Every so often, I have families get induced at the hospital. Sometimes these inductions are planned, and we’ve had time for those moms to ask me all the questions and I’ve cleared my calendar well ahead of time. Sometimes, there’s a sudden need, and everybody is scrambling. This post is primarily for my clients, so I can send a link with some succinct information when it’s needed, but I’d love it if what I’m writing here is able to help more people! This is not going to be comprehensive, but an overview of the main induction techniques that I see at our local hospitals. I’m including links to more in-depth articles if you want that information!
This is the second part of my overview of inductions. In my earlier post, I introduced the ideas of a Bishop Score, which helps you understand how ready your body is to do the work of labor and how successful an induction is likely to be, Cervical Ripeners, which help your cervix get ready to soften, thin out, and dilate, and the Foley Bulb, which can be a nice non-drug tool to help you get 3-4 cm of dilation. In this post, I’m going to talk about the thing that everyone thinks of first when they hear the word “induction:” Pitocin.
Pitocin
I kind of feel like Pitocin has a fairly deserved bad rap that no longer fully applies. I used to see moms get hooked up to a Pitocin drip that was turned up aggressively and on a pre-scheduled timeline until babe was born, and it caused terrifically strong contractions and a fairly harsh labor. These days, Pitocin is used much more carefully and thoughtfully and moms are having far better experiences with it.
Here’s the thing: Working through labor and birthing your baby is like pushing a piano uphill. It’s going to take hard effort, and you’re going to need to give a push, take a break, give a push, take a break….but if those pushes aren’t strong enough or your breaks are too long, that piano is going to roll back down on you, and you’re not going to make progress. If your contractions aren’t getting stronger or closer together, you might not be getting any cervical change for all that work. And nobody wants to work this hard without results.
I think the way we typically look at Pitocin is as if it were a huge truck, and a mom (with her piano) gets hooked up to it and just dragged up that hill. In reality, Pitocin is used more like the neighbor’s fourteen-year-old kid. They’re not so bright, but they’ve got muscles, and they put their shoulder against that piano, next to yours, to add their strength to yours. If they have someone giving them good directions, they’re much more pleasant to work with. Towards the beginning of my doula career, I saw Pitocin drips get turned up all the way to 20 or 25 mlu/min, but nowadays it rarely gets up above 10 mlu/min. Nurses in our area have been carefully trained to watch the effects of Pitocin, how a mom, baby, and contractions are all responding, and adjust very slowly and carefully.
I know most of my clients really do not want to have Pitocin as part of their birth, but if you and your caregivers have decided together that an induction is going to be a beneficial route for your birth, I’m hoping to reduce some of the fear around this aspect.
There’s a lot more you could read to help yourself be informed and make decisions that are right for you and your labor. These are some great links with more general information about Pitocin and both the risks and benefits: Here, here, or here.
I had more to say about inductions, but this post has already hit the length that I feel is best, so….there’s going to be a part three, where I talk about the “Cascade of Interventions” (it’s a very real thing, so let’s talk about it), and some of the procedures that I occasionally see becoming a part of an induced birth: having your amniotic sac broken, or the use of either a Fetal Scalp Electrode or Intrauterine Pressure Catheter. I find that talking about these things ahead of time can really help a mom feel prepared for the induction process, even if they don’t become a part of her story.
Meanwhile, just to repeat myself:
*This is meant to be the most basic of overviews. You are probably going to want more information. Please talk to your provider, ask lots of questions, and definitely hit up your doula. I’m able to get a lot more information to my clients in person than I can throw out on this blog
*None of this is medical advice. Doulas are not medically trained, but you knew that, right? It still just has to be said.
Snohomish County Doula 