Let’s talk induction!!! What do the numbers mean, what do the meds do and what choices do you have??
First off the induction process and available choices are different hospital to hospital and even provider to provider. The info below is what we as experienced birth doulas see most often.
First things first-the bishop score. Understanding how favorable your cervix is for induction is one of the main ways your provider will make an induction plans for you. In generally the higher the bishop score, the faster the induction and the inverse being true as well, though there will always be exceptions https://www.ncbi.nlm.nih.gov/books/NBK470368/figure/article-18340.image.f1/
When are inductions done? In a healthy mom and baby you’ll see inductions offered between 39-42 weeks depending on the provider. Inductions shouldn’t be offered before 39 weeks unless mom or baby is experiencing a complication.
Some reasons people would be induced early are: preeclampsia, gestational diabetes, low fluid levels, HELLP syndrome, ICP, high blood pressure, decreased fetal movement, poor non-stress test or low scoring biophysical profile.
So what does this all mean? Usually if you have a lower bishop score it means you will have a multiple step induction those methods include:
Cytotec (miso): this is a medication that comes in pill form. It can be taken orally or inserted vaginally. Depending on the route of administration and hospital policy doses can be given every 2-4 hours depending on cervical change and how much the uterus is contracting. You need the IV placed and to wear the monitors while you have it. Traditionally it given vaginally every 4hrs, up to 4 pills. Some docs will do the balloon and cytotec together so it doesn’t add any time to the induction process. Some do 1-3 doses first (so 4-12hrs) and then the balloon. It makes you crampy, but is doesn’t commonly put people into labor unless your body is almost there on its own or you’ve had a baby or two vaginally before.
The CRIB (cervical balloon) isnt the most comfortable to have put in for most people (most clients opt for IV pain meds to have it placed especially when the cervix is barely dilated or very long) and is usually in for 6-12hrs. It feels like a bad period for most people and is just uncomfortable all around because there’s a tube hanging out of you with tension. For some people the balloon comes out very quickly. Usually the closer it is to being ready to come out the more uncomfortable you are. Most people are 3-5.5cm after the balloon comes out depending on if it comes out on its own vs is removed and how thin the cervix is.
If your cervix is soft and somewhat thin, they’ll usually do just the CRIB or just cytotec unless there’s a medical need or personal desire to move it along faster.
Pitocin is done via the IV. If your cervix is open and soft they sometimes go straight to pit, (usually 2+cm). Sometimes people kick into gear and only need 6-12hrs of pit (thin cervix, multiple babies before, already contracting on their own), but more common is 12-24hrs.
Pitocin labor pattern is different compared to a natural on set pattern. Natural onset contractions get stronger/longer/closer in unison as labor progresses. Pitocin they get close first (2-3 min apart), then strong, then long. This usually results in looking like/feeling like you’re in more active labor compared to your cervical dilation initially. Your cervix will catch up, but this can be hard mentally.
Pitocin is given continuously through the IV and turned on at a dose of 2 and turned up by 1-2 units slowly until you reach the 2-3 minute apart pattern. There isn’t a specific dose they’re aiming for, more just a specific pattern of contractions. Once you get to that pattern they will leave your dose alone. If you’re contracting too much it’s turned down.
Breaking your water usually is part of an induction process but doesn’t need to be. First off if you’re walking around very dilated 3+ cm some providers will agree to let you try an induction of just breaking the water to start if the baby is low enough to see if this will trigger labor. In most cases your provider will offer/encourage to break the water after your pitocin has started, baby is lower and the cervix is changing or an extended period of time has passed on pitocin and no cervical change is happening.
Ultimately there are tons of different ways you can be induced and your personal preferences for your birth, your providers standard of care, your health and where your bishop score is will all factor into which method(s) of induction are recommended for you.
