Doctors today will only let you go 14 days overdue, and then they will recommend induction. Some doctors recommend induction before 14 days for reasons such as: low fluid levels inside the womb, baby’s weight is getting too big, or mother has medical warrant. Obviously if there is fetal distress, a Caesarean will be scheduled. But most doctors realize that a Caesarean, because it is a surgery, is less preferable than a vaginal birth as long as there is no reason why a vaginal birth couldn’t occur. You can also get recommended for induction if you are dilating considerably (i.e. 4cm) but not going into labor, or if your water breaks but labor doesn’t start. That is to avoid infection or other concerning birth issues that can occur by waiting.
Induction is intravenous medicine (usually Pitocin) given to start (“induce”) uterine contractions. You go to the hospital, usually in the morning if you are scheduled beforehand—and Mondays/Tuesdays are particularly popular for hospitals—and get hooked up to the IV. You can eat something small before you go to the hospital but once you’re on the IV you can neither eat, drink, or move around. This is the stinky part of induction. The other stinky part is that between the IV and the continuous fetal monitoring, you really feel roped in. It is difficult to labor naturally because you really can’t change positions easily.
Plus, the contractions are artificial, quickly repeating, and therefore arguably more painful… most ladies end up getting an epidural. (Although not too early in because they don’t want the epidural to counteract the good contracting—you have to be over 2cm dilated, preferably 3.) I had four inductions (at 42 and then 41.5 weeks) and I went in at 6am, got hooked up by 9am, and started contracting about every two minutes by 10am. They start you on low doses of Pitocin just to get going and ramp it up about every 30 min or so until your body is doing fairly heaving contracting about every 1-2min. And they check your dilation pretty regularly but not overly so.
The goal is to get your body doing the labor thing even though it doesn’t want to. Which is why the process is slow. Depending on how ready your body was before the induction started, it can take almost all day. The nurses basically want you in by 9am and delivered by the end of the night. My first baby came just after 9pm, another at 6pm, another at 5pm, and another by 10pm. For the last baby, probably because my body really wasn’t read, she almost didn’t come at all. Pitocin isn’t magic. Your body can resist it. And my contractions, even though they were coming almost every minute for 8 hours, were just not working the baby out! She resisted the encouragement until around 6pm when my midwife had pity on me and got special permission to give me even more Pitocin (20 is usually as high as they go, she got permission for me to go up to 30). And somewhere around the 28 level, just as I was crying and my husband and I were packing the bag to get ready to leave the hospital, the familiar severe pain began. I knew it was going to work after all, I got the epidural at 7, my water broke, and 2 hours of pushing later, she was out.
The rest of the labor experience is pretty standard if you have had a hospital birth before. An induction is nothing to be afraid of, nor is it dangerous for the baby. In fact, because the baby is on the monitor all the time, and you don’t have to have a surgery, it is a safe option when there is benefit to the baby to being born sooner. Nothing about the Pit (as they call it) can affects the baby once born, or the breastfeeding, or your own body once it’s over. In fact, the Pit helps your body during the afterbirth (some women are put on it through an IV even if they have gone naturally), and the epidural, if you get one, eases the immediate recovery period. So while an induction and epidural may wreck your birth plan, it does not wreck the birth. It’s important to keep this perspective even if it is not the way you dreamed the end/beginning would be!
Update: After watching Ricki Lake’s “The Business of Being Born,” I have a deeper understanding for what the natural childbirth camp is trying to achieve. I am not against making the natural choice for women more available. I am against the demonization of the medical establishment, however, for the promotion of another option. This is not giving more power or “choice” to women; this is convincing them to trade one route of delivering for another (often through guilt and fear). While it is a worthy goal to reduce unnecessary medical interventions, one should not confuse inductions for good reasons with inductions for bad. There is real scientific evidence that inducing (and Caesareans, fetal monitoring, etc.) can prevent drastic circumstances in certain situations. Epidurals may be more worthy of debate, but the fact is that some conditions warrant medical interventions and in those cases (or ones that in the heat of the moment seem warranted), it is right for conscience’s sake to give it.