What to ask before scheduling an induction.

In 2018, the study that started the 39 week induction craze was published and it has become a routine part of pregnancy care in America. As a labor and delivery nurse, I meet expectant parents all the time who schedule their inductions religiously at 39 weeks and zero days because it was offered to them. The thought of meeting your baby sooner usually appeals to people. As does getting rid of the constant lower back pain, the swollen feet, and the urge to pee every five minutes.

But most people come in with unrealistic ideas of how the induction is going to go – get some meds, have a baby later on today!

Their facial expressions usually go from excited to “what did you just say?” once I begin to discuss the length of scheduled inductions and my particular hospital’s policies regarding them.

The truth is inductions take time! They can take a few days, to be honest. Days of being tethered to an electronic fetal monitor and maybe even an IV pole depending on the facility you choose to give birth in. I can only attribute everyone’s confusion about the length and protocols surrounding inductions to a lack of education during prenatal visits.

Because all birthing facilities have their own policies, here are some questions to ask your healthcare provider (midwife, Ob/Gyn, etc) when you are given the option to schedule your induction. I highly recommend asking these questions during your prenatal office visits so that you have time to think them over before making a decision, or find another provider if you do not like the answers you get.

What are the benefits and risks of inducing labor?

Asking this question will hopefully equip you with the tools needed to make an informed decision on whether or not you even want to be induced. There are risks and benefits to everything, and inductions are no different. For some people, inductions are absolutely necessary, and for others, it is not. Find out which one you are.

What medications are used to induce labor?

Common drugs used to induce or augment labor include misoprostol (cytotec), dinoprostone (cervidil), and oxytocin (pitocin). I have seen these drugs cause fetal distress more times than I can count. This is not something I believe parents are educated on early enough. I do not say this to dissuade you, but to prepare you for what could possibly happen. Again, there are risks and benefits to everything. Discuss them with your provider.

What about mechanical dilation?

Some providers will use different methods to dilate (or open) your cervix. Mechanical dilation consists of placing a balloon or catheter into your cervix and using tension or pressure to open it up. Ask your provider what type, if any, they prefer to use. Also ask what the procedure looks like, e.g., how long does it take, is it painful, etc.

Do I have to be continuously monitored?

Usually you will be monitored if you are given any of the drugs I mentioned above to induce your labor. Some drugs will require you to be monitored only for a few hours, and others will require you to be monitored continuously. Find out from your provider what your hospital’s policies are on intermittent versus continuous monitoring.

Click here for a great review of the evidence on continuous fetal monitoring.

What factors could affect the length of my induction?

While there’s no crystal ball that will tell providers exactly when your baby will be born, they can speculate. There’s no harm in asking if there are any factors that might make your induction very short or very long.

Can I eat while I’m in labor?

From my personal experience, if you are being given certain medications or have an epidural, you can only ingest clear liquids. Clear liquids are anything you can see through at room temperature, e.g. water, apple juice, cranberry juice, ginger ale, jello, broth, water ice, and popsicles. However, I do believe that some places keep birthing people NPO (nothing by mouth) during labor. This Evidence Based Birth article discusses why some hospitals do not allow birthing people to eat in labor and what current research says about this practice.

How long does your practice allow people to stay pregnant?

Every birth care provider will be comfortable with keeping you pregnant until a maximum amount time. The longest I’ve personally heard of was 42 weeks and zero days. But this is something very important to discuss with your provider, especially if you opt not to schedule an induction. According to ACOG, the risks of “postterm pregnancy” is stillbirth, macrosomia (large baby), meconium, and decreased amniotic fluid. Again, discuss these risks with your provider to come up with a plan that works for your body and your baby.

This information should not be used in place of medical advice. Everyone’s situation is different and inductions are medically necessary for some people. This information is meant to be a tool to help you ask your healthcare provider important questions so that you may make an informed choice.

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