Inductions are a hot topic in the “birth world.” Are the necessary? Sometimes, absolutely. Are their unnecessary ones? Sometimes, absolutely. This post isn’t going to be about whether or not your induction is/was necessary, instead, I would encourage you to check out ACOG’s stance on inductions, as well as head over to Evidence Based Birth and check out her posts about inductions (they are awesome, and so thorough). What this post IS going to be about is pitocin during inductions, and other induction options that you might have. I say “might” because every situation is different, every care provider is different, and every hospital is different. As always, we are not care providers, so please discuss anything that you read here with your provider regarding your specific situation.
Inductions happen for many, many reasons. All induction methods are not equal, but one thing that IS something every woman who is facing induction should consider is her Bishop Score. The Bishop Score is a scoring system that providers can use to determine how likely an induction is to succeed, and also the liklihood of spontaneous pre-term labor. The Bishop Score is determined by scoring from 0-3 each of the following: cervical dilation (0-10 cm), cervical effacement (0-100%), cervical consistency (firm to soft), cervical position (anterior to posterior), and fetal station (how high the baby is in the pelvis).¹ For a great chart with this scoring system on it, check out Wikipedia. The higher a woman’s score, the greater chance of a successful induction (successful meaning ending in a vaginal delivery). A score of 8 or higher is generally considered to be favorable for induction. If a woman’s score is not “favorable,” it does not mean that she will be unable to have a successful induction, it just means it’s less likely. If you have a lower Bishop score, and are facing an induction, have a chat with your care provider to see what options you might have to make your chances of an successful induction better (waiting, for example, or possibly going home if induction doesn’t start labor).
If you and your provider agree that an induction is the best course of action for you, make a plan for how you would like your induction to proceed. You have options about how to start the induction process. These include a cervix ripening suppository, if necessary, which often takes more than one day to make an effect on the cervix. Cervidil and Cytotec are both used to help soften the cervix, but we strongly encourage you to look into the medical indications for using cytotec. If you choose a cervical ripening suppository, you will be checked into the hospital and stay (usually overnight) while the suppository is in place. Sometimes these cervical ripeners also start contractions, in which case you may need nothing else to get labor going! After doing the cervical suppository, often pitocin is the next option. Pitocin is usually started off slowly, and increased as labor goes on. Sometimes if a woman’s body appears to take over all by herself, pitocin is turned off. If your cervix appears favorable for induction, but you want to avoid pitocin, another option is AROM (artificial rupture of membranes). This is sometimes done in addition to pitocin is the pitocin doesn’t seem to be doing the job on its own, but could also be done without pitocin. This basically means that your care provider will break your water, which hopefully signals to your body to start contractions. Another option for starting an induction is a Foley bulb catheter. This is a catheter that is inserted into the opening of the cervix. The catheter is slowly filled with water to dilate the cervix. Once the cervix is dilated to 3 centimeters, the catheter falls out or is taken out, and hopefully will have encouraged a woman’s body to start contractions and continue the dilation process.
Inductions do not always have to be an all-or-nothing process. We have all had clients and know others personally who have gone in to attempt an induction, have it not work, and leave to come back and try another day. Pitocin can be turned off and the induction can be halted, as long as a woman’s water is not broken. Once a woman’s water is broken however, the induction needs to proceed forward due to the risk of infection for the longer the induction process goes on. Have the discussion about what you would like to do if the induction does not work ahead of the induction, so that you and your care provider are on the same page.
There are also more “natural” methods for potentially inducing labor. We are not endorsing any of these, and none have been scientifically proven to work, however they are options that you can talk to your care provider about, should you be interested in them. The first, and most often recommended method of starting labor is by having sex. The prostaglandins from semen can help ripen the cervix, and an orgasm causes contractions of the uterus, which can also start labor. This will only work if a woman’s body is ready to go into labor, however. Having sex at the end of pregnancy is not going to put you into labor if your body is not ready for it! Other options are nipple stimulation (manual or breast pump) and taking castor oil. There are also plenty of opinions about which foods can also induce labor– we have never seen any of these necessarily work, but many of them are worth a shot (spicy foods, pineapple…you name it 🙂 ) Natural methods of labor induction can be used in addition to medical options for induction, as long as you have the discussion with your care provider ahead of time.
Next up in our blog series about pitocin, we’ll be discussing pitocin during labor for augmentation, as well as pitocin used postpartum. Stay tuned!