Induction Without Medicine

I attended two hospital inductions last week that did not involve pitocin or pain medication.  In fact, they did not involve any medications at all.

First, a disclaimer:  this post is not meant to be a full exploration of risks/benefits of inducton methods.  Please seek full informed consent before choosing any induction method–whether at home or at your birthplace.

Second, I do not fancy inductions at all.  I am, however, quite happy when my clients do not need pitocin or an epidural during the dreaded induction.

Induction #1:  This mom was 41 weeks and having her 2nd baby.  Dr. Polo Shirt inserted a foley catheter at 9pm.  Mom began feeling contractions almost immediately.  She used gravity for a few hours to help the cath work and then went to bed.  Around 4:30am, she had to concentrate on her contractions.  Nurse offered pitocin at 6am and client declined.  At 8am, Dr. Polo Shirt removed the cath.  Her membranes ruptured on their own at 10:10am.  Baby was born at 10:45am.

What is the deal with the foley?  This is a urinary catheter.  But in this case, it is inserted vaginally.  The cervix needs to be dilated enough to admit the cath.  Once it is above the cervix, the bulb is inflated.  My understanding of the way this process works:  the bulb mimics the pressure of the baby’s head.  Typically, it falls out when the mom dilates to 4 or 5cm.  It is not painful but may feel distracting since there is tubing coming out of the vagina.  It is usually taped to the inside of the mom’s thigh.  There is a risk that the doctor/midwife will rupture the mom’s membranes.  However, for someone who wants to avoid medicine, this might be an alternative to explore.  Having seen this work beautifully and gently several times, I’ve become a fan of this method over other induction choices.

Induction #2:  This mom was 37 weeks and also having her 2nd baby.  She had a medical condition that required her baby come early.  Knowing this, she prepared her body through acupuncture, massage, hypnosis, and other easy induction tricks.  She was 3cm when admitted in the late afternoon.  Her doctor offered pitocin or artificial rupture of membranes.  My client chose rupture of membranes.  This procedure is painless though contractions may feel stronger without the “cushion” of an intact bag.  There are several risks.  The most significant is a chance of cord prolapse which would result in an immediate cesarean.  After her water was broken, it took some time for labor to kick in.  We climbed many, many flights of stairs and I used several doula tricks.  She dilated ever so slowly and she was offered pitocin 15 million times.  Just before midnight, things became intense.  Baby was born around sometime after 3am.

The typical induction is cervadil or cytotec followed by artificial rupture of membranes followed by pitocin (followed by epidural).  These non-chemical options don’t always work but can offer other options.