Medical Induction Methods
The most recent estimate in 2018, states that just over 31% of births in the United States are a result of medical induction. This number has nearly tripled since 1989. More and more, birthing people are being induced for a variety of reasons. Most commonly, it’s cautionary due to some medical reason that might mean an induction will reduce risk. Induction is also used due to the convenience of the provider and/or birthing person. And of course, it’s also used alongside emergencies at times.
So what does medical induction even look like? There are a variety of techniques. But before I go through, I’d be remiss not to mention BRAINS - a helpful tool in deciding on medical interventions like induction. Using BRAINS looks like considering all of the following:
B - What are the benefits?
R - What are the risks?
A - What are the alternatives?
I - What does your intuition say?
N - What happens if you do nothing?
S - Taking space to consider all of the above
Also, I want to mention “the tipping point.” This is where a person’s body is at the top of the summit and can go into labor at any time. If a birthing person’s body is at the tipping point, any of these interventions can spark labor. But if they are not, these are not likely to work.
And here’s the dilemma with medical interventions. If they don’t work, but there is too much disruption to the process, the birthing person ends up with a cesarean section. Thus, there is a much higher risk to have a c-section when using medical induction methods.
To be specific, medical inductions are interventions that occur under the guise of a medical provider. Some are used individually, but most are used in combination. They can include:
Pitocin - Pitocin is a synthetic version of Oxytocin which is the hormone a birthing person’s body releases to contract the uterus. Pitocin is used to cause contractions in the uterus with the intent of sparking labor. Pitocin feels different than natural labor, as it creates continual contractions on a regular basis. They are often closer together and stronger. The benefit is that it tries to work quickly. The negative is that both the birthing person and the baby do not get a break. In natural labor, contractions are apart in order to allow the birthing person to rest, and also for the baby to regulate their heart rate. Pitocin can override this crucial break. Also, some say that contractions from Pitocin are more painful.
Cervidil - a prostaglandin inserted into the cervix in a tampon-like device. Prostaglandins get the cervix ready for labor causing it to soften and dilate. This method brings them right to the source, with the hope that the cervix ripens and instigates labor. However, it’s more often used as a prep for induction than actually starting labor itself. The benefit of cervidil is that it’s a localized medicine. This means that if you take out the insert, the medication stops and so do any side effects of the medicine.
Cytotec - this is a medication also called misoprostol. It causes the uterus to contract and also works to soften the cervix. Here, the purpose is to get things going in order to move past the tipping point. The negative to cytotec is that it’s systemic, meaning that it cannot be stopped once it has started. And, one of the side effects is hypercontraction of the uterus. In this case, there is no break between contractions which is a significant risk to the baby. This then becomes an emergency c-section.
Foley bulb - this is a balloon that can be inserted into the opening to the cervix and is filled with saline. The pressure from the bulb on the cervix encourages it to dilate. Once 3-5cm has been reached, the bulb just falls out.
Artificial membrane rupture - this is when a medical provider takes a tiny plastic hook and punctures the amniotic sac causing the water to break. Once the water breaks, labor is often inevitable. So it is a quick way to start labor. The negative is that birth can still be a long way off from this point. And the longer the membranes are ruptured, there is increased chance of infection to the little babe.
Sweeping the membranes - is when a provider sweeps their finger between the amniotic sac and the cervix. The point is to try to activate the release of prostaglandins in order to encourage labor and dilation. The negatives are that it definitely hurts and causes contractions for 24-48 hours whether or not they turn into labor, and there is a risk that the provider can rupture the sac unintentionally. This technique is becoming more and more popular, as it’s often used by many midwives as well. However, it’s not often spoken as a method of induction, when it most definitely is.
There are many options to medical inductions, but the main point is that you as the birthing person always have a choice if induction is on the table!
When I had my second, I was told at 39 weeks that my amniotic fluid was too high. They were worried about my baby’s kidneys. Their words were, “we can’t let you go to 40 weeks.” I grow and birth big babies (10lb even and 10lb 5 oz to be exact) so I said let’s do it asap, in the hopes that being a tad bit early might increase my chance of a successful vaginal birth. That was my thinking. I will admit that I did not know nearly as much as I do now. And I likely would have made different choices along the way.
They started Pitocin and it did not work for me, not even kind of. My body was not at the tipping point. After scaring me that if my water broke at home, I could hurt the baby with a cord prolapse (when the cord comes out before the baby) plus way more fear tactics and strong-arming, I ended up with a c-section. If I could go back, I would have just gone home when it didn’t work, and let it happen naturally.
So my advice…BRAINS and choice. And remember no is a full sentence.
