For various reasons, some women either choose to induce labor or are pressured by their medical providers to induce labor medically. Whether you fall into the first or second camp, I want you to know you have options on how induced labor works. You always have options, even if an option is to do nothing, for hours, days, or weeks. Let’s talk about what information you’ll need to know your options and what these may look like…
What is an Induction of labor?
Induced labor or Induction of labor is when a woman’s body is not given its own time to spontaneously go into labor, but instead, there are interventions, either medical or natural, to stimulate and bring about labor. This can either be performed at the mother’s request or if the provider deems it medically necessary.
Why would a Provider recommend Induction of labor?
Most obstetricians, as a standard protocol, check the patient’s cervix for dilation at 37 weeks. Sometimes the mother is asked for her consent for this cervical ripening check and sometimes it’s assumed this is “just how it’s done” so no one asks for the mother’s consent. Just to give you a frame of reference, an expectant mother needs the cervix to ripen, dilate or open from 0 to 10 centimeters. At 10 cm, her cervix is considered complete and she is ready to birth her baby. But cervical dilation or ripening is just one factor in the induction process! Other factors are the effacement, or pliability, of the cervix (0-100%); the station of the baby (-3 to +3); the consistency (hard-soft) of the cervix; and the position of the baby in the womb (posterior-anterior). All of these factors make up the Bishop’s score, something many providers don’t even bother taking the time to calculate anymore, especially with educating expectant Mothers about how Induced labor works.
So what does the Bishop’s score mean?
In short, A LOT! If the Bishop’s score is 6 or higher, the chances of the mother having a successful medical induction are good, and the higher the number, the better the mother’s chances of having a successful medical induction. You can find a Bishop’s score calculator here, before a cervical exam. You can ask your provider to tell you your Bishop’s score or provide you with the information to calculate it yourself. Make sure you subscribe for more information on cervical exams next month!
However, if a medical provider is recommending a medical induction of labor, the mother still has the right to informed consent or informed refusal after a foreknowledge of how induced labor works, just like any other medical procedure. Informed means just that, the mother is informed about her options, the risks and benefits associated with each, and given a reasonable amount of time to make a decision to consent or refuse an induction of labor based on the information provided. Knowing your bishop’s score alone is not enough information to make an informed decision for or against a medical induction. Consider the gestational age and your mental and physical readiness for the baby to arrive, consult with your doula and your spouse or another loved one, and pray. God’s timing is always better than humans'. After knowing all the information, including your options, be willing to wait until you feel peace in your heart about the decision. Check out Pregnancy Promises by Melody Castrellon below for more on God's perfect timing!
Medical vs. Elective Induction?
A medical induction uses, you guessed it, medication or medical intervention to induce labor. An Elective Induction is when an induction of labor is not medically necessary but is chosen for convenience. The same methods apply for both. Some of the most common methods for an induction of labor are cervical ripening agents, foley bulb, and membrane sweep. Let’s look at these methods…
Cervical ripening agents can either be a rod, suppository, or prostaglandin gel inserted vaginally, a pill taken by mouth, or an IV medication administered through the vein.
There are a number of agents but the most common are dinoprostone or misoprostol. Both medications are drugs that have several different forms. What method is used should be your choice, but most times the provider makes the decision without giving the mother facts about the rates of effectiveness. Another factor in deciding the ripening agent is the availability of the drug in the medical facility you’ve chosen for induction of labor. The Foley bulb is very similar to the rods or suppositories but is not medication. A catheter is inserted into the vagina and blown up with saline. The pressure on your cervix created by the catheter encourages your cervix to open. Typically, it’s inserted by medical staff in a hospital during the evening hours and sits overnight in your vagina, but some providers perform this procedure in an outpatient setting.
A membrane sweep is often the first procedure or intervention that a mother undergoes in an induction of labor to prompt the onset of labor. A membrane sweep or strip is when a provider inserts two fingers of a gloved hand into the patient’s vagina and cervix to the amniotic sac and sweeps around the sac to prompt the sac to separate from the uterine wall thereby instigating the beginning of labor. Some women say it’s the worst cramps they’ve ever had and would never agree to the procedure again, and some women ask for a membrane sweep, even up to three membrane sweeps if labor isn’t beginning. Something to keep in mind regarding how induced labor works, is that all women are different and all babies are different, down to even our fingerprints. What works for one mom may not work for another, and what worked for a previous birth, may not work for this birth.
The mother should also consider the risks involved in a procedure. For prostaglandin gels, or suppositories this could cause an infection called chorioamnionitis because the provider would be more satisfied with monitoring how well the cervical ripening agents are working. Therefore, there would be more cervical exams and the more cervical exams, the more likely the mother is to develop an infection of the uterus. In a membrane sweep, this could rupture the amniotic sac or cause the water to break.
All births are not created equal, thank God! If they were, so many women would have to suffer through a less-than-stellar birth again and again, but we have the opportunity for God to redeem our past and rewrite our story with each birth!
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To listen to our Redeeming Eve episode on inductions, visit bit.ly/reinduction.