Induced labor without tears?

February 9, 2006 2:50 PM

I wanted an unmedicated birth, but at 41 weeks and counting I've agreed to schedule an induction. How can I make the best of a less-than-ideal situation?

My first pregnancy, at age 35, has gone just about perfectly. No problems with blood pressure or blood sugar; every test passed with flying colors. Having read Henci Goer's The Thinking Woman's Guide to a Better Birth and attended a doula-led birthing class, I was determined to have a natural birth -- not so much because I'm opposed to modern medicine, but more because many interventions standard in modern obstetrical practice tend to have the effect of slowing down labor and encouraging more interventions to the point of increasing rates of unnecessary Cesareans and creating a very disempowering experience for the mother. The OB practice and hospital I'm signed up with are, I think, very good, but certainly in the high-tech, high-intervention mode. I'm worried they're going to turn my low-risk birth into a circus of beeping machinery and "procedures".

The baby is now a week overdue. Because of increased risk of stillbirth and many other bad outcomes, my OB regards 42 weeks as a cutoff point, and I've reluctantly agreed to schedule an induction for next week. We've been trying all the folk remedies (sex, walking, spicy food, evening primrose oil) to bring on labor on our own, with very little effect so far.

I have two related questions: First, what can I expect from an induced labor? I'm scheduled to go in the night before for Cervadil to ripen the cervix, with Pitocin to follow the next day to bring on contractions. I'm mostly terrified of the Pitocin since I've heard that the pain is so much worse that I'll have to end up having an epidural. Stuck in bed flat on my back for endless hours seems like a one-way track to the surgical suite. But, maybe Pitocin isn't that bad, and I'll be able to avoid the epidural and have an upright labor like I planned. Does anyone have experience with this? Labor pain is so subjective, and there's an element of self-fulfilling prophecy, too... FWIW, I had gall bladder surgery a few years ago and do long-distance mountain hiking, so I feel like I have pretty good stamina and tolerance for pain.

Secondly, is there anything I can do to make the best of this? Are an IV and continuous electronic fetal monitoring inevitable? Are there alternatives I should be asking for? My husband is very supportive and will be there with me, but this is his first time as well. If I could just get my confidence back, I feel like the whole thing will go better, but the threat of induction has thrown me off track. Help!

posted by libraryhead to health & fitness (25 comments total)

How can I make the best of a less-than-ideal situation?

Isn't a healthy baby reward enough?

Even though my wife was extremely fit, healthy and careful during her pregnancy, our son's birth was an 11-week circus of beeping machinery and scary procedures (not to mention 3 a.m. breast milk deliveries). He's now 4, completely healthy, and not a day passes by that I am not thankful for all the modern medical care he received. 50 years ago he surely would not have survived.

I guess what I'm saying is all the anxiety over how your baby is born should be secondary to its health. Do whatever is necessary to have a healthy baby.
posted by ldenneau at 3:16 PM on February 9, 2006

My wife was induced for our first (and only) at 28 or 29 or so. She was also a few days past due. As far as I know, she only got the pitocin through an IV (we didn't have to go in the day before or anything). No epidural, either. I think they hung an electronic monitor on after an hour or two, but she was able to push out our son before the docs decided to break out the suction cups and forceps.
Talk to your doc beforehand about this, so you don't have to worry about it while you're in labor. It's all well & good to want the Natural Painful Thing, but you also want to have a healthy kid afterward. Make sure you & your doc are on the same page: no intervention unless you or the baby are in danger. Then, trust him/her to make the call.
posted by spacewrench at 3:18 PM on February 9, 2006

I wish I knew what to tell you; it's so late in the game. I was lucky enough to find a great combination: an OB practice and hospital that offer certified nurse midwives and an integrated birthing center with alternative methods for pain management, but with excellent docs, the latest equipment, and a standard labor & delivery suite right at hand just in case.

Are there any CNMs available through the system you are using? Or perhaps you could consider hiring a midwife privately. He/She could really help you through this process, no matter where it goes. Again, not sure what your options are at this point.

But yes, absolutely talk to your doctor about your preferences if you haven't already.
posted by moira at 3:29 PM on February 9, 2006

Best piece of advice I got as far as avoiding the surgical suite seems to match your goal: stay on your feet and out of bed for AS LONG AS POSSIBLE.

My first delivery was a home birth turned hospital C-section (after nearly two days, I was grateful!) but for my 2nd I labored medication free mostly standing and squatting. Raise the bed up high so you can drape yourself over it if you tire. Both the gravity and your mobility help things progress and I found the entire experience much more agreeable when I was upright.

Don't worry that things have to be perfect. Prepare as best you can and then be open to the fact that labor unfolds in many unpredictable ways.

You're gonna love that little punkin. Best wishes to you in these last l-o-n-g days of pregnancy.
posted by DawnSimulator at 3:46 PM on February 9, 2006

I was overdue and induced as well, but it wasn't a multi-step process like you described. Once everything got underway, I had contractions for quite some time before I even felt them. YContractionsMV, of course.

Also, don't knock the epidural. I fell asleep once I got mine, and went from about 4cm to fully dilated, ready to push within 2 1/2 hours.

Good luck!
posted by mogget at 3:48 PM on February 9, 2006

Do whatever is necessary to have a healthy baby.
....trust him/her to make the call.

I think libraryhead's concern here is that her doctor's personal high-tech preference may not be what is strictly "necessary" to ensure the baby's health. Induction carries with it a number of serious health risks for mother and baby, so it's really unhelpful to say that a woman should simply give up all control of her own birth and stop worrying.

Have you asked your doctor if he/she can measure your amniotic fluid level via ultrasound before making the final call on induction, to see if the baby's health is in fact under threat?

You should definitely ask your doctor now about your concerns regarding the need for IV, fetal monitoring, etc., and hopefully you'll get straight answers that will help you feel less anxious about these details. Fear is your biggest enemy when dealing with pain.

Do not hesitate to request specific things of your doctor if there's no valid medical reason why you shouldn't have them. For example, you can request intermittent external monitoring in early labor to avoid being tethered to a bed, and you should be allowed to walk the halls even if you have to drag an IV stand along.

You are doing all the right things to try to jumpstart labor, so keep it up. Best wishes for a healthy baby and fulfilling birth!
posted by naomi at 3:57 PM on February 9, 2006

In the Netherlands unmedicated births are the norm. The cutoff point for induction is 42 weeks here also, and people with an induction are not routinely medicated. Some woman do curse that policy, though. I do think, if you prepared as well as you have, it will probably be easier for you than for most woman.

Do you have a doula? If that's an option, I would absolutely do that.

I hope labor starts soon on its own!
posted by davar at 4:00 PM on February 9, 2006

I was induced for my second child, and Pitocin didn't bother me too much. My seriously hard pain began when my water was artificially broken several hours into labor, because I wasn't progressing even with the meds. Plus, Pitocin is not just run in wide open - it's titrated up, so you may not even notice a lot of effect at the beginning. No two labors are alike, though, so all we can give are suggestions.

As the others have said, be sure you and your physician are truly on the same page about your preferences - but in the end, they are only preferences. You sound like you think the hospital is an enemy to be avoided - it's not. We (RNs) know that laboring moms need to get up and walk, and I've never worked in a place that ties mom to the labor bed unless they've had an epidural or another kind of anesthesia. The external monitor comes off really easily for walking and goes back on the same way - and if something bad happens you'll be really glad you had it.

The monitoring and IVs and RN staff are there for your safety and to ensure that you and your baby live. In the end, that's all that matters.

Good luck!
posted by lambchop1 at 4:15 PM on February 9, 2006

My wife had two pretty intense inductions but she made it through them and got a pretty neat gift in the end! She says it was worth 10x the pain she endured. Basically the procedure is Cervadil all night then they start a Pitocin drip in the morning. Once the waves started getting intense she got an epidural and that allowed her to sleep. When she awoke she felt stronger, started pushing and out came a big 10lb boy!

Some tips:

go for the epidural over the spinal tap. Don't take the drugs, my wife took them the second time and just made her feel weird. If you go in at 41 and are bent on having a vaginal birth don't be afraid to walk and come back in a week if you are not dialating with the Pitocin. We did twice and both times we avoided a C-Section. Read up as much as you can and don't be intimidated by a doctor who might have plans to go skiing next weekend. It's your body and you have the final decision.
posted by any major dude at 4:26 PM on February 9, 2006

You are already making the best of a less than ideal situation. You are letting your concern for your baby's health guide you in your decision making. It may lead to some disappointments in your expectations about the delivery you wanted, but your sacrifice will be well worth it.

You are sort of in a double bind. On the one hand, you don't want to have an induction. On the other hand, the risk of neonatal death begins to rise dramatically after 42 weeks. You are correct that the chance of intervention rises with induction, but that's partly because the placenta may begin to decline in function before 42 weeks, and labor (whether induced or not) will certainly place additional stress on the baby.

Take things one step at a time. Don't make any decisions about pain medication until you feel the pain. There is absolutely nothing compared to having a baby, no surgery, no injury, nothing. Furthermore, the location and intensity of the pain can depend on things beyond your control. For example, if the baby decides to face your front instead of your spine (occiput posterior position) you may have a lot of back labor, and that could be toughter to deal with. Try to hang on without anesthesia until you are in active labor, though (4-5 cm). An epidural will not affect contractions once you are in active labor.

A lot depends on how long your labor lasts. Most women can withstand anything if they know it will only last for a few hours. However, if your labor stretches on for 20 hours or more, it is a different story.

There is risk in any delivery and in general, the baby carries the risk. Anything out of the ordinary (like being 2 weeks late) increases the risk even further. At that point, the doctor will suggest that you take on the extra risk by having an induction. If increased risk is revealed by the fetal monitor, the doctor will recommend that you have a C-section, increasing the risk to you (because it is surgery), but decreasing the risk for your baby.

Good luck and be proud of yourself no matter what happens!
posted by DrAmy at 5:02 PM on February 9, 2006

Both of my kids were induced with Pitocin, and born without epidural. Both were pretty big (8.6 lb and 9.1 lb) and the youngest was born when I was 40.
I have to agree with Any Major Dude about standing up for your rights with the staff-- I was promised just a "kick-start" with Pitocin to get the labor rolling along and then they'd take me off. Then they refused to stop the drip. And I let them. I wanted to stand up or squat or kneel on all fours, they wouldn't allow it because of the fetal monitor or some nonsense. The doctor, not my usual OB, let it slip that he had three other women in labor that evening, so it became kind of clear that the Pitocin was as much a patient/time management tool as a necessity. Get a doula or nurse that's strong and will advocate for you with the staff.
That said, I have some great good news for you. Women do it over and over again for a reason. It hurts, yes. But it's over in just a day, you immediately feel much better afterwards (no lingering in bed recuperating as with an illness), and that big door prize that you get to carry out and love forever? That's makes everything worthwhile. The only time you'll think about Pitocin again is when someone else brings it up. Good luck!
posted by eve harrington at 5:22 PM on February 9, 2006

If your caregiver was a midwife, you would not be considered overdue at 41 weeks. Normal gestation is 36 to 42 weeks, so you would be overdue or late once you reach 42 weeks.
Your OB regards 42 weeks as the cutoff, but is she at all flexible? Have you discussed with her doing the biophysical profile and non stress test first before agreeing to induction? If you and the baby are both fine, you may be able to talk her into letting you go a few more days. Your intuition, your birthing class and your reading are pushing you to advocate for you and your baby, I think you are right on.
Also, have you thought about acupuncture?
Definitely continue the sex and evening primrose in the meantime.
My personal experience, normal pregnancy, normal labor until fully dilated, pushed for four hours, then tried pitocin. As you say, pain is subjective, but for me the contractions with pitocin were a lot stronger, but still did not have an epidural.
With all that said, the birth experience really pales in comparison to new motherhood!
posted by peeps! at 6:38 PM on February 9, 2006

My last birth was an induction. It wasn't that bad-all I had was a little Nubain to take the edge off. However for me it was baby number three.

Have they stripped your membranes yet? That's one thing they can do for you that might bring on labor.

Do make sure if they do induce that you have space between contractions. This is very important as this is what allows the baby to get oxygen.

And don't give up hope-all my kids were overdue and I only had to have the one induction. You may go into labor all by yourself!
posted by konolia at 6:39 PM on February 9, 2006

Get a Doula. There is a ton of evidence out there that when a doula (sometimes called a "birth coach") things are healthier for mom and baby all around.

I'm too lazy to link these stats right now, but having a doula leads to something like 50% fewer C-sections, a 25% reduction in the length of labor, 40% reduction in the use of foreceps, 60% reduction in epidurals

And, in your case, she can act as an advocate for your wishes. She can act as your advocate with the doctors when you're too tired/scared/busy to stand your ground. A good doula will also know when to tell you "do what the doctor says".

Its all going to be fine. Best wishes and good luck.
posted by anastasiav at 6:53 PM on February 9, 2006

Sorry, I forgot my cite for those stats: The Vital Touch, Sharon heller, PHD; 1997.
posted by anastasiav at 6:55 PM on February 9, 2006

My wife was induced with Pitocin for our first son. She was disapointed that she needed to be induced, and scared when the time had come to start the drip. The nurses started her on a slow drip and then gradually increased the amount. At one point it was too much for her, the contractions were lasting for 30 minutes, so she told them to lessen it. They did. Also, we asked the nurses to monitor the baby periodically, not continuously, and so she was able to move around the room. Overall she had a wonderful birth experience and was able to cope in her own way.

Your labor will be different from every other woman that has birthed a baby. Good luck, and be brave. As for making the best of the situation, have people around you that love you and that you trust. That helped my wife more than anything else.

If you have any questions for me or my wife, feel free to email me.
posted by recurve at 7:45 PM on February 9, 2006

Best of luck to you. I had a 41 week, 5 day long pregnancy myself. Once week 40 ended, they insisted on doing ultrasounds to make sure baby was ok and that there was enough amniotic fluid (I didn't mind, and everything was ok). I actually agreed to induce if the baby didn't come by Monday, and she starting things off herself and was born late Friday night, so thankfully I didn't have to deal with induction.

Odds are overwhelmingly good that you & the baby will make it through just fine. That said, I understand your trepidation with interventions the staff may recommend and/or insist on. It's a scary situation in some respects. But trust in your own good judgment, and remember that you have the authority to disagree with what they suggest if the cost/benefit analysis is not good to you. Sometimes people get intimidated by the staff and forget that they can refuse certain things reasonably or make counter-offers to what is suggested.

A suggestion: you might want to talk to them about having the pitocin turned down or off once your contractions get going. Sometimes all your body needs is a bit to get going, then nature kicks in and can handle the rest. Obviously, if the contractions diminish in potency you can always turn it back up again, no big deal. (Of course assuming that all signs show the baby is handling things well and not in danger). It is perfectly reasonable to want to use interventions only as much as is necessary, and no more. Don't let anyone paint you as some kind of freak out to risk her baby's health, or anything ridiculous like that. (Yes, I have heard of people being bullied basically with "agree to X or YOUR BABY MIGHT DIE!!!$#!@!@" when that's far from true).

The whole situation can be rather nervousness-inducing when you are wanting a normal birth and you aren't sure how the staff are going to react. It may be worthwhile to tell them quite clearly that you understand the baby's health is what's going to guide things, to reassure them that you are level-headed and have your priorities in the right place. They might hear "I want a natural birth" and let preconceptions color their views of you, which can strain relations.

I was lucky and had a labor nurse who was quite delighted with the fact that I wanted to do everything naturally. From what I've seen on things like A Baby Story, that's not always the case - sometimes you get someone who has the attitude "Oh haha I've seen women who say that but they all get epidurals in the end!". Hopefully you will get someone committed to helping you birth the way you'd like.

I think with Pitocin you have to have an IV, because that's how they administer it. It may be a bit of a pain to drag the IV stand to the bathroom and back, but going frequently can help move things along.

Hopefully your nurse will be somewhat flexible with the monitoring - mine was willing to use a handheld doppler at times when I had the monitor off and was trying to squat next to the bed, and stuff like that. Some people find the monitor annoying, but I had no problem with it. Of course, ymmv.

One thing you might want to be prepared for is that there might be meconium in the amniotic fluid. This is more common for "overdue" babies. They will check for this when your water breaks. If there is some, they may need to take the baby immediately to the other side of the room and suction carefully to make sure that none is aspirated after birth. This was the case with me - they knew I wanted to hold her right away, but I was fine once they explained why this would not be possible.

I wish you the best of luck. I think the most important thing is to trust yourself and your judgment, and remember that being assertive if necessary doesn't mean you take your baby's health any less seriously, not at all. Trust your body, and adopt whatever position seems to be comfortable while allowing / helping labor to progress. Only you will know what feels right.

And I want to be a bit of a cheerleader and tell you that you most likely *can* do it without drugs if that is your goal. This is more likely the more normally things progress. But as you know, something may happen - the pitocin could make the contractions way more powerful and painful, and you are not any kind of failure if you do end up opting for an epidural or whatever. You're the only one who can figure out what you feel you are able and willing to withstand when it comes to pain.

When I was in labor, I did not ask for meds, but at one point I did ask, in all seriousness, to be shot. :) Keep in mind that during moments of extreme pain, your mindset can change in strange ways, and it may feel as though the pain is going to go on forever. If you can, remind yourself that it's temporary. That might help a bit. I was able to make it because I knew it would be over soon, that I was almost dilated enough to start pushing.

One other piece of advice I'd like to add: when the baby's head is crowning, if at all possible, go *slowly*. I was told to just push and oh yowie, I tore (and screamed) and I sure wish I'd gone with a midwife, warm compresses, and slow stretching instead.

I don't know what your wishes are for actual birth position, but something I did that you may want to consider is birthing on your side. I knew I didn't want the traditional position, and I did want to be in bed at the time. The doctor had no problem seeing everything and reaching the baby, and someone helped hold my upper leg back, and it worked out really well. Just an idea, take it or leave it as you wish.

Be prepared for some extreme hormonal weirdness afterwards, too. I think it was about 24 hours after my daughter was born that I was hit with a tsunami of emotion, brought to tears with love for her and I vowed I would do whatever it took to protect her. The bonding stuff can come in big bursts sometimes.

I wish you luck with breastfeeding, also. I am somewhat of a breastfeeding geek, and I read dozens of books and so forth beforehand. Even so, I needed help and thank goodness I called a lactation consultant when I needed one. If it hurts, get help! And the earlier the better! I wish I didn't wait as long as I did. Breastfeeding was one of the most satisfying things I ever did in my life, once we got everything running smoothly.

I hope all goes well for you, and that you are able to have a birth experience that you are happy with. This thread will be open for 30 days and I know I'm not the only one who would like to hear how it turns out! :)
posted by beth at 8:16 PM on February 9, 2006

Thanks, everyone, for all the enouragement and kind words. I didn't realize I could ask to turn off/down the Pitocin once contractions start, so that's something to keep in mind if it seems apppropriate.

I've been having a lot of Braxton-Hicks contractions, and they've stepped up a bit in the last few hours, so I'm hopeful I may end up going into labor before the deadline after all. I had an amniotic fluid check and a nonstress test this past Tuesday (everything completely fine), and will go in for another nonstress test tomorrow, so we're certainly monitoring the situation carefully.

I'll let you know how it goes!
posted by libraryhead at 10:20 PM on February 9, 2006

One other thing I would add to the amazing advice above. My second (homebirth) was 41 weeks and I was TIRED! My midwife suugested the most natural first step (protagladins ((found in sperm!))to the cervix) delived by natures best delivery mechanism - the penis!
When that didn't work she told me to order the hottest indian curry I could stand. Well, I like hot so I ordered Vindaloo. 6 hours later I was on the loo, sorry to be graphic, but it was as hot coming out as it was going in. However, my waters broke and contractions started!! So result, beautiful delivery 5 hours later, I was on my knees, with my upper body supported by my husband, with my midwife behind. I thoroughly recommend the position.

again, once your pain starts, take whatever help you need. The result that matters is you and that baby happy and healthy! Good luck
posted by Wilder at 3:08 AM on February 10, 2006

AN ALTERNATIVE TO PITOCIN...

My wife was 35 with our first and we were going for the Bradley method (natural birth), no induction or other mediation and we used a midwife.

She was also a week late and her amniotic fluid was low. The midwife reluctantly decided to induce that evening. We went for a walk, had sex, took castor oil, had some spicy food. We went into the hospital at 8pm and the midwife administered CERVIDIL (not sure about the spelling) around 9pm. It's kind of a semen substitute that's administered on a string of sorts inserted in the vagina.

Her labor started around midnight and our daughter was delivered around 7am.

It was a good thing she was induced because our daughter had the cord around her neck. As a matter of fact she didn't breathe for the first six minutes (the longest six minutes of MY life). They bagged her immediately and she's absolutely fine, but she might not have been had we waited.

Pitocin makes your contractions come one on top of another without rest for you in between. Try everything else FIRST.
posted by organguy at 8:02 AM on February 10, 2006

I was scheduled to be induced and ended up having an emergency c-section. Best-laid plans and all that.

YMMV.
posted by cass at 11:34 AM on February 10, 2006

I would also add that I think you will be very disappointed in the whole "birth experience" if things do not go the way you "planned" them to go. The most important thing is healthy baby/ healthy mom. Be ready to roll with whatever happens.
posted by cass at 11:35 AM on February 10, 2006

There seems to be a false dichotomy in some of the replies that the mother has to choose between a good birth experience and a healthy baby. There's a very good chance that she can have both, and there are no indications whatsoever that she'll not do everything for her baby. It's not like she asked how to do an unsupervised homebirth at 43 weeks gestation!

Also: I don't agree that a healthy baby and a healthy mom is all that counts. I think it is a little offensive, as if modern hospital care can really 'ensure' a healthy baby. Babies still die during childbirth. Mothers are not always healthy after childbirth. Also: I have seen that childbirth really can be very traumatic, that's not something to wave away, or to belittle with "a healthy baby is all that counts". For some women, thinking that way may be helpful, but certainly not for all.
posted by davar at 12:32 PM on February 10, 2006

My mother was pregnant with me for a full 10 months (in 1982.) She was induced with Pitocin twice about a week apart- neither induction attempt worked. I was finally born about 3 hours after the doctor broke her water. Apparently that wasn't a common thing to try, but they felt they'd tried everything else, so why not?
Yes, this is anecdotal, but I urge you not to be too worried. I was in there way longer than I should have been, and I turned out just fine. Your baby will too. :)
posted by hyperfascinated at 4:05 PM on February 10, 2006

An epidural doesn't necessarily lead to your being "stuck in bed flat on [your] back." With my first (born at almost 42 weeks, not induced) I had what is called a "walking epidural" -- I could sit up or squat while under the influence of it, but it was strong enough that I wasn't in pain. Highly recommended, if you end up needing and /or wanting that sort of relief.
posted by The corpse in the library at 8:46 AM on February 11, 2006