five THINGS EVERYONE SHOULD KNOW ABOUT AN INDUCTION
I want you to know that you can have an amazing vaginal birth with an induction.
There is so much fear out there about inductions. I get where they are mostly coming from. Since the 1989, induction rates have sky rocketed.
Image: The American Journal of Maternal/Child Nursing. Graph showing the rates of induction surging in the last 30 years.
Should a first time mom who is about to hit 41 weeks get a medical induction who is otherwise healthy and has no pregnancy complications and no medical indication for induction? I think that’s a no from me, friends. Every situation has its own reasonings and I can’t give medical advice. I’m a doula, not a doctor.
BUT I’m not talking about those situations where someone is conned or bullied into an induction because they “didn’t know any better”—a phrase I hear from so many second time moms who hire me for their second baby after having a mess of a labor with their first. The system is kind of set up for first time moms to be held to the whims of the medical industrial complex unless she is fully informed (which falls on her, unfortunately, and it can be hard to know who to trust with ALLLLL the information out there) and prepared (which the doctors don’t usually talk about what to expect in those 15 minute -you-peed-in-a-cup-and-got-weighed-appointments).
I’m talking about when someone has different pregnancy complications like gestational hypertension, preeclampsia, severe polyhydramnios, etc- legitimate medical reasons to change up your birth plan and do what’s best for mom and baby.
When you need to be induced because it’s actually what’s safest for you, here’s what you need to know:
1. Birth is mental.
Don’t let the fear mongers get to you. If you need a medical induction, instead of asking yourself ‘why is this happening to me,’ start asking yourself ‘how can I make this the best birthing experience under these conditions?’
I’m not saying that to invalidate your feelings. They matter. Feelings matter SO much that they can totally derail a laboring mom. Or cause labor to not come at all.
If you walk into your medical induction after looking at your Bishop score and being terrified you’ll end up with a csection…you’ll probably end up with a csection. That is not to say it is your fault if you do. What I mean is your mind plays major role in releasing the labor hormones that tell your baby ‘hey friend, this is a safe place to come out.’
Birth is 20% physical—can you get to 10cm, fully effaced, can you push a baby out? 80% of it is staying in a positive place in your mind.
Did you read that last statement and think, yeah sure, Jan.
Well, an amazing study was done in 2023 called “The mindset of birth predicts birth outcomes: Evidence from a prospective longitudinal study” where doctors studied two different groups of women- those who had a more medicalized view of birth and those who had a more natural view of birth (those are their words, see the study to learn more). I’ll quote directly here so you get the info straight from the horse’s mouth:
Predictions: Conceivably, the mindset and its associated cognitions and emotions could influence the course of the birth, for example, in the sense of a self-fulfilling prophecy. Thus, a more medical mindset could cause the women to be tense during labour, implicitly expecting things to go wrong. Such tension could interfere with the natural hormone release, increasing the probability of complications that then need to be solved with interventions such as episiotomy, vaginal assisted birth, or unplanned/emergency C-section.
Results: The results revealed that the birth-related mindset assessed during pregnancy predicted labour and birth: Women with a more natural mindset had a higher probability of having a low-intervention birth. This in turn had a positive effect on the birth experience, which led to greater general emotional, and physical well-being in the first 6 weeks after birth. Breastfeeding and the well-being and (perceived) behaviour of the infant were also positively affected. These short-term positive effects in turn predicted longer-term psychological well-being up to 6 months after the birth, operationalized as postpartum depression, post-traumatic stress symptoms, and bonding with the infant. These results are crucial as depression in mothers does affect both mother and child, for example, the mother's caregiving ability (Priel et al., 2019) and children's stress response and physical health such as the function of the immune system (Dekel, S. et al 2023).
So, guys, I’m telling ya. Mindset is very important in birth. That doesn’t mean you have to be fearless. It is normal to be worried—especially about an induction. But you need to release those fears in some way. In HypnoBirthing, there is a specific script for releasing fears that helps a lot of people. For some people, they need to bring in professional help with a therapist to guide them through their birth anxieties. Doulas can absolutely help you prenatally and during the induction to give you confidence, education, and support you in whatever way you need in that moment.
If you are really scared, you’ll be releasing those stress hormones. That causes a physiological response in the body. Your birth team needs to work with you (ideally your partner and/or doula) to get you into a more calm, relaxed state of mind.
We want you to release that oxytocin and send the message to your baby that ‘this is the place we get to meet you and we welcome you with JOY!’
Partners can set the mood by building your birth cave—private, intimate, low light, relaxing touches, smells, sounds. As your birth team, our job is to help you relax and build you up, making you feel like the birthing goddess that you are!
Image: Deviant Art. Drawing of mother with baby connected through the tree of life.
2. You will probably be in the hospital a little longer than you’d like to be.
Go into this knowing that statically, a medical induction is going to take anywhere from 24-36 hours before you’re in active labor. It could be shorter; it could be longer.
Pack your hospital bag accordingly! Bring a laptop/firestick/something to watch things on. Too many clients end up watching the hospital tv and somehow always land on a Law & Order Special Victims Unit marathon. Which, hey, Mariska Hargitay is a babe, but the subject matter is not the best for labor.
Image: Yahoo Entertainment. Mariska Hargitay 1990s.
Watch things that make you laugh! Laughter releases oxytocin and can help things progress. Make sure you have your own pillows, blankets, sleep mask, etc because with inductions, people are in it for the long haul (most of the time).
EAT!!! The hospital will bring you some food (sometimes clear fluids, sometimes food from the cafeteria). But you need to have both a bag of snacks and you need to eat REAL food, especially for an induction. Eat before the induction and then if you’re still waiting for things to happen and labor to kick into gear, EAT! Even if you plan an epidural at some point, your body will be numb to the sensations, but your body is still running that birth marathon and you will get tired. You need to fuel up!!
3. The worst thing you can do is only lay around.
You do need to rest and sleep—those are super important. But you need MOVEMENT to get things going. Even if you can’t walk around the delivery ward, you should be moving.
Depending on where baby is in your pelvis (baby’s station), you will move your pelvis in different ways. Familiarize yourself with the positions to use based on baby’s station in the pelvis before you’re in labor. This is covered in my Birth Prep Course included with the birth doula package.
You can pump! Nipple stimulation is highly effective at sending the message to the baby that it’s time to Come On DOWN (Bob Barker style). If you ask for the hospital grade pump, they should bring one to you and show you how to use it.
Image: Parents. Woman collecting colustrum with pump.
You can also do hand expression and collect the colostrum yourself. This is a skill you should practice starting at 37 weeks. If you’re able to already know how to get the colostrum out before your baby is born, once they are here and you put them to breast, you can hand express to help them know exactly where to go with more confidence.
If you’re at all stressed about how breastfeeding will go, there is also the option of seeing a Lactation Consultant prenatally. Independent lactation consultants do prenatal meetings to show you how to do hand expression, share breastfeeding position tips and tricks, and make sure your pump flange sizes are correct/show you how to use it, and much more.
Note: for inductions, sometimes the medicine they give you causes too many contractions and that would not be a good time to pump. Once you’re on Pitocin, you should not pump as it can overstimulate the uterus.
You can also do the Miles Circuit! You can do this before the medical induction (if it’s after 37 weeks) and/or in the hospital. It’s three exercises/stretches to help bring the baby down in such a way as to up pressure on your cervix to help it open and soften, and send you into active labor.
And again, Be sure to rest, hydrate, and EAT!
4. Remember that You are in charge of your birth. Yes, the doctors or midwives are going to be suggesting to you what to do and they do have a lot of knowledge and experience in that. But you’re still the one who gets to say yes or no.
If a provider comes in and says ‘I’m going to check you now.’ That’s a red flag. They need to ask you—‘Can I check you now?’ If it hasn’t been 4-6 hours and your baby is fine, ask what the medical indication is for checking you.
You’re allowed to say no to ANYTHING they want to do. Remember to use your BRAIN:
Ask questions and don’t feel like you need to make a decision right when they’re talking to you.
The power balance of a) Woman in labor, nearly naked on a bed feeling vulnerable vs b) Doctor/midwife in uniform usually literally standing over this woman saying what they need to say—it is honestly a crazy situation—the power imbalance is off the charts. A lot of people at some point, especially if labor has been long and they’re tired, just feel like they need to do what providers say. And I’m not anti OB or anti midwife. They are needed and life saving wonderful people who get to help people have babies.
BUT sometimes, for them, it’s just another Tuesday when for you, it’s the most important day of your life. They may not list all the options when they give a suggestion because you’re their tenth person in labor today and they’re tired and feel like this is what you need to do (and they may or may not be right). Their capacity in that L&D room is so completely different from that of a doula who can walk you through everything and remind you of your options and what your plan birth is.
What I tell people is that the birthing person is driving the train. You get to decide. The rest of your birth team is on the train with you, trying to help you get to where you’re going—a safe, supported birth with a healthy mom & baby.
5. Pitocin contractions are different.
If Pitocin is coming into the picture, they will start low and go slow. That wasn’t always the approach and it was not so great for a lot of moms and babies. Slow is better, but if you’re aiming for an unmedicated birth with Pitocin, you need to prepare like you’re going to war because Pitocin contractions are different.
The labor cocktail you would naturally produce is not the same as when Pitocin comes into the picture. Nature’s pain relievers—endorphins—are not released in Pitocin contractions the same way as natural labor because Pitocin does not cross the blood–brain barrier (Lothian 2014).
This doesn’t mean you can’t have an unmedicated birth with Pitocin, but it does mean it will be harder to do so—more physically challenging and more endurance is needed from you, mama. You can do it!
What I tell clients who are on the fence about an epidural in the middle of a birth who originally wanted an unmedicated birth, is that I can’t make the right choice for you. You know what’s best for you and your body.
If contractions are so intense that you are tensing up every part of your body to fight them, you are going to have a harder time. If you’re reached a place where you cannot relax and release, an epidural is a tool on the table. There certainly are draw backs to getting one and only you can make that choice for yourself. I spend a lot of time talking about the details of this during my prenatals with clients.
When thinking about getting an epidural when you originally didn’t want one- for some women, at a certain point in labor things go from “Ok, this is hard, but I can handle this” into a place of just suffering.
Not everyone hits that place of suffering.
I had a home birth the other day with a first time mom who called me in a bit late to the party because “I was just waiting for it to get worse.” She pushed that baby out like a mermaid Goddess in the birth pool.
In my second birth (the car baby), I never hit a place of suffering, even when she was crowning. How labor feels to you has many factors—baby coming down in a different, less than optimal position will feel more intense and harder than if baby is in the best position; your mindset will also have such a huge effect on how you feel everything.
Birth is never easy, epidural or not. But you have to remember, if you do have an epidural, you still need to rest! So many moms get the epidural and stay up talking for longer than they should—your body is still running a marathon, whether you feel it or not. You need to hydrate, rest, fuel, and move (with a peanut ball or all kinds of different positions you can do with an epidural).
Inductions should not be proposed lightly. They change so much about the way your labor will unfold. But if you have a legitimate medical reason for having an induction, I want you to know it can still be the empowered, beautiful birth you wanted.
It’ll look a little different than what you originally thought, but I hope you still can feel calm, confident, and empowered by it.
Sources:
Dekel, S., Ein-Dor, T., Berman, Z., Barsoumian, I. S., Agarwal, S., & Pitman, R. K. (2019, December). Delivery mode is associated with maternal mental health following childbirth. Archives of women’s mental health. https://pmc.ncbi.nlm.nih.gov/articles/PMC6821585/
Hoffmann, L., Banse, R., & Hilger, N. (2023). The mindset of birth predicts birth outcomes: Evidence from a prospective longitudinal study - 2023 - European journal of Social Psychology - Wiley Online Library. Wiley Online Library. https://onlinelibrary.wiley.com/doi/10.1002/ejsp.2940
Lothian, J. A. (2014). Healthy Birth Practice #4: Avoid interventions unless they are medically necessary. The Journal of perinatal education. https://pmc.ncbi.nlm.nih.gov/articles/PMC4235054/
