During pregnancy induction of labor may be necessary for either fetal or maternal indications. For uncomplicated pregnancies, we do not routinely recommend induction of labor prior to 41 weeks gestation to provide the best opportunity for spontaneous labor. Induction of labor, especially in a patient whose cervix is not favorable, does slightly increase the risk of cesarean delivery. Factors that contribute to the likelihood of a successful induction include:
- Prior vaginal delivery
- Cervical dilatation, effacement, and position
- Fetal station in the pelvis
Induction of labor may consist of one or two parts. In a patient whose cervix is not favorable (ie: has not started to dilate or efface), the induction process is a two-step process, and begins with “cervical ripening”. This is accomplished in the hospital and usually requires an evening admission (sometime between 7:30 and 9:30 PM), where a foley catheter is placed through the cervix or medication is placed in the vagina to ready the cervix for labor. Most patients have one support person spend the night with them during the cervical ripening process. It is ideal to limit visitors during this time and get a good night’s sleep before the more active phase of induction starts the next day.
The following morning, IV pitocin is usually started to stimulate uterine contractions. The pitocin dose is gradually increased over time, allowing one to grow accustomed to the intensity of the contractions, and providing the opportunity for an epidural if desired. If one’s water does not break on its own, the physician may also rupture the membranes as part of the induction process.
In a patient whose cervix is already dilated, usually at least 2-3 cm, the induction process begins during the day with pitocin.
From a timeline perspective, the induction process can be unpredictable, and especially for first time moms with an unfavorable cervix, can take more than 24 hours. The early or “latent” stage of labor, up until one’s cervix is 5 cm dilated, is notoriously slow, and can easily take 12 hours in and of itself.
If you are scheduled for an induction of labor, here are some key pieces of information:
- AM induction- If you are scheduled for a morning induction, you will receive a call after 5:00am on the day of your scheduled induction. You should register at the hospital within one hour from the time given to you by the nurse. If you have not heard from the nurse by 9:00am, please call L &D at 919-350-8059.
- PM induction- If you are scheduled for a evening induction, you will receive a call after 5:00pm on the day of your scheduled induction. You should register at the hospital within one hour from the time given to you by the nurse. If they have not heard from the nurse by 9:00pm, please call L&D at 919-350-8059.
- For AM inductions, please eat a light breakfast prior to your induction time.
- For PM inductions, please eat a light dinner prior to your induction time.
- On a rare occasion, WakeMed may not have a bed available until the next day. If your induction is moved to the next and if it has been a week or more since your last OB visit, please call the office 919-781-6200 to schedule an appointment for an evaluation.
- Bringing hard candies or ice pops to the hospital are a great idea to satisfy your thirst, and are a nice alternative to sips of liquids and ice chips.