how are inductions scheduled?

[Anonymous]

Seems a few of us are ready to be un-pregnant...

I'm 39 weeks, and haven't started dilating or effacing. My next check up is tomorrow, and we'll likely talk about scheduling an induction if I'm still not dilating. I do plan to go until my due date regardless of what we discover tomorrow. But my doc and I have already talked a bit about inducing b/c I'm very petite. My baby (while average size) is tracking a bit big for me. My mom tore very badly with me when I was born (I was only 6 & 3/4 lbs) and has had a lifetime of problems down there b/c of it. This is my no. 1 biggest fear about childbirth.

Was curious how inductions are typically scheduled. I know inductions can still take awhile to progress, so I'm not expecting a speedy L&D if we go this route. But do they generally admit you in the morning, or the evening? Or maybe it doesn't matter?

I know this is probably going to stir some people up, but I figure if we're going to schedule something, we'd like to maximize my husband's paternity leave. Like if I deliver over a weekend, then he doesn't give up leave for L&D, and then we get a full two weeks together at home. So, ideally I go in Friday afternoon and we go home on Monday. Then again, not sure I want to wait until I'm almost 41 weeks...

[Anonymous]

At 40 weeks, my cervix was barely dilated. My OB scheduled an induction at the end of 41 weeks. You go into the hospital at night (check in around 7 PM). The doc will give you cervidil to soften the cervix. They will give you the option of taking a prescription sleep aid (such as Ambien), in anticipation of the exhausting day ahead. Early the next morning, the doc will check to see if labor has commenced. If not, s/he will give you pitocin to artificially jumpstart contractions. At some point, the nurse will ask about your pain level--which leads to an epidural if you choose to have it.

Good luck!

[Anonymous]

Thanks! Exactly what I wanted to know.

[Anonymous]

My experience was identical to the PP's. I was induced at 40 weeks due to decreased fetal movement. The induction was textbook, though. Good luck!

[Anonymous]

If your cervix isn't even dilated...chances for a successful induction aren't good. You most likely will end up with a c-section...then you'll certainly be wishing your husband had longer than 2 weeks off. Please, please, please, don't rush something that isn't ready. Your mom tore, but that doesn't mean you are going to tear badly. I know of a petite woman that gave birth to an almost 10 pound baby with minimal tearing. Fat is pliable. You need to have faith in your body. You can do it. Let your baby choose his/her birthday!!!!!

If you are set on an induction, google Bishop score. And if you do go in for an induction, DO NOT BY ANY CIRCUMSTANCES let your OB use Cytotec on you. Cytotec is NOT APPROVED BY THE FDA for use in laboring women. It can and has killed women and their babies. I know of a woman who had a very bad reactions to it which led to immediate delivery of her baby (the mom was put under general anesthesia) Cervidil is a much safer induction medicine.

Also, find out more how your doctor plans to induce. Are they going to break your water? Once they break your water...you are typically "on the clock" to deliver. If they don't break your water and labor stalls then you can always call off the induction. Are they telling you that you need to dilate a cm per hour? What happens if you don't follow that schedule? My first labor took 39 hours before I hit 10 cm. My second was 22 hours. If you are stuck at 4cm for several hours, don't despair. Your body WILL eventually dilate to 10 cm - don't get coerced into a c-section for failure to progress. Do you think 100 years ago women just never hit 10cm?

[Anonymous]

Some doctors don't schedule inductions on Friday b/c then they would need to work the weekend (of course they work the weekend if someone goes into labor naturally but some don't like to schedule extra patients for the weekend if they don't have to)...usually if it is a scheduled induction, it would take place on a weekday most likely.

[Anonymous]

Anonymous wrote:If your cervix isn't even dilated...chances for a successful induction aren't good. You most likely will end up with a c-section...then you'll certainly be wishing your husband had longer than 2 weeks off. Please, please, please, don't rush something that isn't ready. Your mom tore, but that doesn't mean you are going to tear badly. I know of a petite woman that gave birth to an almost 10 pound baby with minimal tearing. Fat is pliable. You need to have faith in your body. You can do it. Let your baby choose his/her birthday!!!!!

If you are set on an induction, google Bishop score. And if you do go in for an induction, DO NOT BY ANY CIRCUMSTANCES let your OB use Cytotec on you. Cytotec is NOT APPROVED BY THE FDA for use in laboring women. It can and has killed women and their babies. I know of a woman who had a very bad reactions to it which led to immediate delivery of her baby (the mom was put under general anesthesia) Cervidil is a much safer induction medicine.

Also, find out more how your doctor plans to induce. Are they going to break your water? Once they break your water...you are typically "on the clock" to deliver. If they don't break your water and labor stalls then you can always call off the induction. Are they telling you that you need to dilate a cm per hour? What happens if you don't follow that schedule? My first labor took 39 hours before I hit 10 cm. My second was 22 hours. If you are stuck at 4cm for several hours, don't despair. Your body WILL eventually dilate to 10 cm - don't get coerced into a c-section for failure to progress. Do you think 100 years ago women just never hit 10cm?

OP here. I appreciate your concern. I'm not really set on anything - I'm much more of a "play it by ear" person. I don't have my heart set on anything one way or the other. I just wanted some more information so I could have an informed discussion with my doctor about it. I plan to have her walk me through the entire process with me no matter what. Not to worry there.

[Anonymous]

Although your plan for a weekend birth does potentially give your husband a bit more time at home, there are some other factors to consider: As a PP pointed out, inducing without regard to your body's readiness can very often lead to a c-section for "failure to progress." A c-section, in turn, can complicate early breastfeeding. And most hospital lactation consultants don't work weekends. If you want to breastfeed, this isn't the ideal set of circumstances to set yourself up for success.

There's also the question of whether you're really due or overdue. Although the calendar says it's time to come out, your baby may need a little extra cooking time. Did you have a very early sonogram to date the pregancy? Do you know when you ovulated, or are your dates based on LMP? See the recent study on babies born officially full-term, but still on the shy side of 40w: http://www.cnn.com/2009/HEALTH/01/07/c.section/index.html

[Anonymous]

The main thing that makes a baby easy to deliver or not is the head size, which does not change after 36 weeks. So inducing for size makes no sense.
I think a lot of OBs are willing to induce because the mother is fed up .and it's easier in terms of scheduling for the doctor. But "fed up" has nothing on "hideous induction" (not that they're all hideous), so put that into your calculations

[Anonymous]

Anonymous wrote:At 40 weeks, my cervix was barely dilated. My OB scheduled an induction at the end of 41 weeks. You go into the hospital at night (check in around 7 PM). The doc will give you cervidil to soften the cervix. They will give you the option of taking a prescription sleep aid (such as Ambien), in anticipation of the exhausting day ahead. Early the next morning, the doc will check to see if labor has commenced. If not, s/he will give you pitocin to artificially jumpstart contractions. At some point, the nurse will ask about your pain level--which leads to an epidural if you choose to have it.

Good luck!

See, mine was different.

I was asked to check-in at 6am at the hospital (no sleep the night before b/c we were sooo excited, but I digress). I was given pitocin around 8am. Delivered beautiful healthy baby at 1pm.

So, obviously, everyone's experiences are going to differ - based on how ripe your cervix is, the hospital policy, your doctor's policies, etc.

OP - you mentioned your mom tore a lot when she delivered you and has had problems with that ever since. To clarify, inducing is not going to create or lessen tearing. Second, you should discuss with our doctor about episiotomies and the pros/cons of it. Third, be sure to follow up 6 weeks postpartem to make sure "down there" is correctly healed to avoid problems like your mom had. And finally, don't ever stop doing Kegels.

[Anonymous]

Just to follow up on PP, it is correct that induction is not going to reduce tearing. The things that reduce tearing are:

1. pushing in a position which does not require your legs to be spread WIDE apart and back. A good position to reduce tearing is to be on your hands and knees, side-lying, or a squat with your legs medium-width apart.

2. Using warm moist compresses during the final pushing time and during the crowning of the head (make a plan ahead of time as to who will do this. It should be either your doula or nurse, or maybe DH or the doctor, though doc's don't normally like to sit there doing this. Bring a small crock pot to the hospital so that you can have warm water right there during your pushing time)

3. Using oil such as olive or grapeseed oil to very gently massage around the baby's head as it is crowning (same as above, make sure you plan who will do this)

4. Very slow and gentle delivery of the baby's head (your doctor should encourage you to STOP pushing as the head is crowning, and only give gentle short pushes after that). If anyone in the room is yelling PUSHHHH! at this point, you should really ignore them

5. not using forceps or vacuum, except in true emergencies

6. not getting an episiotomy. Episiotomies often extend into bigger tears. This is very likely what happened with your mom, because 30 years ago every woman was given an episiotomy to get her baby out. This could also be the cause of your mom's pelvic floor issues.

7. Do lots of Kegels. Strengthens and oxygenates the entire area to reduce tearing during birth.

8. Eat lots of healthy fats, which help the skin to be supple. Eat lots of Vitamin C rich foods, which help the body produce collagen which helps make healthy pliable tissues that heal easily.

9. Try some perineal massage ahead of time. This isn't proven to help avoid tears, but since there are no risks with doing this, it doesn't hurt to try it.

I think it is fine to get induced if that's what you want, but you should know it isn't going to prevent tearing. Small women can push out very large babies with no or minimal tearing if they follow the steps above. Induction does lead to a greater risk of c/section, but some women are okay with that. It's really your choice and don't let anyone try to make you do something you don't feel comfortable with -- so if delivering your baby early makes you feel safer, then go for it.

[Anonymous]

Lots of great points made that induction really doesn't prevent tearing. Why does your doctor state that it does?

[Anonymous]

OI - OP here.

The decision about whether or not to schedule an induction AT ALL is separate from when I would schedule it. I was curious how they time it out, if it came down to looking at the calendar while I was at the doc this morning.

Thanks to all who answered my actual question, and also to the person who brought up the fact that specific staff may not be available on the weekend. That *is* something to consider. While I'm eager to maximize any time off my husband has (I know I'm lucky he has paternity leave at all), I think you raise some good points that would probably trump those extra days.

I'm not going to lay out my personal medical history so you can judge whether or not I'm a good person or selfishly willing to put my baby in danger for even considering an induction. I think I made it clear that I wasn't considering the procedure b/c I'm "fed up," and I stated quite plainly that I was planning to wait until my due date to do anything. The induction wouldn't be to prevent tearing, the point is that they don't want my baby to get too big for me.

[Anonymous]

There are other options to resort to BEFORE getting induced which will help to bring on labor. A lot have been discussed previously here, one of which is acupuncture. If you want to help the baby come out faster so that induction is not necessary, this might be something that you'd like to consider.

[Anonymous]

I'm not going to lay out my personal medical history so you can judge whether or not I'm a good person or selfishly willing to put my baby in danger for even considering an induction. I think I made it clear that I wasn't considering the procedure b/c I'm "fed up," and I stated quite plainly that I was planning to wait until my due date to do anything. The induction wouldn't be to prevent tearing, the point is that they don't want my baby to get too big for me.

I don't think anyone was calling you selfish or saying that you were endangering your baby. Lots of women get induced and it definitely is your choice. I actually think you got a lot of helpful sort of information on the thread. And, to be fair, you did start by saying how afraid you are of tearing (which is certainly a normal fear!) and that you didn't want your baby to get too big precisely because it could lead to extensive tearing. So the information about induction not reducing tearing is relevant, IMO. Honestly, it doesn't matter to me at all if you want to get induced, but please try to trust your body that you will not grow a baby that is "too big" for you. Your body knows exactly what it is doing. Also trust yourself that there are things you can do (other than trying to make your baby smaller) to help prevent the type of tearing your mother had. Good luck to you and I think we all hope that you have an easy and happy delivery!