Getting Induced? A Few Things to Change in your Natural Birth PlanOct 13, 2022
First the good news! Most of your birth plan can stay intact, even if you are choosing induction.
When a woman has planned long and carefully for a natural birth, it can feel so discouraging to face induction. She might feel like her plans were meaningless, her values misplaced, her hopes foolish. None of this is true.
If you are an intentional woman, who knows a good reason for induction when she sees one (hint: those are rare—we give you a roadmap for an informed induction decision in the Intentional Birth program), then if you are choosing induction your plans have led you exactly where you need to be.
Second, more good news. You don't have to take whatever induction they are serving at your hospital. You can be informed and intentional about all of your options! Read more about how to have a gentle induction.
Now for the other news. Besides the obvious changes to your birth plan (no laboring at home, acceptance of induction drugs, IV port, etc.) There may be a few items on your natural birth plan that you will need to reconsider because you are choosing induction. The decisions are still in your hands.
But while the evidence is against some practices during normal birth, it supports the use of those same practices in an induced birth.
Continuous Fetal Monitoring. Strong evidence suggests that continuous EFM during a normal birth is not necessary, and actually increases the use of cesarean surgery without improving outcomes. But common induction drugs such as Cytotec (Misoprostol) or Pitocin can hyperstimulate the uterus and reduce oxygen to the baby. Because the risk of fetal distress is now higher than in a physiologic birth, continuous fetal monitoring may be indicated.
Pre-labor Vaginal Exams. These are not evidence-based under normal circumstances. But if you are contemplating induction, a vaginal exam can give you more information on which to base your decision. How soft is your cervix? How open is it? What position is it in? How thick is it? What station is the baby in? The answers to these questions can be combined to give you your Bishop Score. Higher than 8? That's pretty favorable and you are more likely to have a successful induction. Lower than 7? Your induction is more likely to lead to a cesarean (and/or to be very long).
Vaginal Exams During Labor. During a normal birth, many signs indicate labor progress besides cervical exams, which are uncomfortable and disrupt the hormonal flow of labor (and don't accurately predict how long your labor will take from here). But when induction drugs or mechanical tools are being used, external signs of labor progress are not always as easily interpreted. Sparsely used, vaginal exams may help you make informed decisions about your induction process, such as when/how to adjust drug dosage. (Join us at Intentional Birth to learn how to feel safe and comfortable during a vaginal exam).
Postpartum Pitocin. There is no evidence supporting the use of routine Pitocin after an otherwise physiologic (drug and intervention-free) birth, to prevent hemorrhage. But the use of Pitocin, and the use of an Epidural both increase the risk of postpartum hemorrhage. For this reason, a "managed third stage," with Pitocin delivered immediately after the birth of the baby, may be indicated. (Keep in mind though, that no evidence supports the use of "fundal massage" for hemorrhage prevention if Pitocin is already in use. You can skip this very painful pummeling, and gently palpate instead to determine the shape and position of the uterus).
Proactive Breastfeeding Support. There is an association between the use of Pitocin and reduced breastfeeding success. This is nothing to worry about! It just means that you want to be proactive about getting good breastfeeding support your first few days and weeks. Spend tons of time skin-to-skin, and enjoy that sweet newborn!
We've got a very handy gentle induction guide in our Intentional Birth program, plus a deep dive into the induction decision process, and experience. (We also have some great advice on how to avoid an unnecessary induction!)
Even if you are planning a physiologic birth, it is important to be informed about your options. It doesn't undermine your plan to be prepared for alternate scenarios. Rather, it reflects your intentionality and commitment.
Photo by Paige Driscoll