Birthing Options

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 birth center or at home. 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 moms with chronic medical conditions, or if a 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 birth center or at home. However, some insurance providers do not cover birth centers and home births. Check with your insurance provider to learn what they will cover. Before you can be discharged from the hospital, you must have a pediatrician picked out for your new baby.

Vaginal Delivery

Safest and most common type of childbirth. A baby is born through your vagina or birth canal. With vaginal delivery, your recovery is faster, and you have lower rates of postpartum infection. Vaginal delivery can happen on its own when your body is ready. Vaginal delivery can also be induced. Your provider may recommend inducing labor with medication or other steps when they think it will lead to better outcomes for you and your baby.
Cesarean Section or C-section

A surgical procedure where the baby is delivered through the mom's abdomen. C-sections are recommended in certain situations when the baby cannot be safely delivered vaginally - for example if the baby is too large or not in the right position for delivery. If you need to have a C-section, you will have a longer recovery time than with a vaginal delivery. C-section rates in the U.S. are higher than in other countries and are highest for Black birthing women.
Vaginal Birth After Cesarean (VBAC)

A VBAC is when you have a vaginal delivery after having previously delivered a baby by cesarean. A VBAC can be an option for you if you meet certain criteria. Talk to your provider about your options.

My provider says I need to be induced. What now?

What is labor induction?

Induction of Labor: The use of medication or other methods to bring on (induce) the onset of labor rather than allowing labor to begin spontaneously. Spontaneous labor is the onset of labor without the use of medicines or interventions. In the U.S. approximately 25% of labors are induced. Most induced labors result in a vaginal delivery.

Why may labor induction be necessary?

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:

Hypertension (high blood pressure), either chronic hypertension, preeclampsia or eclampsia
Diabetes, either before pregnancy or gestational (pregnancy-related)
Conditions of the heart, lungs or kidneys

Conditions of the unborn baby include:

Growth restriction (poor fetal growth)
Low amniotic fluid
Placental insufficiency, when the baby isn’t getting enough nutrients or oxygen from the placenta
Premature rupture of membranes (PROM), when the “water” breaks too early

Conditions of the pregnancy including:

Pregnancy lasting more than 41 weeks
Premature rupture of membranes (PROM), when the “water” breaks too early

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:

Distance from the hospital or inadequate access to transportation in an emergency
Military service or deployment of a partner
Providers’ schedule (rare)
Patient preference

Recent data support the consideration of elective induction at 39 weeks for first 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:

Elective induction should not be performed before 39 completed weeks of pregnancy.
You should not feel pressured to proceed with an elective induction.
An elective induction is ideally performed with a favorable cervix.

What is a Bishop’s score?

A clinical assessment (examination) of the cervix is the most common method to rate the readiness of the cervix for induction
A 10-point system that standardizes the readiness of the cervix for induction (dilation, effacement, station, consistency, position)

A ‘Bishop 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 however, it could extend the process from the start of induction to deliveryby several days.

What can I expect from the induction process?

Labor induction is a process starting with cervical ripening followed by the stimulation of contractions.

Methods of Induction:

Cervical ripening: used when Bishop score is “unfavorable” – softens, thins and dilates the cervix (mouth of the womb)

Cervical ripening can be accomplished with synthetic prostaglandins (hormone-like substances) 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?

Tachysystole (uterine contractions that occur too frequently)
Meconium-stained amniotic fluid

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 is inserted through 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?

Vaginal bleeding
Rupture of membranes
Maternal discomfort

Once the cervix is “ripened” uterine contractions can be stimulated with:

Pitocin: a synthetic form of Oxytocin (a hormone) and one of the most commonly used drugs in the U.S.

Pitocin is administered intravenously and is dosed per protocol with the goal of producing 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: the artificial rupture of membranes, this is often performed after contractions are regular and the cervix is already dilated.

Amniotomy alone is generally not performed unless the cervix is well dilated with the goal to increase onset of labor contractions

Risks of amniotomy include:

Prolapse of umbilical cord (rare)
Changes in fetal heart rate due to loss of amniotic fluid and umbilical cord compression
Prolonged rupture of membranes can lead to intrauterine infection (chorioamnionitis)

What is a typical induction like?

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 begins with cervical ripening if necessary. You will be allowed to eat during this phase of labor induction. Generally, the cervix is reassessed after 12 to 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 to 24 hours to obtain regular uterine contractions.

What happens if labor induction doesn’t work?

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 both mother and baby are stable, C-sections can be avoided after a failed induction by allowing early labor to continue for more than 24 hours and ensuring that Pitocin be given for at least (12 to 18 hours) after the membranes have ruptured before considering induction failed.