tell me about inductions

[jgriffin]

Because of a previous fast labor, my mom's fast labors, and current traffic conditions in the Bay Area, DH and I are considering an induction in the next couple of weeks. Up until yesterday I was completely against the idea, having been told by friends (when I was pregnant with E) how horrible/unnatural/painful they are. This may be, but I'm not thrilled with having the baby in the car, either. ("Mama, why did you name me Passat?" "Just be glad we weren't driving the Honda Civic that day, dear!")

So, I know absolutely nothing about inductions, other than they (sometimes? always?) involve getting pitocin to kick start the process. Can anyone suggest some good links with more details? And maybe share your experiences with inductions...surely they can't be as bad as I heard.

TIA!

Jen

[megs4413]

i've had two...

i'm pro-epidural, so this comes from that viewpoint...

they were no big deal. some start with cervidil, not pitocin. mine were both just pitocin inductions. each labor was less than 14 hours. the second one was REALLY easy cause my water stayed intact for a long time...i even considered not getting an epidural cause it just wasn't that bad. i loved having this last birth scheduled. we were able to plan for it well....

[hudsonam]

I'm starting to think that inductions are as varied as non-induced labors/deliveries, because everyone has something different to say. I had a wonderful induction. I went in the night before around 10 pm (was supposed to be earlier, but they called to tell me they didn't have any open beds at 8 pm), and they started miso (?), to soften my cervix. They also gave me fluids to help stop the slight contractions I was having but didn't know it. I forget why they had to do that, but I think to allow the miso to work. Then at 6 am, they checked me out and I was ready for the pitocin. About a half hour to an hour after that, I started having labor pains. I had my epidural ASAP ;), and then I was fine. At 11:30 am I started pushing, and at 12:03 pm my DS was born. So I had a great experience, so don't think that it's going to be a horrible, horrible thing. Good luck! :)

[JBaxter]

My girlfriend was induced because they were afraid she would deliver at home. She was 5cm and 90-100% effaced for 2 weeks she had a 3hr labor with her first who came 3 weeks early.
What they did with her was put a gel on her cervix and she started contracting within 10 min. her labor progressed normally and she delivered in 1 1/2hrs. the baby ( Jake) was born with his hand pressed against his head. they "think" thats what was holding him up LOL. I think the key is if your body is ready it will go quickly.

As long as your labor is progressing with something besides Pitocin i would try to avoid that. I would give you details of Nathans inductions but is was VERY VERY long.

[o_mom]

I'm only a few days ahead of you and I'm thinking about the same thing. We don't have quite the traffic issues you do, but still have a 25-30 min drive once we leave the house. This is after DH gets home from work or we get someone here to watch the kids. I went under 2 hours last time. I think we are settled on not doing anything until after my due date since the first two came around that time (2 days early and on time).

I asked the doctor and she said that generally you get faster with each child, but that there is a lower limit and going less than an hour is very unusual. The last time she offered an induction at 40 wks and said that they could just do AROM since I was 4.5-5 cm and the baby was really low. I wasn't super keen on that, but in hindsight it wouldn't have been any worse than the labor since it started on that day with SROM.

There are other options besides pitocin. AROM is one, but once you do that you are committed to getting the baby out in 24 hrs. They can also use prostiglandin (sp?) gels to ripen the cervix.

I would ask the doctor what your Bishop's Score is when you get close. If you google it, you can get details. Basically it predicts the sucess of an induction based on how ready you are.

Passat would be a cool name... much better than Legacy or Odyssey ;-)

ETA: Really research the cervical gels if that is offered as an option. There are some that are very bad to use - the FDA has warned against using them in inductions because of uterine ruptures, but OBs still use them off label.

[Piglet]

>ETA: Really research the cervical gels if that is offered as
>an option. There are some that are very bad to use - the FDA
>has warned against using them in inductions because of uterine
>ruptures, but OBs still use them off label.

HUGE ditto on this last part. My boss shared the story of his son's birth with me a few weeks ago and it went horribly wrong due to "off label" use of cervical gel. Thankfully mom and baby survived, but just barely and with many lasting complications (mind you this was nearly 20 years ago).

As for induction experiences when done right, mine was GREAT! I was 2 weeks overdue with DS2 and was induced with a pitocin drip. I loved that everyone at the hospital was ready for my arrival and was there to help me out. Much different than the first, where I laboured in the hall for hours because there were 2 emergency c/s at the same time as I came in and a bed shortage that night :( As for the actual induction, it wasn't what I would call "fun", but heck, when was the last time labour was fun? It went along slow and steady until I was 3cm and then they did an AROM and WHOOOOOOSH.... baby was in my arms within 45 minutes! Needless to say, it was quite intense in the homestretch. Not that it couldn't have happened the same intensity with my water breaking at home, me scrambling to the car, and naming the poor child Santa Fe ;)

I am already pre-scheduled for an induction on May 13 if I haven't popped the baby out by then. My doctor is concerned that I have a tendency to go quick and late, so he decided to schedule the induction just in case.

[SnuggleBuggles]

How's your cervix? 2nd+ timer with a favorable cervix is a much dif't thing than a 1st timer with an unfavorable cervix.

I wouldn't choose to be induced, personally. However, if you are a good candidate that does change thingts.

There are many drugs and methods they can use to induce labor and theyy are usually chosen based on your cervical stats. If your cervix is favorable then most will use pitocin though some will use (scary, imo) Cytotec. If it is super favorable (4+cm) then they might go with breaking your water (not the way I would go, personally- I would pick pitocin), If it is totally closed and high they will use a cervical ripener (prepidil, cervidil or cytotec) and then maybe one of the other things.

All right, this is my one stop induction info. Easier read format is probably still available over on the Baby Center Preparing for Labor board (they had been keeping a link to it fresh over there since I left my hosting spot). It's long so I'll try and break it up. Feel free to skip over all this or just read what parts you feel like reading. I'm going to hog this thread and post this in a few parts just so it is slightly easier to read. HIH...

3. How favorable is your cervix? This can affect how they induce and how likely the induction is to be successful. Ask for your Bishop's Score.

4. How do they plan to induce? Are they going to use a cervical ripener to soften your cervix? Are they going to go right to Pitocin? The answers should be tailored to how favorable your cervix is.

5. Ask what they would do if you don't go into labor? Do they send you home and wait it out? How do they manage things?

6. Will they let you eat and drink?

7. Will they let you move about, use water, change positions...?

8. Do they require continuous monitoring or do they do intermittent?

9. Can you have pain meds? When can you have them? What narcotics do they have standard orders for? What dose? Is there a cut off point to receiving pain medications (if you are 8+cm, will you be able to get anything?)

10. If labor is progressing well can we turn OFF the pitocin for a while and see if my body will take over? I would like to have the opportunity to have the kind of contractions that are perfect for my body and I would like to be able to get off of the monitor for a while so I can walk and change positions easily. I know that this will help ensure proper fetal alignment, more so than laboring in bed. What reasons are there that I couldn't have the pitocin turned off?

11. Is there a time limit on my induction before it is considered a failed induction or turns into a c-section? Do you follow active management? Do I have to progress Xcm in X amount of time? If I am well and the baby is well, can we take it slow and steady instead?

12. Can I decline having my amniotic sac ruptured as part of the induction process? I know that I can reconsider later, like if I get stuck at 8cm for a few hours, but as a matter of routine I would rather not have it ruptured. I worry about the added stress baby could face with the pitocin contractions if they don't have the benefit of the cushion. Fetal malpresentation, cord prolapse and cord compression are other concerns, as well as infection.


Pitocin- Synthetic from of body’s natural oxytocin. Unlike natural oxytocin, the dosage is not perfectly designed for your body and labor. Some labors are meant to be fast while others are meant to be slow. Some babies come at 38 weeks others are ready at 42 weeks (still term).
Risks:
-Fetal distress caused by the contractions being too strong- hyperstimulation of the uterus (blood flow to baby can be compromised as a result of the compression)
-Contractions that give mom and baby no breaks and increase the desire for pain meds (which have their own pros and cons)
-A contraction that doesn’t end (tetanic contraction)- they have medicine that can end it though
-Increased risk of c-section due to fetal distress along with the other interventions that are common in an induced labor
-Increased risk of postpartum bleeding
-Baby may be born premature if the due dates aren’t right
-Increased risk of newborn jaundice

Artificial Rupture of Membranes (aka amniotomy, AROM or “breaking your water�)- This protective cushion serves many important functions for you and baby. Sometimes Dr.s or midwives do this as a matter of routine which just might not be right in every situation. Also, the popular wisdom that it speeds up labor isn’t always the case.
Risks:
-The fluid acts as a cushion for baby. It keeps the cord from getting compressed. Cord compression can reduce the blood and oxygen flow to baby.
-The fluid makes the contractions easier on mom and baby. Having your water broken can really intensify labor contractions.
-A lot of caregivers put you on the c-section clock to deliver. If labor doesn’t pick up then other interventions (like pitocin) might be necessary. 24 hours is the norm though it might be longer or shorter depending on mom and baby’s condition and signs of infection.
-The fluid protects the baby from infection. Frequent internal exams after AROM increases the risk.
-Fetal malpresentation- If baby wasn't engaged the AROM can push them into the pelvis at a bad angle (posterior, sideways). This can lengthen labor and make delivery more difficult
-Rare but possible is cord prolapse (the cord comes out before the baby). This is an emergency situation.

Prostaglandin Gels (Cervidil, Prepidil)- Used to ripen your cervix and make it more favorable for induction. Usually used before pitocin though it might be enough on its own. It is inserted vaginally. Mom and baby need to be monitored for any signs of uterine hyperstimulation. If mom shows signs of trouble, the drug can immediately be stopped.
Risks:
-Fetal distress as a result of the uterine hyperstimulation.
-Postpartum hemorrhage
-Upset stomach (especially diarrhea because the prostaglandins that ripen the cervix can irritate the bowels)

Cytotec (Misoprostol)- The only advantage to this drug is it is time and cost efficient. The drug comes in pill form and a portion if the pill is inserted into the vagina. This is usually used independent of pitocin. **If your Dr. suggests this drug, just say “no� because there are much safer alternatives**
Risks:
-Uterine hyperstimulation and possible uterine rupture. Unlike Cervidil it can not be stopped if the medicine is too much for you and baby.
-The medicine was formulated for the treatment of stomach ulcers. It is acknowledged by the medical community as a possible labor inducer but the drug manufacturers actually don’t support its use as a labor induction drug.
-The fact that labor is sometimes shorter with Cytotec is not worth the potential risk to mom or baby.

Here are some links to read. They are some of my references.
Pitocin
http://childbirth.org/articles/pit.html

Amniotomy
http://childbirth.org/articles/amnio.html

Cytotec:
http://sheknows.com/about/look/143.htm
http://dir.salon.com/health/feature/2000/07/11/cytotec/index.html

The ACOG's website is acog.org. The links can not be posted per their guidelines and copyrights.

Elective Inductions: This includes important information on how to have a safe induction- elective or nothttp://www.hencigoer.com/articles/elective_induction/
http://my.webmd.com/content/article/26/1728_58677.htm?lastselectedguid={5FE84E90-BC77-4056-A91C-9531713CA348}

Mothering Magazine article on labor Induction:
http://www.mothering.com/11-0-0/html/11-2-0/11-2-babydecide105.shtml

Inducing for size and the c-section factor(Henci Goer):
http://www.parentspl.....ru/articles/0,10335,243385_234322,00.html


Books:
The Thinking Woman’s Guide to a Better Birth by Henci Goer
Planning Your Pregnancy and Birth by the American College of OB/ Gyns


Tips to having a safer and easier induction for yourself AND baby:

Write a birth plan. There are many choices available to you, even in a highly medicalized setting. If there are no complications then there are always alternatives and options. You just need to know to ask for them. So, write up a birth plan that includes some of the below tips as well as postpartum and newborn procedures (don't neglect these- the health and safety of baby is in your hands after that baby is on the outside- not all procedures are desirable or necessary in all situations).

Discuss your birth plan with your Dr. or midwife ahead of time. Make sure that you know how they plan to induce. Speak up if it isn't what you want (like if they want to use Cytotec). Find out what they do if the induction doesn't take. If they don't break your water and the induction isn't necessary for health reasons then do they give up for the day? Or do they break your water this necessitating a c-section? Take a copy of the plan to your place of birth so they know what you would ideally want.

Finally make sure that your partner understands your birth plan and why you have made the requests you have made. They can help you advocate for yourself.

-Cervidil not Cytotec if ripening needed

-Lowest possible dose of Pitocin

-Turn Pitocin off once labor is established. Either your oxytocin will continue labor or you can always go back on Pitocin. Natural contractions will be easier and it is worth a shot.

-Don't have your membranes ruptured. If you do, wait till you are in a well established labor and around 5-6cm (usually you can feel ok that labor will progress and not stall out at this point).

-Avoid pain meds (especially the epidural) till at least 4-5cm because they can stall out labor and lead to more interventions.

-Eat lightly and drink. Yes, the i.v. can keep you hydrated but your stomach still might growl. You need energy- birth is like a marathon. They have the means to keep you from aspirating if you go under general anesthesia.

-Stay active and mobile as much as possible. Even if you are connected to an external monitor you can still pace, use a birthing ball, rock in a chair or simply change positions. They can bring out longer cables for the external monitor, just ask.

-Use the bathroom at least once an hour to allow baby more space to come down and the walking and squatting might help bring baby into better position.

-Don't set time limits on your birth. You don't have to progress at any rate. Sometimes a slow pace is just right. Unless there are signs of trouble, take your time. Remember, your baby wasn't quite ready yet so be patient with them.

-No time limits on pushing. It takes a while to get the hang of it. So long as mom and baby are well then 3+ hours is ok according to the ACOG.

There are more tips in this link:
Elective Inductions:
http://www.hencigoer.com/articles/elective_induction/

Common interventions and risks/ benefits:
http://www.lamaze.com/birth/choices/articles/0,,167805_240720-2,00.html#npo

[SnuggleBuggles]

How a normal induction takes place

A lot depends on the condition of your cervix. This link here helps you determine your Bishop's Score and what method of induction is normally recommended:
http://pregnancy.abo.....dbirth.org%2Finteractive%2Finduc tion.html

If your cervix is not ready, or ripe, then they will administer a drug to help soften your cervix. Most commonly this drug is Cervidil. If ripening is necessary then they often begin the induction process at night. Your body is naturally more receptive to oxytocin at night. Cervidil is a vaginal suppository.

Once the Cervidil is placed then they will require external fetal monitoring for 1-2 continuous hours. This may or may not require you staying in bed.

After this initial monitoring they may let you go home is all is well. If baby or mom to have a bad reaction to the prostaglandin gel then it usually happens in the first 1-2 hours. It is generally considered safe to go off of the monitor and go home to await labor (assuming mom and baby are healthy). I would say that about 50% of moms are given the opportunity to go home.

Less than 50% of the time Cervidil alone is enough to push mom into labor. It may cause cramping but not active labor. Some women complain that the waiting is the hardest part. The drug is usually kept in place for 8-12 hours.

Once the first dose of Cervidil is done then things are reassessed. If things have become more favorable then they will start Pitocin in the morning. You may be given a "break" following the Cervidil in which to walk around and eat. If the initial dose of Cervidil wasn't enough then they may apply another course of it. You can request repeated applications if you would rather avoid Pitocin.

If they start the Pitocin then they usually start it at the lowest possible dose. It will be increased preferably every 30 minutes until a good labor pattern is established. You will most likely be required to have continuous external monitoring but you should not be restricted to the bed. Move within the confines of the tethers or ask for a telemetry monitor (some hospitals have them).

Once labor is active and established you can request that the Pitocin be turned off so as to allow your body to labor under its own oxytocin. If labor stalls then you can try nipple stimulation, walking, relaxing in a tub, or position change before having the Pitocin turned back on.

Many Dr.s will want to break your water at some point. They either do this at a predetermined time (right before their lunch hour) or when you hit a certain dilation. Read over the risks of AROM. It may very well not be in your best interest to have this done as a matter of routine.

That is pretty much the average induction.

If Cytotec was used then it changes things. The Cytotec is a pill that is inserted behind the cervix. It may be used alone or followed up by Pitocin. Cytotec is so new that there really isn't a clear way to administer it. I do not encourage you to use this drug because there are safer alternatives. If you feel that it is in your best interest to use it then follow the ACOG's guidelines which is 25mg. Many Dr.s use too high of a dosage. It should also not be repeated any closer than 3 hours from the last dose and pitocin should *never* be given unless 4 hours have passed since the last dose.

This is one example from one nurse at one hospital. Protocols and practices vary from hospital, nurse, situation and care provider. But it should give you a realistic idea of what to expect.
1)PG Gels: 20-30 min of monitoring prior to insertion of gel, on the monitor for 1 hour post gel then up to walk for 45-50 min, Repeat X2 (total of 3 rounds of gel) then monitor and recheck cervix 1 hour or so after last gel, if baby is okay, mom is okay and labor has not started, go home. (no IV required)

2)Cytotec (misoprostil): monitor 20-30 min prior to dose, get dose either by mouth or vaginally, monitor for 1 hour post dose, up to walk for 1 hour then monitored for 20 min out of each hour. Doses are given every 4 hours to a maximum of 6 doses, although some docs do 4 total doses. If labor has started, great, continue on by yourself. If contractions are to numerous to give next dose and cervix is changing, continue on. Sometimes pitocin is started when cervix reaches 3-4 cms and contractions are not regular.
We require an IV access for Cytotec inductions.

3)Pitocin: Continuous fetal monitoring, okay to get up to bathroom. You don't have to stay in bed and can use a rocking chair, birth ball, stand, squat, etc at bedside as long as we can monitor the baby you don't have to be in bed.

4)AROM: no explanation needed intermittent monitoring (20ish minutes out of every hour)

Set realistic expectations for an induction

If you are inducing labor it most likely means that you are trying to get your body and your baby to do things before they are ready. Be respectful and patient with the process.

Don’t expect immediate results. Especially if you are a first timer.

Some moms do react to prostaglandin E2s very readily- and sometimes they react strongly and aggressively. But, the majority (70+%) don’t have any major changes during this process. That’s normal.

If you are being induced with no signs of labor already and an unfavorable cervix then it could be a long process. Expect to have contractions for 12-24 hours (yes, hours!) before your cervix really starts t change. Don’t expect progress of 1cm/ hour as soon as they start the pitocin. That’s an unrealistic expectation. (Actually, that 1cm/ hour thing is unrealistic in any labor and that theory is quite flawed when used in the US- it is called the Friedman Curve and it is used with regards to Active Management of Labor).

So, take things slow and steady. A common thing I hear is when given the choice between Cytotec or Cervidil moms are told that their Dr. or mw prefers Cytotec because it is faster. Who said faster is better?

Inductions are already stressful for mom and baby because they are trying to imitate a process that wasn’t ready to be initiated. Slow and steady isn’t a bad thing.

Your induction may progress very quickly but don’t go into the induction expecting that- even it isn’t your first baby or first induction. Every birth is different.

[SnuggleBuggles]

Inductions do not have to be that bad

Inductions do carry risks so it is a good idea to know some good strategies to help make things safer. Inductions do tend to get a bad rap and most of the time those cases are more because the induction was mismanaged.

By mismanage I mean this...
If you recieve pitocin they can almost play "Mother Nature." Do they have a lunch date or other patients close to delivery? Well, they can tweak your pitocin levels to speed up or slow down your progress. They can make things stronger and faster which can appeal to some Dr.s that like to work 9-5. The better way to induce is to be slow and patient. The very best technique is one that isn't often used unless requested. That is to establish contractions with pitocin, get mom progressing. Once she is in active labor turn OFF the pitocin. From there mom has a very good chance of continuing labor all on her own. The benefit is that the contractions are natural. They are as weak or as strong as HER body and baby need them to be. Sometimes they get obsessed with labor needing to have a particulair pattern to be effective (contx every X minutes, consistent and lasting X seconds). However, not all moms and babies want or need a labor like that. Even at the very end of my labor contractions were 1-7 minutes apart! I staill gave birth in a normal amount of time. I just didn't fit the textook version of how labor is supposed to be.

Now, there is a chance that they would turn off the pitocin and labor would stall. That's ok. There are other things to try. I would ask for an hour to walk, change positions and/or try nipple stimulation (releases nature's own pitocin). All you have to lose is some time. All you have to gain is a gentler, safer, easier birth for you and baby. It may help the bp too b/c you might not be working as hard.

So, that is my unprofessional (but well researched) pitocin advice. At the very least only let them increase it every 20-30 minutes (not closer) and don't let them keep cranking it up to adhere to some textbooks. Ask for time to just see how your body tolerates one level of the drug. The contx may not be picture perfect but they may be effective. kwim?

Another major mismanagement is breaking the water. This has become so common that most moms don't even realize that it is a bad or risky thing- and that keeping it intact has many benefits to mom and baby. We have been led to believe that breaking the water dramatically speeds things up. Studies have shown that it does speed up labor but not by very much (an hour or less). Yes, an hour less of labor may sound like a good thing BUT when compared to the risks it may not be worth it.

What are the problems with breaking your water? One thing is the pain factor. That amniotic sac works as a cushion for mom and baby. It takes some of the impact of the contractions off of mom and baby. Over and over again I hear moms say that they were handling the pain OK till their care provider broke their water. Or that their care provider told them that they should get an epidural before they break the water. Well, why break the water if it is going to increase the pain that much??? It doesn't need to be done.

Other risks include infection, being on the clock to deliver, possible limitation on activities, malpositioned baby (a situation that can really through a good birth off course), fetal distress, cord compression, and more interventions.

There is a time and place for AROM. But, it shouldn't be routine in your induction. Maybe if you are stuck at 6cm for 4 hours it would be a good option- assuming you haven't tried position change, walking, nipple stim, relaxation or water since they have the potential to speed things up too.

I would say "no" to Cytotec.

Cervidil or a foley catheter are good, safer options if your cervix is unfavorable.

I don't know if you are planning an unmedicated birth or not. If you are then a lot of the advice I already gave should help (turn off the pitocin, use it wisely when used, hang onto that amniotic sac, change positions...).

Beth

[jgriffin]

Wow, thanks Beth and everyone else! I've got a lot of reading to do in the next week (next appt is on Monday). Right now I'm slightly dilated (OB said barely fingertip, so I'm assuming <1cm) and about 50% effaced. What qualifies as a "favorable cervix"?

I hadn't planned on getting an epidural, but possibly something in the IV for taking the edge off the contractions. But I also didn't plan on getting an induction, so I really need to re-think our strategy.

[scoop22]

in my view of labor i did not want an induction at all. i almost cried ok i did when they told me i had to be induced. i was given pitocin at 8. 9:30 i asked for my epidural (LONG STORY THERE) but my water broke and ds was born at 12:35. i can't complain one bit. we are thinking about #2. i would definitly do it again. i know things are the same but i had a great experience. good luck with your decision. it varies.

eta: ds was born at 37 wks due to pre-e.
http://b2.lilypie.com/XbITm4.png

[JoyNChrist]

Well, I was supposed to go in and start cervadil for my induction on Thursday afternoon...and my water broke at midnight the night before! So I guess you never really know what's going to happen!

I did end up being given pitocin, since I only had 24 hours to labor (hospital policy if your water breaks) and wasn't progressing much. I was anti-meds, so I was upset about the pitocin, but faced with the choice between pitocin (and later an epidural) or a c-section, the pitocin was a no-brainer.

I'll say this about pitocin - it WORKS! And it works fast! I went from barely there, slightly uncomfortable contractions to full-blown "Oh my God I need an epidural right NOW" contractions in about an hour. Just so you know...you might want to have the anesthesiologist picked out ahead of time. ;-)

[scoop22]

well put!!!! i agree with the anesthesiologist. i asked for mine about an hour later as well...
http://b2.lilypie.com/XbITm4.png

[jgriffin]

I had this last time with E...without the help of pitocin. :) That's one reason why I'm beginning to think that an induction isn't going to be that different from what I'll do naturally, except I'll already be at the hospital instead of waiting for DH to get home.

[sdbc]

Hm. I don't recommend induction with no epidural. I ended up going that route because I was very overdue, I had been in mild labor for a couple of days, and was losing fluid, so they had to induce. I also was scared to get an epidural. So, pitocin, no epidural... Contractions on pitocin are really painful! I went on that way for nearly 10 hours with pitocin, nearly 7 of which, my cervix was stuck at 4 cm. After 7 hours with no additional dialation, I decided to go for the epidural since there was no end in sight (and then had to have an emergency C-section shortly thereafter).

I'd say, you are more likely to need an epidural with the pitocin. That said, you can try it without, like I did--I was able to go 10 hours without an epi, but it wasn't fun, and I would never choose pitocin with no epidural again. But if you choose to go without the epi, you can always get one later.

Sue, mommy to Aurora (Rory) born 5/13/04

[pb&j]

I had a great induction experience. I was 3cm when I got to the hospital, had cytotec to ripen my cervix, nothing much was going on, it seemed. The OB ruptured my membranes around noon, I was at 8cm by 1 or 1:30, no pitocin necessary. Definitely not as bad as some of the stories you hear. It was a great experience!! :)

[lisams]

I had two inductions, and both were great. I would prefer going into labor naturally, but both times I had pregnancy induced hypertension.

For my first they had to use gel because my cervix wasn't thinning or dialated (not Cytotec (sp?), which is IMO bad stuff, they used prostaglandin gel on my cervix). You have to stay laying down for an hour or so after the gel is applied and they typically have to do more than one. After about 4 hours and my cervix becoming more favorable they started the pitocin. It was a typical labor for a first time baby - about 10 hours with a couple of hours pushing.

With my second, my cervix was aready "favorable" (dilated to 3-4, and soft/thinning) so they didn't even use the gel. The dr. broke my water, they started the pitocin and 4 hours later with about 6 pushes DS was here! It was a wonderful labor!

With both I got the epi around 7-8 cm. The contractions were getting crazy - very strong and with little break between.

There is the the risk of needing more medical interventions with an induction. You also have to be monitored a little more closely. For me the risk of my hypertension becoming pre-eclampsia was higher than the risks associated with an induction.

Good luck with your decision!

[ast96]

I have had two inductions and both went fine. My first started with Cervadil and then Pitocin, and my second started with just Pitocin (my cervix was already fine). My first labor was 20 hours, my second was 10.

I think inductions vary so much because women's bodies vary so much, and you never know how your body will handle Pitocin. Mine does okay with it.

I hope you have a good delivery! I do not envy your traffic hurdles.

[tarahsolazy]

I cannot give you a good induction story, I had a failed induction with DS at 41 weeks due to pre-eclampsia. But I had an unfavorable cervix, and staying pregnant was risking seizures, so it was the best we could do.

However, as a neonatologist, my one piece of advice would be to NOT induce before 39 weeks, unless there is a valid medical reason to do so. The risk of breathing problems in induced or c-section babies goes way down after 39 weeks. So hanging in there awhile longer can have great benefits, IMO. Most babies born by induction or c-section between 37 and 39 weeks are fine, but some are not quite ready, and why take the risk if you do not have to?

[tylersmama]

I had a really good induction experience. I was overdue, so I went in for induction at 41w3d. I went in to labor and delivery around 7pm, they hooked me up to the fetal monitor, did a quick ultrasound, a cervical check (I was only fingertip dilated), and then started the induction. I had two doses of cytotec (a cervical ripener) four hours apart. The first dose didn't really do anything. The second dose set off contractions. I never actually needed any pitocin, just the cytotec. I got my epidural around 4 am (I was pretty uncomfortable being stuck in bed, or I would have tried to hold out longer). I got several hours of sleep overnight. My OB came in and checked on me around 7 am and broke my water. I was ready to push by 11 am, but we had to wait for my OB to come back. I pushed less than 20 minutes and DS was born at 11:39 am.

I think that you hear about the bad induction experiences and they stick with you, which is what scares you. I was terrified of being induced. I had a friend who was due 2 weeks before me who also was 10 days overdue and induced. She was induced Wednesday night and ended up with a c-section on Friday afternoon. That scared the crap out of me. I have two other friends who were induced (one of them twice!) and had super easy inductions, but those are harder to remember, I think.

Good luck with your decision! I guess I'm lucky I didn't really have to make the decision since I was so far overdue, but I know it would have been tough. Just remember, it definitely is possible to have a good induction, if that's what you choose!

[jgriffin]

Oooh, great advice! I'm sure (or at least I'm hoping) my doctor would have said something about this at our next appointment, but I'll be sure to bring it up.

[Alice523]

We are also in the Bay Area (East Bay) and I had a great induction! I went in to be induced after they diagnosed me with pre-e at my 40 week appt. I was 3 cm and 60% effaced. We started Pitocin at 11AM and the contractions started right away but they weren't painful until the dr broke my water at 2 or so. Then, it got extremely painful and I got an epidural around 3. After 1.5 hours of pushing, DS was born at 9:46. It was almost 11 hours, start to finish. I was really nervous about it, but it went beautifully and I couldn't have asked for a better experience.

BTW, I am still nursing my 17 month old, so neither the induction nor the epidural negatively affected breastfeeding for us.

Good luck!

[babyready]

I agree. I was induced due to complications and was really committed to natural birth. The contractions are quite painful with not a lot of relief between them.

Of course, I'm like a hero in some places when I say that I did pitocin with no epi. ;)

Just remember that in general interventions lead to more interventions. If that is OK with you, fine. If that is not OK with you, then you may want to reconsider.

Also, my mom had extremely quick labors (like 1-2 hours) and I had around 6. My hospital was an hour away but it didn't really matter in the end since I was on hospital bed rest for a week and then induced.

[peasprout]

I gave birth twice,...once without an induction and one with. I didn't have an epidural with either one and both were fast labors. All I can say is it was a LOT more painful when I was induced. I was fine with the pitocin until they broke my water and doubled the pitocin. Then it was minutes of intense pain before I was held back from pushing.
Since my two births have been super fast, my doctor wants to induce my next one so I don't deliver in the car. I really don't want to go through that again though. I think I'm going to insist on waiting.
That being said, I don't think it was horrible or unnatural. I was overdue so it was getting dangerous keeping him in any longer. But painful, YES. With an epidural though, I'm sure it's not that bad.

JP

[SnuggleBuggles]

I wonder if you just had pitocin and no AROM how thinsg would be? I can never understand why they like to break the water. Statistically it barely speeds things up the scheme of things when done routinely and it causes more pain and risk. It's just a strange obstetric trend, imo. Sorry for that soap box moment!!

Beth

[firstbaby]

Ask what your Dr. would do for an induction - start by breaking your water and then pitocin? Just break your water? Cervical gel? Etc...

I was induced with DS1. They broke my water and started pitocin. I could feel my labor and contractions being tweaked and changed when they would make changes to the pitocin. I did not like laboring in bed - I was trying to go natural. After six hours of the pitocin, I okayed them putting Staydol (sp?) to "take the edge off". THAT was a bad call - I felt like I was drunk in that the room was spinning and I threw up a couple of times. After nine hours of the pitocin, I got an epidural that only took on one side.

I personally think it is hard to have a drug free birth with an induction since they will usually break your water and that takes a bit of the cushion away. If you are planning to get an epidural anyway and the convenience of scheduling an induction appeals to you, do it.

[Rachels]

As for what qualifies as a favorable cervix, look up Bishop Scale.

-Rachel
Mama to Abigail Rose
5/18/02
http://www.gynosaur.com/assets/ribbons/ribbon_amethyst_36m.gif
Nursed for three years!

and Ethan James
10/19/05
http://www.mothering.com/discussions/images/smilies/bf.jpg

"When you know better, you do better." - Maya

[AngelaS]

I was induced w/all three of mine. Every time my midwife (in the hospital) started my labor by breaking my water. I wound up w/two medicated births and one completely drug free. I wouldn't hesitate to be induced again (not that I'm ever getting pregnant again, but you know what I mean ;))