How long after induction does labor start: A comprehensive guide to inductions
The length of your induction will depend on how you are induced and how ready your body is for labor. If your body is ready for labor it is possible you will have a baby in your arms in as short as a few hours. If your body is not ready for labor, induction can become a long process and take anywhere from 1-3 days.
When you get to the hospital to start your induction they will need to do a cervical check to assess how ready your body is for labor in order to decide how to induce you.
This assessment will give you a Bishop’s Score. A Bishop’s Score is a number from 0-13 that will indicate how ready your body is to go into labor.
If you have a good bishop’s score, of 8+, your body is ready for labor. If your bishop’s score is 6 or less, your body is not yet ready for labor.
The bishop’s score will be decided based on the fetal station (how high baby is), and on the cervix itself including dilation (how open the cervix is), effacement (how thick or thin the cervix is), position (pointing towards the back vs pointing down), and consistency (hard vs soft).
In many languages the cervix is called the ‘neck of the uterus’. Please keep this in mind when we talk about the cervix. It is not a separate organ, but instead it is part of the rest of the uterus. The cervix is not a crystal ball, it is just a piece of the puzzle. However since doctor’s base their recommendations for induction types on the cervix, we will talk about how they come to their recommendations.
After deciding your bishop’s score, your care provider (doctor, midwife, OB), will make a recommendation for (or against) induction.
It is your decision to proceed with the induction at this point or not. A low bishop’s score does not automatically mean an induction is counter indicated, depending on the reason for induction.
In most cases, once the doctor makes the initial suggestion for an induction, they are unlikely to change their recommendation, however it is your responsibility to weigh all the benefits and risks for your own unique situation and make the final decision.
It is important to note before proceeding that having your labor induced with any of these methods listed below will increase your likelihood of an assisted delivery, whether by forceps, a vacuum, or a c-section.
The following are the different types of medical induction for labor and when they are used. See here for some natural induction techniques.
Cervidil
If the neck of your uterus, your cervix, is firm and thick, your bishop’s score will be low, since this is one of the first things that the cervix will do when getting ready for birth.
Cervidil is a cervical softener/cervical ripener, which will try to chemically soften your cervix by using a prostaglandin medication called Cervidil (in Canada) or Cytotec (UK).
This can be given as either a pill taken orally, or as a tampon inserted into the vagina. The tampon is more common since it can be taken out and the effects wear off quickly if the patient has a negative reaction.
If you live within an hour to the hospital, you can be given Cervidil and discharged after a 30 min-1 hour wait to ensure you have no negative reactions to the drug.
You will be told to come back in 12 hours for reassessment. However, many people have back pain within 6 hours and may choose to return to the hospital for pain management earlier than 12 hours.
Cervidil is taken out once active labor starts, after 12 hours, if you need a cervical check, or when you request it’s removal.
Once removed, the medication quickly leaves your body. In some cases your body will continue laboring and nothing else will be required to induce you. In other cases your care provider may want to try Cervidil again, the Foley Bulb or Pitocin depending on your dilation and the consistency of your cervix.
Induction with Cervidil will typically take a minimum of 12 hours and up to 3 days.
Foley Bulb
The Foley bulb is a medication free cervical opener. It uses a Foley catheter typically used for draining urine from the bladder.
It looks like a tube that they insert into the vagina and into the cervix with a balloon on the end (see image to left).
Then they blow up the balloon part to put pressure on the cervix to encourage it to open.
This is only an option if the cervix is at least 1 cm open and ideally if the cervix is soft.
If the cervix is still very hard and firm, like your forehead, this would not be the best option since the cervix needs to be soft if it’s going to stretch by pressure alone.
Once the Foley Bulb is inserted you are free to walk around. You may even be able to return home if you live close enough.
The Foley Bulb is left in until it falls out (around 3 cm). If it does not fall out, your care provider will take it out and reassess after 12 hours.
Sometimes the pressure of the Foley Bulb causes your uterus to be irritated and start contractions. If this happens your body was likely ready for labor.
However, your hormones might not be at high enough levels to continue the contractions once the Foley Bulb falls out. If this is the case, and you are hoping to continue doing a more natural approach to induction, I’d suggest doing these 3 things:
Nipple stimulation
Staying away from all stress
Have sex (if your waters are still unbroken)
Induction with a Foley Bulb will typically take a minimum of 12 hours and up to 48 hours. This technique is typically faster than Cervidil because your body was more ready for labor when you started.
Both Cervidil and the Foley bulb are the start of the labor process and are the slowest, so have patience. This isn’t a sprint, it’s a marathon.
Be sure you are staying fed and hydrated and get as much rest as you can.
Most people don’t typically know when their cervix is softening or dilating at the beginning, when it happens naturally. So feeling discomfort during this stage when using a Foley Bulb or Cervidil may make your labor experience longer.
Pitocin
Pitocin is a synthetic form of Oxytocin. In many hospitals they will just call this drug Oxytocin for ease of understanding, however it is important to know that it is not the same. It can’t cross the blood/brain barrier which means you won’t get the natural endorphins that typically come with Oxytocin. Those endorphins are what block your pain receptors in your brain, which is why people who are induced with Pitocin typically experience more pain during labor.
Pitocin is usually suggested either after a cervical ripener has done it’s job, or the cervix is favorable (bishops score 6+) This means the cervix is already at least 3 cm dilated and soft to the touch or the cervix has started to thin.
Pitocin is administered via an IV. The nurse will want to monitor your baby before, after, and during Pitocin to ensure you and baby do not experience hyperstimulation (contractions that are too strong and too frequent). Most people will start to feel contractions within 30 minutes of starting Pitocin. Once it is started the hospital will require continuous fetal monitoring. Ask for a wireless telemetry monitor, in order to stay mobile. Most wireless telemetry monitors can also go in the shower! The more you stay mobile, the more space baby will have to get into the positions it needs to in order to descend and be born.
Pitocin works by causing the uterus to contract. It literally causes contractions. The higher the dose, the harder and/or more frequent the contractions. Because of this it is typically best to request to start at a low dose. Nurses and doctors will then increase the dose as time goes on. If the dose becomes too high, the mother (birthing person) and/or baby can react negatively. The mother (birthing person) can become very nauseous or have increased blood pressure . The baby can become stressed indicated by an increased heartrate. These negative reactions do not immediately indicate the need for a c-section however. There is evidence to support that turning off the Pitocin is effective. If labor has entered the active stage, no further Pitocin may be needed. If Pitocin is again necessary to stimulate contractions it is best to start again at the lowest dosage.
You will not be given the option to return home after starting Pitocin unless they turn it off and decide to try again another day. This is because Pitocin is administered via a continuous IV drip. It is also because you will need to be monitored and have access to immediate medical care should you experience any negative reactions.
Induction with Pitocin will typically take a minimum of 3 hours and up to 24 hours. This shorter time frame is in part because the body should already be ready for labor based on your bishop’s score. But it is also because Pitocin is increased over time, generally every 30-60 minutes. Ideally you would start at 0.5–1 mU/min with a max dose of 9–10 mU/min. If the max dose is reached, or you or baby start reacting negatively to the drug, ask for the Pitocin to be turned off. Labor may continue without this additional assistance if you are in active labor. Labour typically doesn’t go longer than 24 hours with a Pitocin induction because if you don’t give birth within that time, a c-section is typically recommended. It is unheard of to start a Pitocin induction and end up stopping and going home if things are not proceeding as quickly or in the way the doctor wishes.
You may be offered or recommended a C-section if you or baby have a negative reaction to the Pitocin, if the cervix is opening slower than 1 cm/hour, baby’s heartrate increases or decreases. Ask about all your options and what the risks are if you decide to continue to labor instead of opting for the c-section. An increased heartrate may be managed by the mother resting and eating while a heartrate that decreases with each contraction might return to normal after a position change.
Reasons Labor Isn’t Progressing
Contractions are an important part of labor, however they aren’t everything. If you aren’t moving your body, it is very difficult for baby to move within your body. If you are extremely tense (clenching those butt cheeks for instance) baby will have a hard time finding his/her way through that tight pelvic floor. If baby is in a less than ideal position, like a forehead pushing on the cervix instead of the crown of the head, baby will have a harder time moving through the birth passage.
Stronger contractions are not always the answer. A higher dose of Pitocin likely won’t help you dilate faster in any of these instances. If your labor is not progressing or you suspect any of the above difficulties, I suggest doing some Spinning Babies Techniques or the Miles Circuit.
Doctor Preference
While this is typically how each method is used and decided, some doctors prefer some induction methods over others. For example some doctors rarely use the Foley bulb, while others use it pretty frequently. Some doctors use Cervidil, but only use the tampon, never the pill. Some doctors like to start at a high dose of Pitocin while others are happy to take their time and start low and slow to more closely resemble labor. You likely won’t know your doctor’s preference before your induction begins. If you know your options, you can make the best decision for yourself. It is always your choice.
Biggest Advice
Stay Mobile!!!
This is the biggest mistake I see during inductions. Get up and walk around, do lunges or squats or whatever feels good. If you are stuck in bed, roll over from side to side, sit up with the support of the bed etc. Get up to pee, sit on the toilet, get in the shower. Sway, rock, dance. Whatever you feel like doing, just stay mobile! Don’t worry if the nurses have to come in a million times to adjust the monitors, that is their job. Your job is to birth that baby! If you are moving, baby will have the space to move too.
