Orrrr…If you AREN’T expecting a labor induction AT ALL…because many times inductions are unplanned!
Alright, Hey Mamas! This week I’ve put together a post outlining the basics of how to prepare for labor induction through my eyes as an L&D nurse.
First off…let’s go over some basics…
WHAT IS A LABOR INDUCTION?
An INDUCTION OF LABOR is exactly what it sounds like…you aren’t in labor…we put you into labor (or we ATTEMPT to put you into labor).
You may be induced if you…
- Are overdue (most practices consider this to be past 41 weeks, but many nowadays wait even longer, up until 41 & 6 days)
- Have pre-eclampsia
- Have gestational diabetes
- Your baby has IUGR (intrauterine growth restriction)
- You’ve broken your water early in your pregnancy, and you’ve been hospitalized for it
- You have a history of stillbirth
- You have cholestasis
- You’ve got another medical condition that puts risk on yourself or to baby to continue your pregnancy safely
NOW, inductions differ from augmentation of labor. An augmentation of labor is done when you’re already in labor.
Here’s an example:
Let’s say you’re contracting, you get an epidural, and your contractions space out after you get comfortable with your epidural. It’s been a few hours, and it seems that your contractions aren’t getting much closer, and your cervix hasn’t changed either. Your provider may suggest to start some PITOCIN, or BREAK YOUR WATER. This isn’t a labor induction, this is an augmentation.
Augmentations are similar to inductions, in that the methods are similar, but we’re more just helping your labor instead of starting it.
WHAT INDUCES LABOR…
Labor inductions can be done MANY different ways, in fact, I’ve already referenced two above! PITOCIN and BREAKING YOUR WATER. I’ll go over all the methods that we use at our hospital (and a few others that I’m aware of).
- Let’s start with the most common…Pitocin!
Pitocin is a medication that’s given through your IV to get your labor started. It’s the man-made form of the same hormone your body naturally produces when you’re in labor…oxytocin. By giving you Pitocin synthetically, we are attempting to tell your body that you’re in labor!
Every hospital is different (and every nurse is different), but generally Pitocin is started at a very lose dose (usually only 2ml/hr, which is less than half a teaspoon) and titrated up to a certain threshold. This threshold is different for every woman.
At our hospital, we may max our patients out at 40ml/hr of Pitocin, and we are only allowed to increase the dosage by 2ml every 15 minutes. I’ve heard of many hospitals who only allow their nurses to max out their patients at 20ml/hr, however.
So, let’s do some math…
If you started your labor induction at 8 am in the morning, and your nurse was ON IT, increasing your Pitocin EVERY fifteen minutes, you’d be at 40ml/hr at around 12:45 pm
Now, not every woman needs 40ml of Pitocin to be in labor.
In fact, MOST women need much less to have an adequate labor pattern.
It all depends on the woman, her gestation, her uterus, how irritable her uterus is, HOW BABY IS REACTING….and so on and so forth. There are a lot of factors that come into play when determining how far your certain Pitocin threshold is.
Our hospital policy allows us to increase Pitocin every 15 minutes, until contractions are in an ADEQUATE labor pattern. This usually means, they are 2-3 minutes apart, painful, and CHANGING YOUR CERVIX.
That’s a big one. You can be having crazy, long, painful contractions coming every 2-3 minutes, but if your cervix isn’t changing…I’m going to keep increasing your Pitocin.
Now, there are certain things that I must look out for as your nurse.
First off, I don’t want your contractions to be TOO close together. Your uterus needs to adequately relax in between your contractions, before you have another. This cannot only stress out baby but it also increases your risk for something really scary called a uterine rupture. Yuck, you don’t want that. So just know, if I see your contractions are a little bit TOO close for TOO long…I’m going to back down your Pitocin.
Second, Pitocin can be stressful to baby (any labor, in general, can be stressful for baby), and if I ever see baby start to get stressed out (as evidenced by his/her heart rate), I’m going to back down your Pitocin…or shut it off completely.
Ain’t NOBODY got time for a stressed-out baby…um no!
- Moving on to the next most common…BREAKING YOUR WATER!
Also, I must add…during your labor induction you may have SEVERAL different methods used. Totally common and okay!
Breaking your water is a form of induction, and I’ve heard of many hospitals using this method FIRST, as a means to get labor started.
We don’t typically do that. Usually, breaking your water is something that we use in conjunction to being on Pitocin. It’s usually done later, after you’ve been contracting for some time, and baby’s head is low, and well-applied onto your cervix.
This is when it WORKS THE BEST.
Now, breaking your water helps speed up your labor in a few different ways.
First off, it helps to bring baby down into your pelvis, creating more pressure onto your cervix. This increased pressure helps your cervix to change!
Second, it releases PROSTAGLANDINS around your cervix (magical labor-inducing hormones), this stimulates cervical change!
Related: Will I Poop During Labor?
- Speaking of Prostaglandins…most of the other methods that I mention below will be some sort of synthetic prostaglandin.
Or, in this case, a manual form of induction that EXCITES prostaglandins…just as breaking your water did.
A FOLEY BULB
So, a Foley bulb is a little catheter that’s manually inserted inside your cervix to attempt to somewhat DILATE it manually, and also (like I said) release some of those prostaglandins around your cervix.
We do Foley bulbs A LOT at our hospital, but I’ve also heard of certain hospitals not using them AT ALL. It just depends on your provider and his/her preference. Many providers use medications that are inserted in your cervix (which I’ll get to in a moment), instead of placing a Foley bulb.
They work really great if they are used properly and in the right circumstances.
Now, USUALLY, Foley bulbs aren’t meant to do the job on their own. I have seen some women get a Foley bulb placed, and they start contracting and have a baby WITHOUT Pitocin. But, 90% of the time you’ll get a Foley bulb placed, in addition to getting Pitocin started (typically a little later in the game).
So, let’s go over how they get in there…
First off, NO NEEDLES go inside you. I use a needle to draw up the fluid that is used INSIDE the end of the Foley bulb, and sometimes women get a little nervous at seeing the needle in action. No worries, it’s not going anywhere near you. 😉
A Foley bulb is a long (about 12-14 inch) flexible catheter about the thickness of a McDonald’s straw (you know how they are a little thicker than normal straws). It’s nice and bendy, and it’s usually made of latex, or a similar material (if you have an allergy to latex). It’s got an opening on one end that I hook a syringe up to, and the other end is a BALLOON-TYPE mechanism that can be filled with fluid (this is the part that goes in your cervix).
Your provider will get you in lithotomy position, and use his/her hands or a speculum to place the Foley bulb in your vagina, and feed it up through your cervix. This can be a bit uncomfortable (you might feel lots of cramping, and may have some contractions after the procedure). Once your provider has the balloon part of the Foley bulb through your cervix, I start to fill the bulb with water until your provider tells me to stop.
Once it’s filled up, it stays in your cervix for anywhere from 30 minutes to 12 hours. I know, that’s a REALLY long range, but it all depends on HOW dilated you were to begin with, and if you have any contractions while the Foley bulb is in.
Typically, if you are having your first baby, and your cervix is completely closed, or only 1 centimeter, your Foley bulb will stay in overnight…PREPPING your cervix for labor (Pitocin) the next day.
Sometimes we use Foley bulbs and Pitocin at the same time though, it all depends on your circumstance!
If you need a visual (I love visuals), I actually made a video you can check out below on how a Foley bulb works!
There are a couple different medications out there that can be used to induce labor! Most of them are inserted intravaginally and work similarly to having a Foley bulb…in that they mainly work to PREP your cervix…instead of causing you to have rip-roaring labor contractions. (Sometimes they do this, too, though)
It all depends on your provider…and your situation. AND, one method of induction may work great for one woman, and work terribly for the next.
ALRIGHT, so now that we’ve gone over WHAT a labor induction is, WHY you’d get induced, and WHICH method your provider might use, let’s go over HOW it all goes from my perspective!
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HOW TO PREPARE FOR LABOR INDUCTION
You’ve got your labor induction date scheduled, and you get a phone call from the hospital! WE ARE READY TO MEET YOUR BABY!
If you’re a first-time mom, you’ll probably come to the hospital at night to get your cervix “prepped” for labor overnight (using one of the methods I’ve discussed above).
If you’ve had a baby before, you’ll probably get a phone call in the morning!
Once you arrive at the hospital, you’ll go through registration and be brought up to labor and delivery. Your nurse will meet you in your room, and ask you a few preliminary questions…
- Have you been having any contractions?
- Have you been leaking any fluid?
- Has baby been moving around well?
- Have you been bleeding at all?
Once you answer these questions, and we determine there’s no immediate health threat to you or baby, your nurse will ask you to undress completely, provide a urine specimen and change into a gown.
Or…if you have a gown of your own you’d like to wear, then change into your own gown!
Here’s an extra cute one from Gownies! 🙂
Once you’ve changed, your nurse will put you on the monitor for a little while to monitor baby. She will hook up a contraction monitor (a TOCO), and a monitor that’s used to hear baby’s heart rate. They are both small EXTERNAL monitors, that go on your belly.
Once we put these on, UNFORTUNATELY, we can’t take them off again until your baby is on the outside.
If you have to use the bathroom really fast, it’s okay to take them off briefly, but INTERMITTENT monitoring is not allowed once we start PITOCIN (or according to your hospital’s policy).
NOW, if you’re coming in for a night labor induction to PREP your cervix for labor, we typically DO NOT have to leave your monitors on all night (unless something funky is up with baby). I would start continuous monitoring in the AM with your Pitocin…just a little tid-bit to add.
The main reason why we need to leave monitors on you the entire time is because…
- We need to see your contraction pattern to titrate your Pitocin
- More importantly, we need to see your baby’s heart rate for safeguard…in case we need to jump ship. AKA, in case we need to turn down the Pitocin, turn OFF the Pitocin, or head the operating room…
Don’t be too bummed out about continuous monitoring though, because MANY hospitals nowadays still allow you to move around your room, get in the shower, and walk around the unit. Many hospitals have wireless monitors that can be applied, instead of having to lay in the bed for the whole thing!
While your nurse is monitoring your baby, she will be going over a series of questions for our database. Just general stuff…prenatal care, what you want to do for pain, your medical history etc.
She will then start an IV on you, draw some preliminary labs, and start some IV fluids. Or, sometimes if you are coming in for a PM induction, she will not hook you up to any IV fluids yet.
Your doctor will come to see you next and talk to you a little more about your labor induction. He/she will talk about the methods that will be used, the risks vs. benefits, and scan your abdomen to see where baby is lying.
We want baby to be HEAD DOWN…we don’t like inducing BOOTY-FIRST, or SHOULDER-FIRST babies, and your provider will just make sure baby is still lying this way!
Next, your provider will check your cervix, and determine which method of induction is appropriate for you.
If you’re a first-time mom, and you’ve come in at night to PREP your cervix, but your provider checks you and you’re already 3 or 4 centimeters dilated…you probably will skip forward to get some Pitocin, instead of having your cervix prepped in any sort of way (it’s already prepped itself if it’s 3-4 cm dilated!).
If you need a Foley bulb, or any other “prepping” medication to get things started, this is where your provider would do that part…
Once that’s done, your nurse will keep you on the monitor for a little while to make sure baby tolerated that Foley bulb insertion, and if everything is okay after about 20 minutes, you’ll get to remove the monitors and go to sleep (or rest…it’s hard to sleep in the hospital the night before you have a baby).
Alternatively, if you’ve come in for an AM induction, after your provider checks your cervix, your nurse will get your Pitocin started!
If you’re a PM labor induction, Pitocin would most likely get started in the morning…or sometimes in the middle of the night if your Foley bulb comes out early.
START THE PITOCIN
Now, Pitocin isn’t like a WHAM BAM THANK YOU MA’AM sort of drug. I’ve already referenced earlier, Pitocin needs to be titrated to a certain level to get you in adequate labor!
This can be a WIDE range of time…
MOST women do not start feeling contractions AS SOON AS Pitocin is started…usually after about an hour, you may start to feel some cramping, followed by mild contractions, followed by stronger contractions that start to get closer and closer together.
Like I said, usually it takes at least an hour or so to feel ANYTHING, but I’ve had ladies feel contractions in 15 minutes, and others it takes 3 hours. It all depends on your body!
Once you’ve reached an adequate labor pattern (remember, PAINFUL CONTRACTIONS, 2-3 MINS TOGETHER, AND CERVICAL CHANGE), your nurse will STOP turning up your Pitocin.
Then, your body will do its thing, change your cervix, and eventually you’ll deliver!
Don’t be surprised if this is a LONG time from when we first started your Pitocin. If you are a first-time mom, my PM labor inductions typically don’t deliver until the FOLLOWING night…on night shift. It takes a LONG time (usually) for your body to get the idea that it’s time to have a baby.
But don’t stress, this is NORMAL…babies can take a long time to make appearances when they are induced!
That’s pretty much a labor induction in a nut-shell! (Find out what happens during DELIVERY, here!)
Have you been induced, or is your provider scheduling a labor induction for you? What are your experiences? I’d LOVE to hear from you!