I feel bad about my induction
"Women think they’re in control, but they’re really not."
My firstborn son will be 11 years old in August, and I’m just finally over how he came to be born.
I had what I had been told was a very “boring” pregnancy (to quote my OB), which ended at 37 weeks with a high blood pressure rate that led to me being induced. This was an arduous, frightening days-long journey I was not prepared for, marked by a series of things being put inside me—ungentle hands, an IV, the epidural, a balloon, a hook to break the water, a suppository to break the fever that came from laboring for several days.
It was so long and exhausting that my son actually being born, a tiny hard pit being pried out of an unripened peach, felt like an afterthought. Shortly after that, the OB chided me for babbling as she sewed up my labia with no pain relief. The next day, when the magnesium rendered me too weak to eat more than a few squares of Frosted Mini Wheats, a representative from Bella Baby Photography came by, played me a video of newborn baby photos until I cried, and informed me that this was my one and only chance to have baby photos done because she couldn’t guarantee she could come back later, so I said yes. If you haven’t had kids, you should know about the trickery and bullshit behind many of these beatific photo sessions. I hadn’t even taken my first postpartum poop yet.
After it all, I felt blindsided and eventually mad that I wasn’t at all prepared for this (compared to sort of knowing what would happen in a typical vaginal birth or a C-section). I also felt foolish for thinking that if I turned myself over to a hospital and doctors rather than a midwife or doula who would try to force me to deliver without medication, I would deliver without pain or fear. For a long time after, I couldn’t fall asleep at night unless I recounted every step of the process, from my call back to the triage ward on Wednesday til we went home several days later with the baby on Sunday.
So many other women I’ve spoken with who got induced felt the same way—bitter and blindsided, even though up to 40% of American labors are induced.
The reasons why there are so many inductions are covered in part by the ARRIVE trial, which states that inducing pregnant people at 39 weeks leads to fewer adverse perinatal outcomes and less risk of cesarean birth. Some people also speculate that induction is more convenient on hospital and doctor schedules.
I want to explore why, if there are so many inductions, so few women felt adequately prepared for this particular process. Can anybody be genuinely ready for a birth process like this?1 Can anything help make it less traumatizing? And what can help already-exhausted, vulnerable new moms recover from the experience?
I spoke with several birth and postpartum professionals about induction for this issue. I don’t feel exactly heartened that many more expectant people are getting an accurate roadmap of what may lay ahead. (And I say “roadmap” with purpose because it is a real journey, my friends.) But I do think that if we continue to share stories, stop applying value systems to different types of births, and talk more about how the birthing process is not over once the baby is out and breathing, we’ll maybe be on a more rational path that could someday lead to more new moms who are…slightly less traumatized.
A trained ER nurse and midwife in New York City:
Generally, western medicine thinks about labor in two stages: early labor and active labor. Active labor is when you’re dilated 4-5 centimeters, and the cervix is open and actively continuing to open.
Induction depends on where you’re starting in terms of that labor process. We can do things like give a cervical ripening agent, use a mechanical balloon, administer Pitocin, and break the bag of water.
That really starts the clock. Suppose we’re reproducing early labor, which normally takes weeks. In that case, we’re trying to reproduce it in a day or two; you’ll live and sleep at a hospital. You should pack like you’re walking into a weird, uncomfortable hotel where people keep waking you up all night long, and it’s exhausting.
People think, “I’m going to the hospital; I’m going to have the baby now.” Everyone’s texting you wondering where the baby is, and it’s hard to deal with for four days. I want people to think about the things they can do to prepare in advance for a chance for a successful induction. How can I keep my head and body in the game?
I always wondered why I wasn’t given a heads up later in my pregnancy, when my ankles and feet were incredibly swollen, that I may come down with gestational hypertension and be prepared for the induction. Why don’t more OB’s spot someone who might be likely to get an induction and advise them to learn about the process?
If you’re seeing a provider who sees 30-40 people, there are too many hypotheticals in pregnancy to possibly spin them out. When something seems to be causing a person some concern, they’re up nights worrying about it.
I wonder if I should have had a doula or a midwife to help me through the process. At the time, I was worried one would try to discourage me from an epidural which I knew I wanted, and encourage me to breastfeed, which I did not want.
The majority of midwives, I would say, want a woman to have a birth that is safe and feels good for her, and I want her to have what she wants. I want everyone to have an epidural or a C-section who wants one.
Doulas are not delivering babies; they support the birthing person. In the form of prenatal education and sometimes in the birthing room can be anything from “Let’s talk about what’s important for you beforehand, like crowd control. Do you need me to keep your mother-in-law out of here?” People pigeonhole doulas as only rubbing backs and doing breathing exercises.
Sadly, right now, doulas are needed to fill a major gap in our broken healthcare system. Providers aren’t doing as much explaining as they should or being as hands-on as they should. Doulas are stepping in to fill that gap.
I wish that every person who’s going into giving birth would have a person say, to them, “At any time, feel free to say, ‘Pump the brakes: I know you feel you may have you have explained this to me. I need you to explain it again.’”
Your body doesn’t ever stop being your body. Unfortunately, your providers sometimes need to be reminded that they can’t touch you without your permission.
A witchy pediatrician/ newborn hospitalist in Oregon:
My perspective is that medicine acts like it knows a lot more about gestation/labor than it does and that we can just force a body into labor. That process often is longer/more intense than people expect. Also, this is my pet peeve: OBs’ perspective seems to be that we are good to go once the baby can breathe. But there is so much more, and it might be a long haul for that mom. For example, 37-weekers look like term babies but often don’t act that way.
I think most quick and painless inductions are with people who are going to go into labor on their own. But I see this all the time: the induction is 3-4 days long, and you’re getting all kinds of medication. They’re monitoring every little thing; you can’t eat. It’s just one thing after another. It creates this spiral that often ends in a birth that is way more traumatic than it needs to be. Nobody addresses those emotions during the postpartum period. It’s a black hole, basically. “You had the baby; see you in 6 weeks.” All of this interferes with breastfeeding as well.
My experience made me realize how much a false dichotomy is established that pits hospital/medicalized births vs. natural/at-home births.
I just feel strongly that informed consent is bullshit. I can inform you in any way that I want to. Last shift, I had a mom who just had twins. She already had one baby, and the second was transverse. They bullied her into a C-section when she wanted a vaginal birth and scared the bejesus out of her. The notes say we have a “robust discussion.” You had a discussion where you scared the crap out of her and bullied her into doing what she wanted her to do.
People don’t get enough information and support. It would be helpful if we had more doulas available for these induction births that go on forever and ever. If you want a doula, OBs sometimes are like, “Fffff….” They want control. To some degree, I feel that the fear-mongering has wrested control away from women. Women think they’re in control, but they’re really not. I see people who want an unmedicated birth and end up with epidurals because they get bullied into it. You don’t know what it’s like to have a baby until you have one.
Induction is unpredictable. I don’t think, in general, OBs do a good job of preparing people for what is going to happen. And I think the same thing is true with C-sections. They treat it like it’s mole removal. A C-section is major surgery. It’s brutal.
The main thing I wish was different is that the postpartum period is not “You’re done, go, take care of this baby.” The postpartum period to me, is a very fragile time. It’s really emotional. It’s not as easy as people make it out to be. I burned “What to Expect” because I friggin hated that book. That you’re just there rocking your baby.
Is it responsible to try to prepare people for what could be a terrifying, anxiety-filled birth?
To some degree, it’s individual. What makes one person feel in control doesn’t work for another person. I was one of those crunchy crazy people who had babies at home. Going to a midwife made me feel in control and supported.
One of the things that made me feel supported was that my visits with my midwives lasted an hour, and they listened to me bitch. This is your whole life. That is not the way OB works. It’s a process that is very terrifying because you're not in control of what’s happening.
Heather McCullough, a midwife and doula in Evanston, IL:
70-80% of our clients give birth at Northwestern Prentice Hospital [ed: including me], and we’re experts in the facility. We know all the providers. If a provider is making a suggestion, a doula can ask questions like “Is this absolutely appropriate, or even within the same group? Is there another provider who might make another suggestion?”
We’ve all had visits with a provider where you’re like, “I’d love it if you’re not the person there on baby day.” We can help our clients get the best care out of these massive systems.
I’m also a midwife. I know on the medical side what options are available to people. Was an induction due to pregnancy-induced hypertension for you appropriate, or could there be some other steps? Although most likely, it was appropriate.
We require all our clients to take a 6-week class, and we discuss all these methods and share statistics with them. For instance, Northwestern right now has an 80% induction rate. That’s not medically necessary. It is part of the nursing shortage, and Northwestern is the third-largest birthing facility in the country. It’s challenging for them to do births safely, so they can only declare some safety by scheduling everyone’s deliveries so they can staff and ensure most people get epidurals to slow things down and manage it.
When people have more epidurals, they don’t have as many nurses.
We are astounded by the high number of inductions in Chicago. We are set up with a lot of fear language early in pregnancy. When providers try to push a person into an induction, they start it early. I know a client who was nine weeks along who was over 35 years old and had a high BMI. By 36 weeks, they’ve got some sort of factor that says they should be induced. The providers use this language “Every day after 40 weeks, the stillbirth risk just greatly increases.” While it does slowly increase, it’s not a large amount.
Sometimes these conversations are not based on the relative risk but are trying to convince their clients to do what’s easier for the larger system. Inductions are not easy. Just yesterday, we got three messages from clients saying, “I regret my induction.”
Is there any way to prepare pregnant people for what an unexpected induction might look and feel like?
There’s no true informed consent in most situations. So often, even when I’m in the room, the provider will share their preferred next step but not all of the pros and cons. We have to lead with that more: “Can you tell us more about this?”
I had my lungs collapse five times. I wish I had a pneumothorax doula to explain the pros and cons of the treatment more deeply. First, I was on morphine. I’m a 40-year-old woman who didn’t have my makeup on; I’m in my pajamas and don’t feel powerful. My surgeon was really cute; he was standing above me. It felt like he poured acid into my chest.
And afterward, I was so mad. I was mad at myself because I didn’t ask questions or advocate for myself. It’s like that on the other rise of inductions. “I had no idea what that was going to look like. I had no idea how long it would be. I had no idea I wouldn’t eat.”
It uses up your resilience emotionally and physically. It’s a heroic journey. On the other side of induction, many people leave feeling like their bodies are broken. They didn’t know how to be low-risk or dilate fast enough. The induction causes lactogenesis, too, where the milk is delayed by 24-48 hours.
A lot of people tell me, “I came into this story a powerful healthy person and now my baby and I are medically fragile.” And they have held that story for years.
How can we avoid people feeling this way?
The first question we ask people is, “Tell me your perfect birth story; what would that look like?” Almost everyone will say, “I don’t want to be induced.” Yet almost all of them go to Northwestern, where they have an 80% induction rate. If somebody says, “I have risk factors; I have a safer feeling of an epidural being induced,” we won’t say a thing. But suppose our clients already know they want intervention birth and are in a high-intervention facility.
We encourage everyone to ask providers what percentage of their first-time families are induced, what percentage of their first-time families have operative vaginal delivery (forceps or vacuum), and what percentage of their first-time families have C-sections.
None of them should be zero. But it should be low, under 20%.
You would never buy a car without knowing the safety rating, the gas mileage, and the resale value. People will go to a hospital because of their ads or because their friends went there. If you don’t know the stats, you’ll just be a cog in the wheel. Information is power, but very few people know they can ask those questions. A red flag is if a provider is unwilling to share or just says, “They’re very low.”
Krysta Dancy, MA, MFT, CBD(CBI), a licensed perinatal trauma therapist with 20 years of experience in the fields of psychology, trauma and birth, the founder and CEO of Dancy Perinatal Counseling in California
Trauma from any kind of birth is all too common (30-40% of new moms describe their birth as “traumatic”), although I haven’t seen literature supporting induction itself as being inherently more traumatic.
I think that what induction means for most people is that they spend much more time in the hospital, which results in an opportunity for disappointing care experiences and more opportunities for interventions.
Some inductions are ordered by the provider out of medical necessity, which means that there is a strong correlation between induction and other factors that might make the birth scary or, again, high intervention. We know that induction (compared to spontaneous onset of labor) increases the risk of complications by itself. It becomes easy to theorize that there would be overlap between those who experienced induction and those who struggle to come to peace about their birth even years later.
What do people who want your help after an induced birth often tell you about why they came to you? What are they looking for?
Clients might question their decision or feel that their provider let them down by leading them down this path. In the case of a medically indicated induction, the induction itself might have felt unavoidable. Still, it set them up for a painful, exhausting and complicated birth which becomes the focus of their need to heal.
What can you do for them?
I find that most people struggling after their birth experience this way have some level of PTSD or trauma. I am a big fan of the theory that says that trauma results from memory formation going awry and your central nervous system needing support. Techniques like EMDR are among my favorite ways to help them “re-process” the birth experience so that they can begin to feel like it is causing them less distress.
Usually, they know they healed when the birth becomes “something that was hard, but it feels distant and less interesting” instead of an endless loop of self-examination that they feel stuck in.
How much of your work involves helping people reconcile their experience with how they thought of themselves, birth, or medicine before their induced birth?
Some birthing people feel that the medical system failed them completely, and that is a feeling of deep disillusionment (or sometimes even worse: abuse). A sense of guilt is also common in trauma, even if it’s not quite fair to ourselves. It’s the part of our brain that wants to make sense of our experiences as a way to make sense of the experience and to protect ourselves from future risk as well.
I have found that there is little point in talking someone out of this feeling until they have healed the traumatized memory. As their healing progresses, these kinds of larger questions: what does this mean? What can be learned?) can sort themselves more organically.
What, if anything, can be done to prevent the type of post-induced birth trauma you most often see?
Increasing a sense of control over the environment is an important first step. Often in a hospital room, there is a feeling of vulnerability and powerlessness. Professionals who help increase the voice of the birthing person in the room can make a huge difference.
Similarly, truly informed decision-making can make the difference between “something difficult” and “something traumatic.” After all, we are strong and resilient in the face of difficulty, and we can accept hard things if we are respected and feel that we participated in the process. People have a harder time making peace with a birth where they feel confused, overwhelmed and not heard.
Is there any benefit to preparing pregnant women more up front that they may need some type of trauma counseling after a birth? Is that just too scary?
This is a million-dollar question. With such a large percentage of women having trauma from their birth, it makes you think that they need to know what resources are available so they don’t delay getting support.
On the other hand, telling a group of women (most of whom will not need trauma support) that birth is traumatic... might not be a nice or even accurate thing to say. I think the best compromise is a conversation like this, where women can seek out the information if needed. Social media has done so much to increase education around this and assure people that they are not alone and that there is meaningful help for them.
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One witchy thing
My second son was also induced, but compared to the first, it was a breeze thanks to the lack of mystery and no magnesium. Shout out to others who have given birth but never known what it feels like to “go into labor.”