go before it wants to so it may take a while to convince it or it may reject it all together requiring a cesarean birth.

So how can we make things easier or make the induction more successful? Firstly, try to avoid an induction without a medical reason until after 40 weeks.  Yes, the last weeks of pregnancy suck but try to spend it being occupied.  Spend time with your partner, go out for a relaxing time with friends and family because when the baby comes your focus will be on baby and recovery for awhile.

Also consider doing things like having sex, massage, acupuncture, going for slow walks and practicing relaxation through meditation.  These can all help with encouraging your body to go into labour.  Perhaps hire a doula that can help with position changes and comfort measures to encourage labour and even with an epidural make things move along faster.

While induction is mainly up to the birthing parent, go into it with your eyes wide open.  It may not be the quick walk in the park you think it will be.

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