Advice for induction

Barefoot84 · September 2014

After months of preparing for a natural birth, I've made it to 40w6d with no sign of baby wanting to come out on his own. I have GD, so my doctor ordered an U/S and an NST tomorrow, but she said to bring my suitcase because she would most likely be insisting on an induction afterwards. I'm going to be following her advice, since I'm already grateful she let me get to 41 weeks with GD, while other doctors would have pushed for an induction days or even weeks ago.

I've tried sex, nipple stimulation, RRL tea, walking, spicy food and everything else I could think of. He's being a little stubborn fellow, and at this point, a healthy baby means more to me than my birth plan.

Any advice for going as med-free as possible after an induction? I'm worried I'll give in to the epi simply because I know the contractions won't be "natural". My mental resolve is already weaker than it was, since I was so convinced my body was meant to do this naturally, and now, I'm not so sure...

MsMacual · September 2014

Hugs. Ina May does a pretty good job of outlining different induction techniques in her birth book- maybe you can use those ideas (particuarly the less invasive ones) to discuss with your care provider and develop a plan that would rely on drugs as a last resort? She doesn't really discuss using a foley bulb (I think that is what it's called), but it might be something to research a little if you have time.

I actually know a mom who had to be induced with pit and managed to deliver vaginally and pain med free. I believe that she asked her provider to start her pit at the lowest possible dose and increase it very slowly so that her contractions weren't unbearable.

Good luck!

jennypolkadots · September 2014

Keep doing what you are doing. Also try some meditation, birth visualization, and just relax and laugh a bit. Watch a funny movie and have more sex. Enjoy this (possibly last) night alone with your family of 3!

Your body is made for this, do not let your doubts creep in. You are strong! Tomorrow if she pushes for induction first ask what was found on the NST and ultrasound that indicate an induction is necessary. Pitocin induction is not nearly as successful if you are not already in natural labor first. If you agree with her assessment from the NST/US, ask about non-medicinal induction such as a membrane sweep that day. See if she can do a membrane sweep and give you 24 hours before medically inducing.

If you are medically induced you need a few things in place. For starters, start that pitocin out on the lowest setting. It goes up to 20 and most of the time they start you at a 6 or 8 and ramp it up 2 notches every 30 minutes. Don't let them ramp it up too quickly. Continue nipple stimulation and other techniques to hopefully assist in dilation. Do not let them break your waters because then the clock starts ticking against you. Make sure you have access to a mobile fetal monitor and will be able to walk around with the pit drip. That is your best hope for dealing with pit contractions. You do not want to be stuck in the bed. Be prepared with relaxation techniques - massage, a cool cloth for your head, ginger chews for nausea (instead of even more meds), and make sure you eat a good meal before going in because after that you will probably be sneaking snacks to keep up your energy.

Many women have pitocin births without an epidural! You can do this! Please update after the baby is here, I will be thinking of you!

sschwege · September 2014

It's wonderful you have gone this far with GD, induction may very well be the right move at this point.

I didn't have to be induced, but I remember my MW saying that part of what makes inductions feel more intense is that women think they must stay in bed. Of course you need extra monitoring, but she said she encourages her patients to stand next to the bed and sway, sit on the exercise ball, bring the rocking chair next to the bed and rock, etc.

You might ask if they are willing to use a Foley Bulb induction to start. Then if Pit is needed ask that they start you at the lowest dose and request that it be turned off once you are in a good contraction pattern. They can always turn it back on if need be, but see if your body will take it over once it gets started. You might also request that they not break your bag of water. This is a tricky one and would depend on the circumstances, but most women report that once their bag goes the contractions feel more intense, so if it were me I would try to keep it intact as long as possible. Some babies are born in their sac, so the bag doesn't have to break for the baby to descend. However, if nothing seemed to be working and this is the last ditch effort to get things moving, I would agree to it.

Good luck!

soulcupcake · September 2014

What is your Bishop's score? If it's unfavorable I'd ask to start with the foley catheter, which usually falls out between 4-5 cm.

I'd avoid AROM to induce, and ask for a low dose pitocin drip once your cervix is nice and "ripe." That way, the pitocin can be turned down or even turned off once you're in an active labor pattern. Once your membranes are broken there is no going back or undoing it and you're on a time clock to avoid risking infection. There are many drawbacks to AROM as well, but it is one of the most widely practice interventions. You risk infection, malpositioning, cord compression, more painful contractions due to the lack of cushion on the cervix that the membranes provided, and more interventions.

As many hospital labors/inductions go, they want to see mom progress 1 cm every hour or 1.5 cm every hour for multiparas. So, your provider may not be open to allowing the process to progress on its own without too many interventions. If you and baby are fine there is no need to rush the process.

Ambulation is key, too. Mobility, staying upright, etc., help with labor progression and baby's descent. If you opt for uterine stimulants you will *have* to be on continuous monitoring, which limits your mobility and pain management techniques/options.

Barefoot84 · September 2014

Thank you everyone for the advice and the support. I was surprised to hear the drawbacks of AROM, I felt sure it was my best option but now I'm seeing it's not the case.

I don't know my bishop score yet, as my last exam was over a week ago, but I was barely dilated (1 cm) and only 50 % effaced. I'm hoping my body has made a lot of progress since.

I'll certainly be asking about the foley bulb, and maybe I'll just need a low dose of pitocin to get me started. I've had all the signs of impending labor this last week so I'm hoping that means I'll be very favorable to an induction.

Thanks again!

DebateThis · September 2014

aeonlux said:

What is your Bishop's score? If it's unfavorable I'd ask to start with the foley catheter, which usually falls out between 4-5 cm.

I'd avoid AROM to induce, and ask for a low dose pitocin drip once your cervix is nice and "ripe." That way, the pitocin can be turned down or even turned off once you're in an active labor pattern. Once your membranes are broken there is no going back or undoing it and you're on a time clock to avoid risking infection. There are many drawbacks to AROM as well, but it is one of the most widely practice interventions. You risk infection, malpositioning, cord compression, more painful contractions due to the lack of cushion on the cervix that the membranes provided, and more interventions.

As many hospital labors/inductions go, they want to see mom progress 1 cm every hour or 1.5 cm every hour for multiparas. So, your provider may not be open to allowing the process to progress on its own without too many interventions. If you and baby are fine there is no need to rush the process.

Ambulation is key, too. Mobility, staying upright, etc., help with labor progression and baby's descent. If you opt for uterine stimulants you will *have* to be on continuous monitoring, which limits your mobility and pain management techniques/options.

I agree with all of this except the bold isn't necessarily true. I had pitocin augmentation after broken water for 15 hrs, continuous external monitoring and it did not limit my mobility or pain management at all. My hospital had mobile and waterproof telemetry units so I was able to walk all over L&D, sway on the side of the bed and get in the tub while being monitored.

OP: good luck to you! Don't let the doubts creep in. Pitocin can be managed w/o an epi. And if you wind up with one, that's ok too.

MommyAtty · September 2014

I had two natural births with pitocin. Totally doable. There is a lot of misinformation about Pit. Yes, some women have different, harder contractions with it. Many do not. I didn't. The second time around, I went into labor naturally but had a blood pressure spike so they gave me pit to hurry things up. The contractions were no different, with or without pit.

jennypolkadots · September 2014

I am genuinely asking, not trying to be snarky... but can a birth still be described as "natural" if labor is augmented? I guess I always considered natural as med free, not just free of pain management medication.

jennypolkadots · September 2014

@danisgossipgirl - point taken. I gave OP what I considered good advice and by now she has probably had her baby which is why she hasn't checked in. I was asking with genuine interest. I have never seen the subject discussed here and flipped a few pages and must have missed the common discussion. My apologies for whatever I did to garner the hostility from a really well meaning question. I'll search some more. :-/

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