Birthing options can include both the location where you would like to give birth as well as how you would like to give birth. In the U.S., most deliveries occur in a hospital. Many people also choose to give birth in a birthing center or at home. In NC, last year 15% more births occurred at home than the previous year. Choosing to have a baby at home or in a birthing center may not be advisable in mom's with chronic medical conditions, or if mom has certain obstetric conditions like gestational diabetes, hypertension or placenta previa, or when labor occurs before 37 or after 42 weeks. When birthing at home or in a birthing center, you can expect fewer delivery interventions like medication for pain or medication to increase the frequency of your contractions. When birthing in the hospital, you can expect access to medical interventions during delivery as well as access to providers who can intervene quickly in case of complications. Most providers only deliver babies in one type of setting, so choose a provider who will deliver in the setting that you prefer. Hospital births are more expensive than births at a birthing center or home. However, some insurance providers do not cover birthing centers and home births. Check with your insurance provider to learn what they will cover. Before being discharged from the hospital, it is important to have named a pediatrician for your new baby.
Labor inductions are considered either Medically indicated or Elective.
Medically indicated induction: occurs when the health of the mother or the health of the unborn baby is at risk. Your provider may recommend induction when the benefits of delivery outweigh the risks of continuing the pregnancy.
Conditions of the mother may include:
Conditions of the unborn baby include:
Conditions of the pregnancy including:
Elective inductions: occur when labor is induced by choice of the mom, in the setting of a healthy mother and a healthy unborn baby.
Some reasons for Elective induction include:
Recent data support the consideration of elective induction at 39 weeks for 1st time mothers (primigravidas) in order to slightly reduce the chance of a cesarean birth, and to slightly reduce the chance of developing preeclampsia if the pregnancy continues.
Before proceeding with an elective induction you should know:
A Bishop’s score < or = 6 (considered unfavorable) > or = 8 (considered favorable)
Starting with an “unfavorable” cervix does not mean that the induction will fail and end in a c/section, but it does mean that the process from induction start to delivery of your baby could be quite prolonged. (Several days)
Labor induction is a process, starting with cervical ripening followed by the stimulation of contractions.
Methods of Induction:
Cervical ripening: used when Bishop’s score is “unfavorable” – Softens, thins and dilates the cervix (mouth of the womb)
Cervical Ripening can be accomplished with synthetic prostaglandins (hormone-like substance) or with mechanical dilation
Prostaglandins: Hormone-like substances (Dinoprostone or Misoprostol) that are given vaginally, orally, or buccally (in the cheek)
What are the risks with this type of induction method?
Prostaglandin cervical ripening is NOT used in patients with a history of c/section as it is linked to Uterine scar rupture.
Mechanical Dilators: provide gentle pressure to dilate the cervix. A double balloon catheter (insert image) is inserted thru the cervix and dilated with saline water.
One balloon is inside the uterus (next to the amniotic sac) and the other balloon is in the vagina.
What are the risks with this type of induction method?
Once the cervix is “ripened” Uterine contractions can be stimulated with:
Pitocin is administered intravenously and is dosed per protocols with the goal to produce regular and strong uterine contractions. In general, continuous fetal monitoring is required when Pitocin is being given and there is an associated restriction of movement with continuous monitoring.
Risks of Pitocin: Tachysystole (uterine contractions that occur too frequently)
Amniotomy: is the artificial rupture of membranes, this is often performed after contractions are regular and cervix is already dilated.
Amniotomy alone is generally not performed unless the cervix is well dilated with goal to increase onset of labor contractions
Risks of amniotomy include:
In the hospital, an induction always starts with a cervical exam (to guide the induction method) and a non-stress test (an evaluation of baby’s heart rate for the safety of an induction).
The process starts with cervical ripening if necessary. You will be allowed to eat during this phase of a labor induction. Generally, the cervix is reassessed after 12-24 hours or sooner if mom becomes uncomfortable if uterine contractions start in response to the prostaglandins.
If the cervix is considered “favorable” (thinned, softened and opened), cervical ripening is followed by Pitocin, amniotomy (rupture of membranes) or both. It may take an additional 12-24 hours to obtain regular uterine contractions.
Sometimes labor induction doesn’t work. If you and your baby are doing well and the amniotic sac has not ruptured, your provider may give you the option of going home and trying again in several days.
According to ACOG, if the maternal and fetal status allow, cesarean deliveries for a failed induction of labor can be avoided by allowing longer durations (>24 hours) for early labor, and requiring that Pitocin be given for at least (12-18 hours) after membrane rupture before considering the induction a failure.