Reasons for Induction
We feel strongly that your best chance for a successful vaginal delivery occurs when you enter labor on your own!
However, sometimes labor doesn’t start on its own and it becomes “medically appropriate” to have your baby anyways. This is when we induce labor—that is, artificially start the labor process. The “appropriate” time to have your baby may be based on your medical conditions, if you are overdue, or other special logistical circumstances. We balance the risks to you and your baby by prolonging the pregnancy, versus the risks of prematurity and unintended cesarean delivery.
Medically Indicated Inductions
Several pregnancy related complications can increase the risk of stillbirth. Examples include preeclampsia, gestational diabetes, lagging fetal growth, and low amounts of amniotic fluid. Certain maternal medical conditions also increase your stillbirth rate, such as hypertension, a previous stillbirth, obesity, age greater than 40 years, or blood clotting disorders. Each condition or complication has a recommended gestational age-range for induction. This age balances the increasing risk of stillbirth against the difficulties associated with prematurity. Most medically indicated inductions occur between 37 weeks and your due date. Often, we will want to provide fetal wellness assessments in our office during the weeks prior to induction.
Keep in mind that your due date is just our best estimate of delivery; only five percent of babies deliver on the actual due date! Normally babies will arrive between three weeks early and two weeks late. For many years the medical community felt that up until 42 weeks the risk of stillbirth was acceptably small and difficult to reduce further (approximately 1 per 1,000 live births). We still feel that way! If you would like to wait for labor up to two weeks overdue, we support you. In the past ten years, large studies have found that the C-Section rate doesn’t increase for women who are induced at 41 weeks, compared to those women awaiting labor until 42 weeks. So, the contemporary practice is to allow “overdue” inductions after the completion of 41 weeks. If you would like to be induced, we will discuss the logistics as you approach your due date. Our hope is that you’ll go into labor, but we can still reserve an induction date with Rex Hospital as a back-up plan. Our office staff will call Rex to arrange it and then contact you for confirmation. Remember, you must be at least one week overdue.
In general, we discourage inductions without a medical basis since this historically has thought to increase the likelihood of C-Section. Some new studies (the ARRIVE trial) suggests that induction after 39 weeks may be a reasonable course, however. We do recognize that sometimes it makes the most sense for your baby to be born on your schedule. Common requests include military deployment of a spouse, arranging special needs- or elder-care, workplace restrictions, geographical distances, or mobility limitations.
Scheduling & Logistics
Rex Hospital allows us to schedule your induction up to one week in advance. Although it may make your planning more difficult, it keeps the scheduling books open by diminishing competition among the nine Ob/Gyn practices making ‘just in case’ reservations. Rex permits five or six inductions each day in accordance with nurse staffing levels. They also permit just one elective induction per day, which are in high demand. At Arbor we do our very best to schedule your induction such that your actual delivery occurs while we are at the hospital, and not at a time that might be covered by our call-sharing partner group Wilkerson ObGyn.
Exactly one week in advance of your planned induction, the Arbor ObGyn nursing staff will contact Rex to request your date. After it is secured, we will confirm with you by phone that an induction slot is Reserved for you at the hospital. A Reservation only means that you are on the Labor & Delivery schedule (which is limited in number), and that the doctors are planning to induce you that day. It does not guarantee an admission that day: Occasionally, the Rex Birth Center is at capacity and they may have to postpone your induction by a few hours or more. Sometimes it may even be pushed back a full day. Further, there may be other patients on your day’s induction schedule that are prioritized over you due to their medical conditions. Although we always advocate for your admission to the hospital, the final authorities for bed availability are the Charge Nurse and Manager of Rex Labor & Delivery.
If you are to come into the hospital the night before your induction – for the “cervix ripening” – you will be called by the evening-shift Labor & Delivery Charge Nurse between 7:00 – 9:00pm. At this time you will receive instructions on when to arrive at Rex, or will be informed if there will be a delay. If there is a delay, the Charge Nurse will let you know when her next call to you will occur, and she will be able to give you some realistic expectations about the evening.
If you do not need the cervix ripening and are expecting to arrive in the morning of your induction, then you will be called by the Labor & Delivery Charge Nurse between 6:00 – 8:00am. At this time you will receive instructions on when to arrive at Rex, or will be informed there will be a delay. If there will be a delay, she will let you know when you should expect to hear from the Charge Nurse.
Please keep your cell phone nearby. Also, have your bags ready and childcare arranged so that you can arrive quickly after being called to the hospital. Come to the Women’s Center and check in with the security desk. They will usher you to the second floor, where the L&D staff will get you settled.
Lastly, in your Arbor ObGyn portal account you will see an early morning Induction appointment. Please do not come to the office or hospital at that time! This appointment notification is merely an administrative place holder, so that we can keep track of our induction commitments. Before heading to Rex, you must receive a call directly from the L&D Charge Nurse.
The Induction Process
Induction of labor is carried out at the Rex Hospital Birth Center. The method of induction that we choose depends on your cervical dilation and effacement (thinning). If your cervix is not very dilated or effaced then you will come to the hospital the night before your induction to undergo ‘cervical ripening.’ There are several methods that we may use with the ultimate goal to dilate and efface the cervix overnight under restful conditions. Mechanical dilation with a balloon catheter and oral Misoprostol medications are two of our most common techniques for ripening. You will stay overnight and continue the induction in the morning, as described below. Your partner may stay with you overnight, but it is not necessary.
If you don’t require ‘cervical ripening’ then your induction will most likely start in the morning. Once at the hospital you will be taken to a labor room and be administratively admitted. The Arbor doctor will then see you and get the induction started. The usual method of induction involves giving you oxytocin (Pitocin) medicine through an IV, breaking your water, or both. After this we typically increase the oxytocin dosage until your contractions become strong, three minutes apart and you progress into early labor. At that point, your labor will be the same as if you had come in for spontaneous labor.
If this is your first baby, we anticipate delivery sometime in the evening hours – although there can be quite a range. Be aware that some women will labor for more than 24 hours. If you have had a delivery previously, then the process is typically quicker.
Please pack light. You only need to bring those items that you want during labor. For most people that would include items like a pillow from home, a water bottle that you love, and a camera (if you want one other than your phone). Also, please be aware that your belongings are your responsibility while you are at Rex.
During the labor you may have up to three visitors with you, including your spouse/partner. Visitors may rotate in and out of your room but you may only have three at a time. Let your visitors know that they will have to check in with security at the entrance and will need to wear the visitor’s tag at all times. The waiting area for visitors is on the ground floor next to the security desk. When your visitors are not in your room they must wait in this first floor waiting area. For patient privacy reasons they are not permitted to wait outside of your room, in the designated area for arriving pregnant patients, or wander in the hallways.
Please take a few minutes to re-familiarize yourself with the second half or your Arbor Pregnancy Handbook, which covers the topics of Rex Hospital, Labor, Induction, C-Sections, Epidurals, and Postpartum. We hope you go into labor on your own soon enough, but if not we look forward to helping you through your induction of labor!