Dr. Michelle Santoyo returns to Healthful Woman to talk about inducing labor with Dr. Fox. In this episode, they discuss why an OB/GYN would choose to induce labor, what the process is like, and what patients should know.
Dr. Santoyo explains that there are three major reasons why labor might be induced: for maternal health, for fetal health, or as an elective option.
An induction may be necessary for fetal health due to growth restriction, low amniotic fluid, or “signs the placenta is not functioning at the capacity it should.” Dr. Santoyo explains that “these tend to be sonographic findings.” Dr. Fox adds that situations where the baby is in immediate danger are rare, and that usually it is less urgent.
For maternal health, common issues include gestational diabetes, elevated blood pressure (including preeclampsia), advanced maternal age, or other underlying issues both specific to the pregnancy or general health concerns the woman has. For example, a woman with an autoimmune disorder may be recommended to have an induced labor.
Elective inductions are also possible. Dr. Fox explains that in this situation, “there’s really no reason to deliver other than the mom [or doctor] says ‘I don’t want to be pregnant anymore.’” This can also be “purely like a social scheduling kind of circumstance.” For example, if a doctor knew they were going out of town towards the end of a woman’s pregnancy, they may choose to schedule an induction to make sure they deliver her baby. Dr. Santoyo adds that “sometimes, people just want a plan and some sense of control.” In the past, elective inductions were frowned upon because inductions had a higher rate of C-sections. However, new studies have found that there isn’t a real connection between elective inductions and a risk for C-sections, so this is largely no longer the case.
Most inductions occur after 39 weeks. For most scheduled inductions, the patient comes into the hospital between 8 and 10 pm, and once they are checked in they are put on IV fluid. Dr. Santoyo recommends that they then get an epidural if this is part of their plan, and stresses that “there’s no brownie points for waiting.” Some patients believe that an epidural slows down labor, however, this is a myth.
Next, a cervical balloon is placed, which is for “mechanical traction of the cervix.” After placing the balloon, Dr. Santoyo says “I tell people ‘nothing will happen for a long time,’” and “your goal is to sleep.” When the balloon comes out, the cervix is usually dilated to 3-4 centimeters.
Once the balloon comes out, the water is broken and Pitocin is started, if it wasn’t already. Then, patients wait until the cervix is dilated to 10 cm, which “could take anywhere between 6-12 hours, and that would be normal.”
There is a misconception that inducing labor takes longer, however, this is only because most patients who are not induced have already been laboring for about 3-12 hours before they get to the hospital, while induced patients spend this entire period of time at the hospital. In fact, Dr. Fox explains that “when you go into labor on your own, something is happening slowly,” while in comparison, induction “is going to get you from point A to point B much faster.” Dr. Santoyo says “as long as you’re patient, we’re patient too.”
Dr. Fox explains that conversations about induction are “much more meaningful” if the patient has a more collaborative and close relationship with her OB/GYN. This allows them to trust in their doctor’s advice and work together to create the best possible plan.
Patients should also be flexible about their plans, because things change quickly toward the end of a pregnancy. It’s possible, for example, to unexpectedly learn that you should be induced at a routine appointment. Drs. Fox and Santoyo also explain that for this reason, it’s good for partners or support to come to appointments toward the end of the pregnancy.
Maternal Fetal Medicine blogs are intended for educational purposes only and do not replace certified professional care. Medical conditions vary and change frequently. Please ask your doctor any questions you may have regarding your condition to receive a proper diagnosis or risk analysis. Thank you!