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Medical Inductions Part 2 - Tricking The Body Into Labour


By Kimberley Fernandez - CLD, CCCE

Kimberley is a dual certified doula and childbirth educator, and a certified sleep consultant. She has been working with pregnant and new families in their birth and postpartum journey since 2006, and currently teaches prenatal classes virtually as well as offering virtual classes through her teaching portal "The Birthing Room"


 


As the holiday season approaches, I thought I would continue down this path of induction and make it a bit of a series. We see around the world, particularly in the US, care providers suggesting inductions before major holidays so as not to interrupt their own time off. In Canada, we have a different system, when you go into the hospital you will get the on-call OB, and that may not be your own doctor. With midwifery care, they work in teams so again, you may not get your primary midwife on the day of delivery. I didn't with my first and I was very pissed about it. I did not like my secondary midwife at all. But thankfully I got transferred to the on-call OB who was wonderful and who I chose as my health care provider for my next two births.


Surprised by the title of this blog? Well in essence, a medical induction is care providers tricking the body to go into labour. Through various procedures and medications, the OB or midwife is hoping to trick the body into taking over the process of labour. Let's look at how they do that.

How an induction is started will depend on what the cervix is doing at the start of the process. If the cervix is still closed, thick and firm, the process will be longer and require more work. If the cervix is softened, and a little dilated then the care providers have less work to do. So lets start on the basis of a fully closed, firm cervix.

Prostaglandin - With a cervix that has not started getting ready for labour the care provider will start with trying to soften the cervix up a bit. The most common way in Canada is with either an insert into the cervix of a product called Cervadil or a gel of prostaglandin. These can cause cramping and with cervadil, it can be easily removed if the body is very sensitive to it. These would often need multiple doses to get the cervix softened and dilated slightly.

Side effects can include, fever and chills which may put you in line for covid protocols, vomiting, and diarrhea. Plus you will need a stretch of continuous monitoring of you and baby to make sure neither of you is reacting too negatively.

Foley Catheter - If the cervix is still long but starting to soften and may be opened just a smidge (that's a technical term), the care provider may use a Foley catheter which is a tube with a balloon on the end of it that is inserted into the cervix to apply pressure and encourage the cervix to open more. Preferably to about 2-3cms dilated. This is a drug free method that can be quite effective and is less likely to cause fetal distress or lead to a cesarean birth because of hyper contracting.

Side effects can include a risk of infection, discomfort and possible bleeding.

Amniotomy or Breaking Your Waters - Once the cervix is dilated to about 2-3cms and is softening, and if baby is low enough in the pelvis, they my use a long crochet needle like device to break your waters. This will flood the cervix with amniotic fluid which is high in prostaglandin and can help get the cervix softened and get the uterus contracting.

It's a good idea to ask to walk around for an hour or so after the amniotomy to get baby's head more directly applied to the cervix. As usually once the waters have been broken, the hospital will start Pitocin.

Side effects can include infection, as well as cord prolapse if that is still high up in the pelvis at the time of the waters being broken. And as previously mentioned, usually Pitocin is started to augment contractions.



Pitocin (Synthetic Oxytocin) - This medication is used to increase the strength and frequency of contractions and is usually the last step used in an induction. Administered through an IV, it is started at a very low dose and then gradually increased over time until contraction are 2 - 3 mins apart.

Side effects can include more intense contractions, hyper contracting, fetal distress so you will be on constant fetal monitoring, increases need for a surgical birth and more serious effects include uterine rupture and serious bleeding after birth. Prolonged use of Pitocin in labour can block your natural oxytocin from flowing so I suggest lots of skin to skin afterwards to help with oxytocin release and bonding and body feeding after the birth.

As a result of these multiple procedures and medications that come with a medical induction, it can mean your labour can take a much longer time than you anticipated, especially if this is your first baby. Being induced on a Tuesday, doesn't mean baby will born on Tuesday. Baby may not be born until Wednesday, or Thursday... So have some patience with the process and hunker down for a long wait. You may also want to consider asking to go home in the initial stages to do some of your labouring at home until contractions pick up.

Next week we will address some things you can do "naturally" to encourage your body to go into labour.



Want more information on Medical Inductions? Check out my virtual class Induction 101



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