DiscoDoula.com - Thinking Induction?

When Induction Is Being Considered

A. The Current Situation

What is baby's gestational age? Risk of complications increases when the forty second week has passed, but some women just have longer gestation times than others, and women do have babies past the forty second week mark. Could there be a mistake in due dates?
Are you dilated? Effaced? At what station is Baby? In what position is Baby? If you are dilated or effacing, then your body is on its way, at its own pace. Maybe your body is waiting for Baby to turn and settle down? Inducing labor before Baby is in an optimal position greatly increases the risk of a posterior or asynclitic presentation (these labors are harder than those with the typical anterior presentation) and your risk of a caesarian section is increased.
How is your health, physically and emotionally? How is Baby's health? Are any of these (or similar) situations present: ruptured membranes with signs of infection or heavy meconium; severe pre-eclampsia/high blood pressure, severe diabetes; severe blood incompatibility; Mom too exhausted to go on (i.e. labored out and stalling to the point of risking a C-section) ; "post-date" with a proven danger to Baby or a failing placenta ?
Are you considering induction due to physician's convenience, medical emergency, or emotional frustration?

B. What Your Body Is Currently Doing

CRH and the fetoplacental clock: The fetal brain and the placenta are producing "corticotropin-releasing hormone", which "regulates the timing of the birth by triggering the changes in the mother's uterus and in the fetus that must precede labor." (Pregnancy, Childbirth, and the Newborn by Penny Simkin) The rate at which the CRH is produced is called the "fetoplacental clock" and its rate varies from woman to woman.
Rising Estrogen + Decreasing Progesterone = Increasing sensitivity to oxytocin. Your estrogen is rising, and the ratio of progesterone to estrogen is dropping. Progesterone is "pro" "gestation" and when there is less progesterone in relation to estrogen, the uterus is going to start contracting. In a non-pregnant woman, that means her period will begin. In a pregnant woman, it will trigger labor. In a pregnant woman who is not producing enough progesterone, it will cause a miscarriage, and that is why some women need the early progesterone shots. The higher the ratio of estrogen is to progesterone, the higher will be the sensitivity of the uterus to our good friend oxytocin, which causes contractions.
Prostaglandins are being produced in your body in appropriate amounts, which will cause contractions. You may want to try natural methods of prostaglandin augmentation before trying synthetic prostaglandin gels, which can cause hypertonic contractions.
Fetal adrenal glands are maturing and producing cortisol, which inflates the lungs.
Engagement, rotation, and descent are in progress. If Baby is not in a good position, and your membranes rupture, either spontaneously or artificially, then he could descend in such a way as will give Mom a very long, hard labor. Baby needs to rotate and engage properly. These last days of your pregnancy are the best time to be doing pelvic rocks, belly dancing, anything which gives Baby many opportunities to rotate properly. Much of labor is simply spent trying to get Baby to rotate! Be patient and you may very well be rewarded with a shorter, milder labor if your baby has turned.
Immunities are transferred to Baby because the old placenta is more porous and allows the immunity molecules to pass through. As long as you are waiting and we are talking placenta, this is a good time to think about what you'd like to do with your placenta. Most women dispose of theirs. Some women keep it and bury it under a tree, or make prints (that look like a tree) to frame. Some women have theirs professionally dehydrated and turned into capsules which will greatly ease their menopausal transition in years to come. If you are prone to postpartum depression, those capsules could come in handy as many a woman has staved off PPD in this way.
Ligaments and cartilage in the pelvis are relaxing.
The vaginal wall is becoming more elastic.
Baby is storing iron, which will supplement the little that is in breastmilk (which is actually more bioavailable to Baby than the voluminous amounts you'd find in formulas). She is also storing fat to hold her body temperature up. The more she has to fight to keep her temps up, the more energy she will use. The more she expends energy, more tired she will be, and the more frequently she will need to eat.
You are psychologically preparing for labor and impending new motherhood. How are you feeling about these great changes in your life? Sometimes our fears have a great impact on our bodies, and it could be that you just need a really good talk to get things off your chest and send that unconscious signal to yourself that "now we can proceed!" It is well established that fear/anxiety causes the body to produce adrenaline and a "fight or flight" response. If you are already in labor, the adrenaline will slow or stop your labor. If you are not in labor, the adrenaline will be sure to keep you that way!

C. Possibilities

What are the available natural induction options? Discuss these options, their risks, and their benefits: breast stimulation, walking, herbs, homeopathy, enema, castor oil, chiropractics, acupuncture, sexual intercourse, massage, reflexology, and yoga.
What are the available medical induction options? Discuss these options, their risks, and their benefits: stripping membranes, prostaglandin gels, pitocin, artificial rupture of membranes, cytotec.
Brainstorm possible scenarios in light of your birth plan and vision, and how these might be affected by certain induction techniques. For example, suppose you wish your water to break on its own, but you are open to pitocin. What will you do if you have been at the hospital for over 24 hours, and the pitocin to augment your stalled labor has only given you painless, non-dilating contractions? Can you face packing your bags up and going back home, or are you likely to throw in the towel and face a very hard labor with ruptured membranes and pitocin in your system? Or say you want to labor at home as long as possible. A pitocin/AROM induction would conflict with that, but you could very likely receive a dose of prostaglandin gel and go home. Being aware of yourself and how you make your decisions under stress or pressure will be a tremendous help in brainstorming these scenarios.

D. Your Birth Plan

What does your birth plan say, and how does that relate to the current situation?
Do we need to make changes or additions to the birth plan? How will the amended birth plan get into the hands of the caregivers?

E. Your Satisfaction

What do we need to make this a safe, satisfying and joyful experience for Mom?
What do we need to make this a safe and gentle experience for Baby?
What do we need to make this a joyful and satisfying experience for Dad?

~Remember 2/3 of babies are born
within ten days
of their estimated "due dates"!!!~

Other induction stats and facts to keep in mind....

According to ACOG, 95% of postterm babies are born between 42 and 44 weeks.

ACOG does not condone inductions where medical necessity is absent.

Inductions are necessary about 3% of the time, and are done nearly 20% of the time, on average.

Tests performed to assess fetal well-being average a 30% false positive rate for complications.

If baby is already stressed, is the best option hypertonic pitocin contractions and possible cord compression resulting from artificial rupture of membranes?

If Baby is posterior, an amniotomy will take away the protective watery cushion around her and she may completely lose her ability to rotate to an anterior position.

Early amniotomy reduces the length of labor by only 1-2 hours.

Trust your body!!