“Epidural-Free Birth: Induction”

In our last blog post, “Epidural-Free Birth”, there was a lot of resources and supports given for learning about the epidural, ways to advocate for yourself, birth plan goals, engaging with providers, and much more!

But there is often a question that is asked to me as a doula, “What happens if I am induced? I hear Pitocin and contractions are much harder/stronger/impossible (fill in the blank)”. So we are going to answer that question here.

Let’s start at the very beginning!

What is an induction?

Also called IOL or Induction of Labor, the Mayo Clinic defines an induction as “Labor induction means getting the uterus to contract before labor begins on its own.” Typically hormones and medications are used to ripen and soften the cervix, and help the cervix dilate (or open). There are tons of reasons for inductions, and probably will be another blog series for another day! But induction conversations can happen at any time and it is wise to consult with your doula and care team to understand the reasoning and need behind an induction, possible outcomes, etc. Inductions have their place in birth, but also have a lot unknown and even some anxieties associated with them. But does an induction REQUIRE an epidural?

No.

Not at all. You can absolutely have an induction and not need pain medication of any kind.

First- you need to gain needed information! Like many of my earlier posts suggest, good outcomes rely on heavy and in-depth communication with your provider well before arriving to the hospital. This information starts early at your appointments…. The beginning of the third trimester, even! Ask questions! The answers are your right to know! Ask questions to learn what to expect with their protocol for inductions.

• How do they plan to induce you?

• What medicines/techniques will be used?

• Are you a VBAC patient? If yes, ask specifically if the practice “requires” epidural placement before active labor begins. (Interested in learning more about this? Click here for more info).

  Now share these answers with your doula and make a plan. Add this topic to your birth plan/goal setting strategies.

Often times, inductions start with ripening agents and/or a mechanical method of opening the cervix such as a Foley balloon or a Cooks catheter. These help to ready the cervix- which is the beginning process for an induction, and used before Pitocin (the synthetic form of our bodies own oxitocin) can be started. To avoid needing pain medicines during this time, I recommend to clients that rest is very crucial in this part of an induction, and that takes strategic action. Patients are usually required to be admitted for this part until the baby is born, and this part can take many hours, even up to 24-30 hours for this ripening/readying to happen. Sleep is your friend. Sleep is needed to give your body time to re-energize and prepare for the labor that will happen. Position yourself with pillows, use a sleep mask, enjoy your sound machine, ear plugs, warm shower, hot tea- all the things to help you get in a state of relaxation and sleep. Your body responds best to labor stimuli when it has had adequate rest.

Once Pitocin is started, contractions will eventually be a result of that medication. Lying in bed can often make these contractions much more painful, so developing a plan with your doula is helpful to have working strategies ahead of time. (How to move, when, what props to have, etc). Movement and gravity tends to help the body deal with contractions much better than static positions.

Circling back around to those provider conversations you have had in office, one of the most important talks is discussing their use of Pitocin and the practices stance on it. Contractions involving Pitocin can be startling, sharp and frequent, and because they are a synthetic hormone, your body knows that it’s different. When having Pitocin-contractions, the body can react quickly, or it may take some time, but eventually active labor contractions will kick in. The answers to these questions will help you prepare in tolerating labor and utilizing non-medicinal comfort strategies.

• Is your provider willing to go slow with increasing the Pitocin drip?

• Is your provider willing to use half the recommended dosage? Pitocin is most often used in 2 milliunit intervals- would they be willing to dose 1 milliunit instead?

• Will your provider consent to extra time in between increasing the dosage so that your body can have time acclimate? Instead of increasing the dosage every 20-30 minutes, would 45-60 minutes be a possibility?

• Is your provider willing to turn OFF or down the Pitocin once adequate labor is reached?

When the body allows for a more physiologic labor process, labor tends to go more smoothly in terms of acclimating to the labor discomfort and tolerating contractions easier. This often results in overall labor satisfaction, feeling empowered by contractions, and non-medicinal strategies are able to be effective, resulting in not needing an epidural. By going “low and slow” with Pitocin, and by turning it off or down, when contractions reach an adequate level can give your body the opportunity to produce not only its own oxitocin, but also its own pain-relieving hormones. Don’t forget the use of a TENS unit during this process. Other hands-on strategies including the tips in my earlier blogpost “Epidural-Free Birth”, double hip squeezes, counter pressure, and using a labor comb are also very effective.

I hope you have found this information and sharing helpful. As a Baltimore-area doula of 15 years, I have seen a lot of scenarios and outcomes. Each birth is unique and so is the outcome that a person is seeking. Whether you choose to have an epidural or not, your satisfaction and birth experience is important. Keep asking questions! Hire a doula! Choose your provider wisely! All of these will help you achieve your birthing goals.

Be well!

Gravity is your Friend!!