The holidays and scheduled inductions of labor

The winter holiday season is upon us! That means feasting and gathering and celebrating and bundling up and inducing labor… wait, what?! Yep, you read that right. Inductions of labor spike dramatically on the days leading up to holidays like Thanksgiving, Christmas, and New Year’s. Natural variations in birth dates exist, of course, but does a pattern where hardly any babies are born on major holidays look natural to you?!

Birth date chart reposted from NPR by mommybites.

Birth date chart reposted from NPR by mommybites.

While this may seem like a cynical take on variations in birth dates, any pregnant person with a holiday-adjacent guess date who has been offered a scheduled induction starting in the springtime will tell you that it is a harsh reality. So I’m here to talk about the potential reasons, risks, benefits, and options around inductions of labor so you can make the most informed, empowered decision for your birth, no matter your guess date!

What is an induction of labor?

An induction of labor is often a long and complicated process rather than a quick, linear one. There are several methods of encouraging labor to begin or progress that don’t require medications, like having a membrane sweep or ingesting castor oil. This post focuses instead on medicalized induction processes that involve drugs like Cytotec, Cervidil, and Pitocin, as this is what you are more likely to encounter at the suggestion of an OB. Regardless of the method, two basic goals have to be achieved: the ripening of the cervix and the induction of contractions.

  • Preparing the cervix. During pregnancy, your cervix is likely long, closed, and posterior, but during labor it shortens (effacement), thins (dilation), and moves into a more anterior position. An induction of labor often begins by softening and ripening the cervix by introducing synthetic prostaglandins like those contained in Cervidil or Cytotec (aka misoprostol, which is actually an ulcer medication!) or by inserting a balloon catheter to put pressure on the cervix. Some medications are inserted vaginally, some are placed behind or near the cervix, and some are taken orally — the options available to you might depend on your provider and birthing location. It can take multiple rounds or doses of a ripening agent in order to prepare the cervix, so don’t expect the magic to happen immediately!

  • Causing contractions. Once the cervix is “favorable” (which is some very unfortunate medical terminology!), your provider will want to get strong, effective contractions going to move your baby down the birth canal. This is often accomplished by administering synthetic oxytocin, also known as Pitocin or “Pit,” through an IV. Your provider will choose the specific amount that your body needs and then adjust as labor progresses to maintain a contraction pattern that is optimal for the health of you and baby, which could mean adjusting the dosage either up or down over time.

Many times, the combination of ripening the cervix and bringing on contractions creates a labor pattern that leads to a vaginal birth; in other cases, certain steps of the induction process might need to be repeated or a cesarean birth might become necessary. Since inductions can progress in many ways, it’s important to stay both flexible and informed — ask questions, be prepared to change course, check in with yourself, and speak up about your needs! A birth that begins with an induction is still your birth.

Assessing readiness with the Bishop Score

Bodies come to induction time with all sorts of unique properties. A few of these properties — cervical position, cervical consistency, cervical effacement, cervical dilation, and fetal station — can help you understand how to proceed and how successful (defined by the level of other interventions, like cesarean sections) an induction is likely to be. You can measure this with the Bishop Score. A higher score suggests that labor will likely start spontaneously in the near future or that an induction is likely to be successful; a lower score suggests that an induction might not be as successful. The Bishop Score is complex and by no means a guarantee of anything, but it can be useful information to know.

Chart detailing how to use the Bishop Score to assess cervical favorability for labor induction.

What are the risks of induction?

Beginning labor before your body is ready does come with some potential risks and downsides. A major drawback that most people find difficult is the experience of confinement and lack of freedom — the medications associated with induction come with monitors, wires, IVs, and some restrictions on movement, food/drink, and hydrotherapy. In addition, you should be aware that an induction increases the chances of:

  • Other interventions, including cesarean birth, to be required or offered

  • Infection

  • Bleeding after baby is born

  • Need for pain medication

  • Low heart rate and/or oxygen supply for baby

  • Postpartum mood disorders when Pitocin is used (a recent study found a 32% increase for those with no previous history of anxiety/depression and a 36% increase for those with a previous history of anxiety/depression)

While not everyone experiences these risks, there is a phenomenon called the “cascade of interventions” in which tampering with the body’s natural process snowballs into more and more “necessary” or suggested interventions. When you’re in a vulnerable position like labor, this snowball effect is hard to avoid (but a doula can help with that!).

How do I know if an induction is right for me and my baby?

Your provider might mention any number of reasons for suggesting a scheduled induction, including their own convenience! There are both medically-indicated reasons and elective reasons to begin labor artificially, so it’s up to you to ask questions and gather information to make the best decision for your situation. (Please note that this list is not an endorsement or rejection of any of these reasons, but rather includes things that providers might mention.) Your provider might suggest an induction if:

  • You have carried baby a week or two beyond your estimated due date

  • Your water has broken but labor hasn’t begun with a set time frame (usually 24-48 hours)

  • You have gestational diabetes

  • Your baby is “too big” or growing too quickly

  • You have a blood pressure issue like hypertension or preeclampsia

  • You have low levels of amniotic fluid surrounding the baby

  • You have an infection in your uterus

  • Your placenta begins to separate from the wall of the uterus before labor has begun

  • They are going on vacation or taking time off for a holiday

  • They are concerned about the limitations of rooms/beds in their labor and delivery or postpartum unit

If you are not experiencing an urgent medical situation, you will likely have time to research and think over the reason(s) that your provider gives for a scheduled induction. You might consider beginning with the position papers on induction published by the American College of Nurse-Midwives and the American College of Obstetricians and Gynecologists, both of which detail medical and elective reasons for induction as well as risks and potential complications.

“Induction of labor should be offered to [pregnant people] only for medical indications that are supported by scientific evidence which indicate the benefit outweighs the risk of induction of labor, including the potential risks of prematurity or postmaturity.” (ACNM)

What can I do when offered an induction?

If your guess date is near a holiday, your provider might begin suggesting very early on in your pregnancy that you think about scheduling an induction. Those who are pregnant can start by asking allllll the questions and doing thorough research before making any decisions. If you decide to induce labor and all is going well with you and baby, you can also explore non-medical (“natural”) labor techniques and less invasive processes first, before moving to medications like those discussed above. (Keep in mind that “natural” labor induction is still an induction of labor!)

You can also gather birth support, like doulas and partners, around you to discuss the possibility of induction early on in pregnancy and make plans for how to approach the topic if/when it arises in conversation with your provider. A good support team can remind you of your options and your control over the birth process, help you settle into a longer-than-expected pregnancy, if necessary, and ease the anxiety and other emotions that the last few weeks before meeting baby can bring.

And remember, you can always question your induction or change your mind — even if your induction is already scheduled!

induction birth informed consent

A doula’s role in an induction

Doulas provide information and support, not judgment. I support all types of birth journeys, even on holidays! If you choose an induction, I will work with you to explore your options, outline your preferences, and prepare for a successful and positive birth experience. During labor, I will support you by setting the atmosphere, suggesting comfort measures, managing your wires as you move about, providing information and affirmation, and talking through your options and needs as labor progresses. I can help you feel not so alone during a vulnerable and unfamiliar process. No matter the type of birth, doulas can increase feelings of positivity and agency around the birth process — that’s evidence-based!

Disclaimer: This post is in no way intended to provide medical advice or guidance on the induction of labor, as doulas are not medical professionals. Please always consult your healthcare provider while making any decisions about your pregnancy or baby.