Failed Inductions: What You Need to Know

Wednesday, October 28, 2020

Failed Inductions: What You Need to Know

When we talk about inductions, we often speak of them like they are 100% guaranteeing us a baby at the end. While this is true most of the time, you’d probably be surprised to learn that indcutins can fail and you may be sent home to wait it out a bit longer. Or, if the option isn’t presented to you, you can ask or take yourself home. It is important to ensure that you and your baby are safe to go home.There are thousands of women each year that experience a failed induction and it can be very hard emotionally. 

What is a failed induction?

A failed induction is the inability to reach active labor while being induced.

There is a certain process we want to take when it comes to induction. I call this your ‘individual induction equation.’ It’s truly individual to you and you get to introduce various induction methods as you see fit which makes your equation unique to you. First we want to ripen the cervix--it needs to be soft. You have options of how we achieve this. Then we need to begin dilation. Many times in undisturbed, unmedicated (no narcotic use or induction) labor, the first few centimeters are accomplished with little or no pain. Many times birthing people will unknowingly walk around a few centimeters dilated in late pregnancy--this is completely normal! You’re that much closer to your goal and didn’t have to work for it! That’s amazing!

If your cervix is effaced and not dilating at all, it’s possible you aren’t ready to have a baby. If you choose to keep going, the next step is to get contractions going. You have a few choices of how you can do this! You can try walking and physical movement. You can try natural oxytocin like nipple stimulation, intimacy with your partner or visualization. You can also try pitocin which is artificial oxytocin. Your body metabolizes it differently so it will impact your contractions. Finally you can break your waters. This is an especially important decision for birthing people who are GBS+ as you will no longer have the option to leave because you will need to begin receiving antibiotics. You can also choose (GBS+ or GBS-) to save this for later in labor plus it allows you to return home.

When using Pitocin, be very mindful of how much you are using, for how long and how your body is reacting. Pitocin is a drug that needs to be used with respect (25% of people who receive Pitocin will have a c-section). If your body is truly not ready to birth a baby, you may find yourself experiencing a failed induction. You want to be educated on a reasonable amount of time to try to induce before you call it and say, “we’ll try again later because my body is clearly not ready.” There is evidence to support the idea that the longer it takes a laboring person to reach 6cm, the less likely they are to have a vaginal delivery. If your body is not responding to medical induction (and you + your baby are safe), instead of forcing it, you could consider going home and giving your body more time. Also, your baby would probably appreciate the extra time, too! That same study also shares that women who were in the latent phase and receiving pitocin for 12 hours still were able to achieve a vaginal delivery meaning we should not call it ‘failure to progress’ before at least 12 hours of pitocin.

TIP: Failure to progress is defined as 6 hours with no cervical change after 6cm. Failure to progress cannot be deemed before 6cm. It is also evidence based to expect a “pause” in labor around the 6cm mark for women who have very long labors. We should be patient as their bodies are typically just resting for active labor and pushing. Evidence Based Birth says, “if more care providers begin using evidence-based definitions of labor arrest and failed induction, we will begin to see fewer of these diagnoses, and a simultaneous, safe lowering of the Cesarean rate.”

A few reasons your induction may fail:

Your baby is not ready. Check out the science on what actually initiates the start of labor (if you were not induced). It will probably be surprising to you! It has quite a lot to do with your baby! Inductions increase your risk of further interventions, including c-section, and this is called ‘the cascade of interventions.’ As c-sections rise, so does infant mortality and NICU stays for respiratory distress since babies were born before spontaneous labor started. Obviously there are tons of evidence reasons to wait for your labor to start on it’s own and one of the most important is your baby’s lung development!

You were induced with a low Bishop Score. You can see here that it is flawed, but also the best tool we have at the moment to predict your chance of a successful induction. Read more about the Bishop Score here!

If you are wondering if a 39-week induction is for you, here is a breakdown of what you need to know about The ARRIVE Trial. If you doctor mentioned this to you, make sure you read this breakdown so you understand why it may not be applicable to you!

The Bottom Line

Be mentally and emotionally prepared when you go for an induction that it is not guaranteed to work! You can have a ‘failed induction’ and I highly suggest you listen to your body and baby on this one. Remember, your baby’s development is very much a driving force of labor starting! There are also things you can do to check your chances of having a successful induction like knowing your bishop score and having a plan of when to call off a failed induction.

If you want to learn more about your birth choices or how to advocate for your birth goals, join The Birth Lounge!

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