You spent months envisioning the natural childbirth you wanted. You took the classes, drafted a birth plan, and had your vision for the way birth would unfold. Your due date approaches, and then passes. You start combing the internet and asking everyone you know for tips on how to get baby to budge. Still nothing. Finally, your caregiver drops the “I-word.” The prospect of an induction you didn’t expect and don’t want is upsetting. But, it doesn’t mean you have to give up on every part of the birth you want for your baby.
I was very worried that having an induction meant getting an epidural, but it doesn’t have to. If you are faced with the same prospect or know someone who is, these tips might help.
Don’t give up on natural induction methods.
Try everything. And I mean everything. Keep up those natural methods of induction right until the moment your medical induction is scheduled to happen. Sure it might mean eating three pineapples, having sex on a birthing ball, doing laps around the block, and then spending hours in the bathtub calmly pleading with your unborn baby. But in the end, it’s still better for labor to begin without medication. If nature’s own pineapples and prostaglandins don’t do it, you may be facing Pitocin.
If you don’t already have a doula, get one. Stat.
There are lots of reasons to have a doula. These reasons are elevated in importance if you are facing an induction. You really need someone in your corner who can be your top advocate when you need it most. She needs to feel comfortable playing the role of advocate and strong in her desire to help you speak up for yourself. While you might have a long history of speaking for yourself, the last thing you want to worry about when you are actively emerged in a Pitocin-induced labor is how to confront an overly-eager nurse. If you already have a doula, make sure she feels comfortable with this role (some aren’t). If you don’t have a doula, make sure the one you choose isn’t timid or easily intimidated. (You can read our full birth stories to find out how having a doula saved my labor for both our first and second child.)
Make an informed decision about the induction.
Labor induction rates in the U.S. more than doubled between 1990 and 2005 to an all-time high of 22 percent. There are better reasons than others to have an induction and ways to determine if an induction is favorable in your particular situation. Not every induction is “medically necessary” — please do your research and make an informed choice. This is a personal choice and one that each woman will need to make for herself and for her baby. It was my experience, and the experience of many women I knew, that the OBGYN offered an induction automatically at that 39 week appointment. (I saw a different OB at my 39 week and he asked rather matter of factly, “When do you want to schedule your induction?” When I said I wasn’t interested in that, he was a little shocked. Surprisingly, he said he doesn’t suggest elective inductions either, but he is so used to women begging at 38 and 39 weeks to “just get the baby out” that he considers it good customer service to offer. Bananas!)
Like most, I never planned to have a medical induction. I also never planned to ever get pregnant again after what was our third, and most heart-wrenching, miscarriage. Our first daughter’s labor was guided by our doula and made possible with hypnobirthing techniques. We expected the same for our second child. However, after spending four months on bedrest for an incompetent cervix and pre-term labor, when we hit our doctor’s 41 ½ week “danger zone” without any real sign of labor, we decided not to take any more risks and went with the induction. Because I was a high-risk pregnancy and because I had already lost three babies, I didn’t want to take any unnecessary risks. There’s plenty of research out there to support women who don’t want to rush into inductions just because they are past their estimated due dates. Like most things birth-related, do your research and then do what you feel is best for you and your baby. Learning to trust yourself and trust your instincts before the baby is born will put you miles ahead of the parenting curve.
Make sure your doctor is on board. And if s/he is not, find one that is.
This is a critical piece of the puzzle. Assuming that you have already had a long discussion with your OB/GYN or midwife about your plans for a natural and unmedicated delivery, you want to now have a discussion to craft an actual plan for the induction that preserves your chances of sticking with the rest of your birth plan. Find out if your doctor has worked with an induction without pain medication before. Get a commitment that s/he is willing to work with you to realize your vision of a natural childbirth and that s/he will write formal orders for managing the induction according to your wishes.
Craft an induction plan with your doctor that honors your body’s processes and keeps you in the driver’s seat.
The most important part of the induction plan is choosing an induction method and determining a process for administering the medication. In my case, we opted for Pitocin so that we could manage the dosage. The recommended standard administration of Pitocin is an initial dose between 0.5–1 mU/min with increases at 30–60 minute intervals in increments of 1–2 mU/min until a woman’s body takes over labor naturally. Once this happens and labor has progressed to approximately 5–6 cm dilation, the dose can be reduced in similar increments until the woman’s body is off of the medication entirely. However, this is not typical practice. In most cases, women are started on a Pitocin drip that is steadily increased every 30 minutes regardless and continued throughout labor. Most women are surprised to learn that they can be removed from the Pitocin and be allowed to labor naturally still relatively early into childbirth.
It is important to work out this type of plan with your caregiver. My doctor and I worked out a plan that started with a very low 0.5 mU/min dosage and then 1 mU/min increases only as my body needed them. That is, if the Pitocin was producing contractions at the current dose, there was no need to crank it up just because 30 more minutes had passed. What’s more, my doctor agreed that once I was in obvious active labor, we could detach the Pitocin completely and I would be able to continue to labor on my own. There is no medical reason not to do this. Because most women have epidurals, it is common just to stick with the easy-to-manage schedule, but there is not a threat to you or your baby to follow a slower process.
Get a copy of the doctor’s orders and know your rights.
Almost important as having a caregiver who drafted a plan with you is to get a signed copy of the plan or a copy of the actual orders. These are your medical records and you have every right to them – even if nurses look at you like you have two heads when you ask. The “orders” will go into the file that they have for you at the hospital or birthing center. Nurses or doctors on call will refer to the orders to determine how to manage your care. If you get a nurse who decides on her own that sticking with the typical Pitocin schedule is easier or more convenient, point to your doctor’s orders as reason for her to stop. This is where having your assertive and confident doula and birth partner comes in. If the nurse has other plans for you or ignores the doctor’s orders, ask to speak to your doctor. You have the right to refuse treatment – whether that is Pitocin or any other birth intervention. Know the role everyone on your birthing team will play and even rehearse these roles. Your job is to move through labor. If you can focus on that while the others around you act as advocates, you will be much more relaxed and labor will be easier. You can go a long way to making sure this plan is going to be followed by scheduling your induction for the work-day of your doctor. In my practice, there were several doctors. Choosing your doctor’s delivery day means s/he will be there instead of someone who isn’t as familiar with you and your needs.
Have a pain management plan.
And now for the bad news. Pitocin isn’t called “the chemical crowbar” for nothing! It is strong stuff and yields really powerful and painful contractions. Labor is intense. Labor on Pitocin can be ugly. That said, when you aren’t a slave to the schedule, you can ease your body into labor with the medication and work your way into managing the intensity of the contractions. But, you need a plan for pain management. For us, that plan was hypnobirthing, but you can choose whatever natural child-birthing method resonates with you. Because it is the medication that is causing labor and not the baby’s signals, an induction can leave you with a feeling of loss of control. Make sure you have talked with your doula about ways to not only manage the intensity of medication-induced contractions but also any emotions and feelings you have such as anxiety or fear. Remaining relaxed is critical. Each contraction brings you one step closer to your body taking over and your baby being in your arms.
Keep your eyes on the prize.
We’ve all heard it, right? There is no medal for having a natural childbirth. But those of us who refuse the epidural aren’t doing it for the glory. We do it because we trust our bodies. We want to experience the full process of labor and we know it is what is best for us and for our babies. A natural childbirth is equal parts a gift to us and a gift to our children. Even in the hardest parts of the labor, stay focused on your reasons for wanting a natural childbirth in the first place. Discuss these reasons with your doula and/or partner and have them remind you when you need to hear it most.
There might not be a medal for a natural childbirth, but doing what your body was made to do is reward enough.