At 6:30 A.M. on the dot, my patient, a first-time mom, and her husband, arrive on the labor and delivery floor for her induction.
As I settle them in and hook up the monitors to her belly, I explain the induction process.
When she asks me when I think the baby will come, I hesitate.
"Most likely, it will be a while," I say, as gently as I can. "With most first-time mothers, an induction can be unpredictable. Your baby may not come until tomorrow."
Shock registers on her face as she looks over at her husband.
"Well, do you think she could get some breakfast then? We were expecting the baby to come by lunchtime, so she didn't eat," he says quietly.
I shake my head. "No, I'm sorry, but we can't let you have anything right now -- not until we see how the baby responds to the medicine."
As they exchange silent looks, I know I am dealing, yet again, with a couple completely unprepared for what lies ahead. As a labor and delivery nurse, I want to make sure my patients are educated on the induction process before they come to the hospital. If you or your care provider is considering an induction for your labor, here's what you need to know.
Understand the reason for your induction. The primary reason for an induction should be a medical one, such as gestational diabetes or high blood pressure in the mother. Some patients, however, and even doctors, will choose an induction for "social" reasons, such as timing the birth for visiting family or to avoid having your baby on a holiday. "When there is a medical indication for a mother and baby, you have to do it," says Denise Huntley, MSN, RN, a labor and delivery nurse and childbirth educator at Brigham and Women's Hospital in Boston. "Often, though, patients choose an induction because they don't want to be pregnant anymore. I discourage that, especially with the first baby."
Unless you have a serious medical condition, no care provider should induce labor before 39 weeks. Even then, research shows, in the last weeks of pregnancy, every day counts for your baby's development.
So you should understand the reason for your induction. If your doctor says she wants to induce you, but you're not clear on the reason, speak up. If there is no clear medical reason for your induction, you do have the right to refuse.
Induction increases the risk for a cesarean section. "There are very good medical reasons to be induced," Huntley says. "But studies show that it does increase your risk for a cesarean." In fact, for first-time moms, an induction can double the risk for a C-section. Julie Marshall, of Fenton, MI, was induced for high blood pressure during her pregnancy. "But at some point during the induction, the baby flipped over, and I had to have an emergency C-section," Marshall recalls. A long labor, external drugs, bed rest, and stress on mom can each contribute to the increased risk.
You probably won't be allowed to eat much. This one comes as a shock to a lot of women. The prospect of not eating for even a few hours was frightening to me as a pregnant woman, so I understand why the thought of a day or more without much food might worry you. The reasons birthing centers may prohibit a woman from eating during labor include the nausea and vomiting that are a natural part of labor -- along with that increased risk for a C-section. (As in any surgery, patients headed to a caesarean aren't allowed to eat because stomach contents could wind up in the lungs during surgery, leading to serious complications like pneumonia.) If your doctor or midwife allows it, eat a hearty breakfast before your induction to keep your energy up. And ask your doctor what his or her protocol is for food during labor. "If we know it is going to be a long induction, we will 'break' a patient," says Michele Hakakha, M.D., FACOG, author of Expecting 411: Clear Answers & Smart Advice for Your Pregnancy. "So for example, after two doses of Cytotec or after a 12-hour dose of Cervidil, we will let a patient eat a light meal, like soup broth or some fruit, and shower before the pitocin portion is started. I find this a lot more humane."
There are different methods for an induction. Many women come in to the hospital for an induction expecting to be hooked up to Pitocin (oxytocin) to get labor going. But the OB staff can't start Pitocin until the cervix is "favorable," meaning that Pitocin won't be effective unless the body shows signs that it is ready for labor. A cervical-ripening agent, such as Cytotec, or misoprostol (which looks like a tiny pill and is placed behind your cervix), or Cervidil, or dinoprostone, a vaginal insert that is placed high into the vagina to start or continue the ripening of the cervix, may be used first to help your cervix stretch and open before Pitocin is administered. Alternatively, manual opening of the cervix can be achieved with a balloon catheter or even a rod made of seaweed that gradually expands.