Preparing for Your Induction
Inductions have become very popular in recent years. As of 2020, about 30% of births are inductions (Dekker & Cayama, 2024). The ARRIVE trial has largely influenced the growing trend of inductions in the U.S. As a doula, over the years I have had more and more clients opt for an induction, so I would say that the families in Chicago growing their families are not immune from this trend.
I wholeheartedly believe that families deserve to be fully informed and held through their pregnancy and birth no matter their preferences and decision-making process. When it comes to inductions, even with how medically involved the whole process is, I still believe that there is room for preparation, education, and comfort throughout the process. Let’s start by mentally preparing you for what is to be expected at a typical, in-hospital induction in Chicago.
General Timeline
This can vary hospital to hospital, so utilize this walkthrough as a general point of reference.
Check-in and Admission (up to 2 hours)
Prior to your scheduled induction you would have received your designated check-in time and instructions. Something that catches families off-guard is that inductions are commonly scheduled in the late evening to early morning hours. So, if you’re scheduled for a 8 p.m. or 3 a.m. induction, this is usually normal.
The plan is for you to check-in through triage at your scheduled time, and then you’ll be taken the Labor and Delivery unit. You’ll be set up with your nurse, placed in your L&D room (where you will most likely be for the rest of your experience), get set up with your IV, and go through a series of intake questions. This initial check-in process typically takes up to two hours. So, if you arrived at 8 p.m. you can expect to officially meet with your doctor and start the induction by 10 p.m. or so.
Cervical Ripening (4-24hrs+)
After check-in and admission the next step in the process is cervical ripening. If the cervix is not soft or open, this step prepares the body for labor. This part of the induction can take anywhere from 4-24 hours. Methods of cervical ripening can be both mechanical and in medication form. Cytotec (misoprostol) or Cervidil are medications that can be taken orally or vaginally to help soften/efface the cervix. This medication is often paired with a mechanical tool known as a Foley balloon or Cook catheter. The Foley or Cook catheter manually dilates the cervix from 1 to about 3-4cm. Depending on the healthcare provider that is supporting you through your induction they will wait until your balloon falls out or they will wait a set amount of time before deflating and removing the foley balloon. It’s also important to note that sometimes before a balloon can be placed the cervix needs to be at least a centimeter dilated. If this isn’t the case, then one or multiple rounds of Cytotec/Misoprostol might be used.
During the cervical ripening portion of an induction, rest is key. A geat plan of action to encourage your body to work with the induction methods being used is to start the process with 45 minutes of movement. Plan to do some hip-focused dancing (lots of belly dancing style hip rolls) or use a birth stool to step up and down on to encourage hip-sifting motions. This movement can help baby’s head to engage in an optimal position, and when baby is engaged and in an optimal position evidence shows that labor can progress smoother. Ideally movement should happen before the start of any induction methods, but if this isn’t possible, moving around after the induction has started is ok too. Once you’ve done your 45 minutes of hip-sifting, try to rest/take a nap. Your partner can perform 10-15 minutes of ‘Jiggling’ (look up The Jiggle on the Spinning Babies website) to help promote relaxation and fascia release throughout your body.
Progression towards active labor (4-12s hrs)
Once the cervix is more favorable providers may start Pitocin (artificial oxytocin and driver of contractions) through your IV. Alternatively, your healthcare team might suggest breaking your bag of water (artificial rupture of membranes: AROM) instead of pitocin or alongside pitocin. Most hospitals start ‘low-and-slow’, and contractions can start to become uncomfortable 1-2 hours after starting the pitocin. The goal for this stage is for contractions to become stronger and more regular to promote cervical dilation. Fetal monitoring is required with Pitocin use, however this doesn’t take away your ability to move around or use the bathroom as often as you’d like. Many hospitals offer wireless fetal monitoring options so that you can move about the room as you’d like. In addition to alternative monitoring options, many hospitals have laboring tools like birth balls, squat bars, peanut balls, a step stool for lunging and aromatherapy. Your doula or your nurse can help you access these tools.
Generally, after the balloon falls out and you are started on Pitocin your body is still in early labor (sitting anywhere below 6cm). It can take several hours for your body to go from 3-4cm (dilation after the foley balloon falls or is taken out) to about 6 cm, officially marking the start of active labor. Continue to do a combination of rest, movement, position changes as your body makes its way into active labor. In a different article we’ll go over the sensations and physical experience of labor, but for this article, we’re primarily focusing on the progression of an induction.
Active Labor and Onward (varies: 4-12+ hrs)
Once your body reaches active labor the induction process tends to pick up speed. If your water had not been broken prior to reaching 6cm, then it might be something that is suggested at this point in time to continue to coax your body and hormonal process along for continued labor progress. In active labor contractions are longer, stronger, and closer together. This is when labor can feel most intense. Pain management options include epidural, nitrous oxide, and/or non-medical coping strategies like use of breathing techniques, counter pressure, and use of water submersion (tub or shower use). Your doula and nurse can help you try different positions and tools during this time as well.
Pushing and Post-Delivery (varies: 1-4hrs)
After the rollout out the cervical ripener, balloon, pitocin, and AROM, you are through with most of the induction tools and now your body will be given time to progress to 10cm, 100% effaced, and a positive station (station is where baby is in the pelvis, and a positive station signals that baby’s head is now in the vaginal canal). At this point, you can then start pushing. On average, even an induction birth, pushing can take anywhere from 1 to 4 hours. After crowning and the birth of your baby, they’ll be placed on your chest for immediate skin-to-skin, the placenta is born minutes after the birth, and your healthcare provider will then monitor bleeding, assess and repair any tears, and after the repair your nurse and doula can help support bonding and breastfeeding.
That is generally what an induction looks like! Mentally prepare for how long and slow going the whole process can be. Decide on whether you want visitors at this time or if you’d prefer it to be just you and your partner. Plan to bring in any comforts like your own pillows and blankets or things to help pass time like cards or a laptop to watch shows/movies on.
Here are some helpful questions that you can take in with you to ask your team at the start of your induction:
“Can you walk me through today’s plan and timeline?”
“Who will be my main provider during the induction?”
“How long can this process take?”
“At what point would this be considered a failed induction? When is c-section an option?”
Expectations & Common Questions:
Eating & drinking: Ask about your ability to eat/drink throughout the process.
You are usually encouraged to eat a light meal before arriving, but depending on the
hospital you can have your last meal in the hospital before they start the induction.
Whether you can eat/drink during induction depends on the method and how labor
progresses. Ask your nurse/OB for specifics.
Induction methods typically used: Ask about what you can expect for your induction.
Foley balloon (mechanical ripening/dilating)
Medications: Cytotec (misoprostol), Cervidil
Pitocin
Artificial rupture of membranes (breaking water)
Monitoring & IV
Continuous fetal monitoring and IV access are common.
Free range of movement is still possible all throughout an induction.
In early labor/beginning stages of the induction (before getting to 6cm) it’s best to rest or
do gentle movements like walking or being on your birth ball. Partners, early labor is a
great time for distraction. There’s not a lot that needs to be done at this point besides
give the induction methods time to work and prepare the body.
Pain relief options
24/7 anesthesiology coverage means epidurals are almost always available when
requested.
Other options: nitrous oxide (availability varies), IV pain medication, and
non-pharmacologic supports.
If labor doesn’t progress
The team will discuss repeating cervical ripening, adjusting Pitocin, or moving toward
cesarean depending on yours and baby’s health.
They should review risks/benefits and next steps with you before proceeding.
