About 50% of births in the US have a Pitocin conversation.

So 50%, approximately 50% of births need to know and have these conversations, or you're going to.

Induction is one of the most misunderstood conversations in the birth world, and it's possible that we may run into a medically necessary induction conversation.

Well, then I want you to know what the hell they're talking about

Motherhood is all-consuming Having babies, nursing, feeling the fear of loving someone that much And there's this baby on your chest, and boom, your entire life has changed

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I'm Lo Mansfield, your host of the Lo and Behold podcast.

Mama of four littles, former labor and postpartum RN, CLC, and your new best friend in the messy middle space of all the choices you are making in pregnancy, birth, and motherhood.

If there is one thing I know after years of delivering babies at the bedside, and then having, and now raising those four of my own, it is that there is no such thing as a best way to do any of this, and we're leaning into that truth here.

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When it comes to induction, I would say that maybe induction is one of the most misunderstood conversations in the birth world, and definitely one with lots of, like, misinformation.

There's a lot of research about it.

People pull in words or vocabulary like natural induction methods versus medical induction methods, so that you're kind of waffling between what all of that stuff means.

I wanna get into that in this episode today, and I will tell you right off the bat that I initially was gonna just do one episode where we just talk about, like, what induction is, what that might look for you, and really, I, what I want you to hear is the methods of induction, right?

And then it felt like too much.

Like, I was throwing too much at you at one time, and I really want you to get all of this, again, because this conversation is really prevalent and really big in the birth world.

So this episode is going to be a part one.

The very next episode re-released after this will be the part two.

So ideally, you are here listening to this one first before you listen to the part two.

One of the reasons I also wanted to separate this out is because part two is largely going to be kind of what type of induction methods are there, right?

And so it might feel a little rote, but it's also going to be a lot of information about the different medications and things.

So less so about natural induction.

Again, this is a big conversation, and that's a whole other thing.

And just to be clear, when I say natural, there's some air quotes with that conversation because really anytime we're intervening in the labor process, we are doing something, right?

That's not inherently natural.

But that's-- We'll save that for the natural induction conversation episodes.

But when it comes to these methods and stuff, there's just a lot of different methods, and while it's easy to want to dismiss them, I think it's really important that you know about all of them because we all know about Pitocin.

Yeah, we're gonna get into that, right?

But there's a lot of other stuff going on here, and a lot more that could come up in your birth process, even if you aren't ever planning on it or if you're someone saying, "I absolutely don't want an induction," right?

We have that.

"That's not part of my birth plan.

I would never choose an elective induction.

I'm not gonna learn about induction 'cause I literally am not gonna do it," right?

And so we can have these conversations in our head, and then I think once we start learning about it, hence being here listening, what we're gonna find is there's a lot more to this conversation than maybe, "I'm just not utilizing Pitocin," right?

So part two, we're gonna get into a lot of the methods, but I think the methods are gonna make a lot more sense, and you're gonna be able to make a lot better decisions about them or choices around them when you understand kind of some language and framework that I wanna go over with you in this part one episode.

So that's what we're doing here, and then I want you to come back and jump right into part two so you do get all of this at once when you're ready to do both, okay?

So goal for today, we're kind of laying framework and foundation so you are smart, literally, so you feel really smart going into these conversations, whether it be pre-labor, and we're talking about induction, or whether we're talking about some sort of change in your labor process, and we're talking a little bit more about augmentation and the overlap between augmentation, induction, what that means.

We're gonna get into it.

So just put a pin in that real quickly.

So let's define the terms that I just threw at you.

Induction and augmentation and why I think they're really important here.

Now, I just mentioned that things can happen in the labor process, right?

And then we end up introducing or needing to, or someone simply suggests, even if we don't need, some sort of thing to sort of speed things along, right?

So that is an augmentation conversation.

So you probably know what induction is, right?

Induction means labor has not started yet.

For whatever reason, we are at zero, or maybe you're at one or two centimeters, and we're gonna get into that too, that riper cervix conversation.

But you are not contracting, and you are not in labor, and then we, the care team, we're going to do something to get you into labor and to get things going.

So that is what an induction is, right?

And again, hearkening back to that natural induction conversation, yes, there are things people are trying to do to get them into labor or trying to do to get their body more ripe for labor, and so that's kind of how that fits in or slots into this conversation a little bit.

So induction, labor hasn't started yet.

You're not having contractions.

Your water hasn't broken.

You're not actively laboring, and then we're trying to get you into it.

These can be medically necessary, and there is a massive number of reasons that you might need a medically necessary induction, right?

Let's throw something out there that, that could be true for one of us.

Let's say you know that you have a large for gestational age.

That's a post-birth term, but let's say they you have a suspected big baby, and it's measuring over like 5,000 grams and you have diabetes.

There's some quantifiable numbers where they say, "Hey, we recommend an induction at a certain point if that's your situation and baby is large and you have diabetes, then we recommend induction," right?

So someone would say that's a medically indicated or medically necessary induction.

There could be some sort of fetal condition.

Maybe you have a maternal condition that warrants, hey, it'd be better for baby to be out than in right now.

Maybe it's like a preeclampsia.

There's a lot of possibilities here, right?

So medically indicated induction is one reason that induction might pop up into your conversations.

Certainly, elective induction is also a choice and a possibility for you, which is when you're simply saying, "Hey, I'm ready to be induced." Now, typically, these are not done until you are at least 39 weeks.

You need some sort of medical reason to do an induction prior.

So anywhere after 39 weeks onward You can have this elective induction conversation as well.

And then sometimes there's these kind of ideas that, or reasons for induction to me that feel a little bit in between.

Like, there's whispers of maybe it being medically necessary, but the research actually doesn't show it is, but maybe a provider's making you feel like it is, but you're just not sure, but you're also ready to have the baby out.

And so it can feel a little bit gray for those types of inductions too, of like, "Why am I actually doing this? I want to, but maybe I should, and maybe it's warranted." So that could be another, let's say, reason where you're being induced as well.

Now, this is not a conversation here in part one or in part two either about, like, should you be induced.

That is a very personal conversation that you need to be having with your provider and figuring out Is there a medical necessity here?

What qualifies this as a medical necessity here?

Is there an elective desire here?

What are those for me?

Why do those matter to me?

Does that make sense with the health of me and my baby and my pregnancy?

And so you kinda have to have all those conversations with yourself and with them so you can make it a really informed, smart choice.

So again, this is not that conversation of should you be induced.

I want you to understand what it is, what the process is, and then we'll get into how that happens, so that if you are to be or if you are to choose it, you really have a good understanding of all of the things that kind of encompass what happens, what you might get to choose, what you might wanna refuse, et cetera, inside of this induction conversation.

So back to augmentation, right?

Because I wanted you to understand those two different terms.

So augmentation, which I mentioned just when we started talking about this, is this idea of moving labor along once it's already started.

And so maybe there's a labor stall, right?

And for whatever reason, you made it to six centimeters, and you've been sitting there now for 11 hours, and nobody knows why.

Or maybe your water broke and contractions started, and they petered out, and we would like to, quote unquote, like give you something to move it along a little bit.

So that is more of the induction conversation.

So you're in labor, there's stuff going on, your body has begun the process, and then the care team, for whatever reason, decides or is suggesting to you, "Hey, let's give you a little something to move this along.

Your dilation isn't changing.

Contractions aren't strong enough," something like that, conversations that sound like this.

And then instead of starting labor, the goal then with augmentation becomes helping labor continue.

So I want you to hear those two differences, the induction and the augmentation.

And again, I wanna circle back to so you understand why I think this is so important for everyone, including the one from the very beginning who's saying, "I'm not going to be induced.

I'm not gonna choose it," that we don't always know what's going to happen in the labor process, and if there becomes some sort of need for augmentation or just even discussions of it, well, then I want you to know what the hell they're talking about, right?

And it's possible that we may run into a medically necessary induction conversation.

Maybe we don't want it, one at all, like I said, and then we still need to know what's going on so we can make really good choices in that scenario, too.

So this is not-- to me, it's not just an induction conversation.

This is just a labor and birth conversation.

So glad you're here.

I want you to hear this because I think we all need it All right, now that I'm sure that I have you thoroughly convinced that you need to care about induction and augmentation and what's going on here, let's move on to what else that you have to know maybe to have smarter, better conversations.

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When you have education like this, everything changes, your mindset, your conversations with your care team, and the birth experience itself.

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Okay, let's get you back to the episode

Now, I will be clear with you as well, I include an entire mini course on induction inside of my birth course, and I want you to hear that because induction, I used to, I used to have them separate, right?

Or you could buy one or you could buy the other.

But then I felt like my birth students were not getting all of this induction conversation that they needed because, what did I just tell you?

So many labors end up in an augmentation process, or it's simply being suggested to them.

And so then my students are going, "Whoa, whoa, whoa, why didn't we talk about all of this stuff?" Or, "Why don't we go in depth about this stuff as well inside of the birth course?" Because let's say half of us are ending up in that conversation.

Now, that 50%, that half that I just threw out there, is actually kind of, let's say, the evidence-based.

It's an ish number.

About 50% of births in the US have a Pitocin conversation, and we're talking about it being utilized in labor, whether that be for induction or augmentation.

So that is a big number of people who are having this conversation.

Even if they never wanted to be induced, like we talked about when we started, they're still being plopped into the middle of this Pitocin conversation.

So inside of the birth course, you're getting all things induction and augmentation, and you're also getting all things birth, so you can put the two things together and make really good choices inside of these combos as well as, let's say, the non-induction, non-augmentation conversations as well.

So 50%, approximately 50% of births need to know and have these conversations, or you're going to.

Let's say your chances are at least one in two that you're gonna need to know how to have these conversations and make choices in them.

If Not honestly, I would say the percentage being even higher, and that's totally anecdotal, just throwing that in from what I've seen at the bedside is, man, we're talking about Pitocin and moving things along a lot.

And so that is important part of this conversation.

So sorry, little rabbit trail, but I just want you to know that you can get that information and have it to make choices like the ones that we're talking about.

Okay.

So let's say instead of choosing an induction method, we're not there yet, and I told you we're getting to that in then part two, so we're not even gonna get into that today.

What about knowing how to make this choice or knowing, like, is this a good choice?

Is there any sort of tool you could utilize or that you could be aware of so you can have better conversations with your provider about this?

There is.

It's called your Bishop score.

So your Bishop score is basically a scoring system that estimates how ready your cervix is for this induction or in the augmentation conversation, it's typically used, we're using that Bishop score before we're introducing Pitocin, right?

And so in the augmentation conversation, it's largely related to Pitocin.

In the induction conversation, typically, we're figuring out the Bishop score at the very start of the entire process, and then that helps them decide what method to use or what method that they think would be best for your body to s- kick off your induction.

So this Bishop score actually drives a lot of decision-makings in either kind of side of or either scenario that, that I just mentioned.

So you can have a ripe cervix, which means you have a cervix that is very, very ready for labor.

You can have a favorable cervix.

Those terms are essentially synonymous.

Or you can have an unfavorable cervix.

There's also kind of a meh, like, who's to say?

And we'll get into that as well So all of this, though, is just talking about this readiness or this lack of readiness of your cervix for labor and can just help you decide, like, should we be inducing?

And then if we have to, like, how can we do it in the best way, the gentlest way, the smartest way to ideally get you to this vaginal birth that you want.

So essentially, your cervix is, is like a fruit, right?

And it gets riper as you get closer to labor.

So I mean, you know this.

I always like to think about a avocado.

Like, as they get riper, you can just tell.

It's easier to separate the skin from the inside.

That kind of goes into this illusion of a, a membrane sweep, right, and separating around.

Sometimes, you know, things are changing on their own before labor begins.

Sometimes we give things more time, if we're sticking with the fruit analogy, before they get ripe.

It's kind of the same with your body.

So when we can give things more time, they're typically gonna get more ripe.

We can't always give things more time, so then we land here in the conversation that we're having right now.

So your Bishop score, there's five things that make up this score.

Essentially, it's all about what we're figuring out or determining during your cervical exam, and you can listen to the episode we have on what the cervical exam is and why they're necessary or why they're not and what your kind of options are around that as well.

We already have that episode available for you, but the Bishop score is part of a cervical exam.

Now, are we always thinking, "What's your Bishop? What's your Bishop?" when we do your cervical exam?

We're not.

Typically, it actually gets charted.

Those are some clicks and some drop-downs that we're always doing, but we're really thinking about it when we're thinking, are we gonna introduce some sort of medication or some sort of option to move things along?

So within the cervical exam, and then as part of the Bishop scoring system, we have your dilation.

So that's all about how open your cervix is.

Most people are really familiar with that one.

Measured in centimeters, right?

And then we have effacement, which is another one that most people are pretty familiar with, right?

And that's that percentage number, and so you move from 0% effaced, which is a- the thickest, like, that your cervix is gonna be.

So it's very, very thick or fully thick, however you wanna say that.

You're not effaced at all.

And then you move from 100% effaced, which means the thinness of the cervix has just totally gone, gone to nothing.

And so that is 100% effaced.

Baby's station is kind of that third number when you hear, like, three, 90, negative two, a cervical exam that sounds like that.

Station is that third number, that negative two.

I mean, it can be other numbers as well.

That's actually all about your- where your baby is sitting in your pelvis and kind of their station inside of your pelvis.

And so they can be higher, they can be lower.

They can be more engaged.

They can be closer to delivery, right?

And that actually moves from Negative numbers, like negative, negative four is not really going to-- you're not going to hear that that often.

That means your baby's really high in your pelvis and unengaged.

But we're going to move from, like, a negative three, negative two, all the way down to the pluses, like a plus two, plus three, which means we are very close to delivering when we're down to, like, the plus three, plus four.

Okay?

So that's station.

That's the third part of the cervical exam.

There's cervical position, which is about where your cervix is at in your body.

So it can be really far posterior in your body, and then your cervix ends up rolling forward as you get closer to delivery of your baby.

So it could be posterior, mid-position, or anterior.

And then there's cervical consistency, which is about kind of the firmness and/or lack of firmness of your cervix.

Softer is, is better in this in-instance, right?

So it can be firm, or it can me-be medium, or it can be soft.

I, I like when people share, I like to tell my patients this if they're kind of curious, like, kind of pressing, like, your forehead, your nose, or your chin shows kind of the different consistencies.

Obviously, you know, like, your forehead is going to be super, super firm, and then you get to the medium and the softer, and you can kind of see what we mean by, " Oh, the consistency is changing.

That's great.

That's progress." So each one of those categories, I just listed off five categories for you, they, they get points, right?

And you get a zero to two score for those, and then when you put them all together, essentially we get this number, right?

Once we add each of those together.

And ideally, what we're looking for on a Bishop score before we're going to start inducing, and certainly before we're going to start Pitocin, right?

That's very important here, is we would love to see a Bishop score of eight, eight or higher.

So this indicates a favorable cervix, a very ripe fruit, a body that is very ready to add something to the mix and march its way onward towards this vaginal delivery that we want A score of, let's say, six to seven is that meh score that I mentioned to you where we're like, "Hmm, not great, not horrible, could be worse, definitely could be better."

And so that's just kind of one of those weird in-betweens.

So it doesn't necessarily say you can or you should not do anything, it's just not, not ideal and nor is it the least ideal, right?

And then anything kind of less than six, that is a non-favorable cervix.

So if we're in a medical induction situation, we still have to work with what we've got, right?

But if we're not, if we could delay this or push it off or have that conversation, then, then we might want to, right?

If you're looking at a Bishop score of, of three or four or five, something like that, where you're going, "Man, this cervix really isn't ready for labor. Is that something that we need to do right now?"

Okay?

And so we have above eight, that's ideal.

The six to seven's a meh.

And then underneath six is less ideal.

That's not a ripe cervix.

Now, you may be going, "Uh, I could never remember all this." Well, that's fine.

I mean, you really shouldn't have to.

What I really want you to know and hear is what this is, and so now you can start having these conversations.

This is why this stuff is plugged inside the birth course, and definitely inside of the induction course too, so you can have these conversations when the provider's saying, " Hey, let's start with this for your induction or this.

Let's get Pitocin going." And you can say, " What's my Bishop score?

How are things looking here?

Like, is my cervix looking good?" Do you have to actually know what each score means or remember it?

No.

But you're gonna have these really great conversations with them when you have this kind of awareness and knowledge of what's going into the decision-making process for them when they're suggesting stuff, and then certainly for you when you're saying, "Yeah, let's do it," or, you know, "Is there an alternative?"

Right?

So this is just really, the Bishop score is somewhere where all of this starts to come together.

Now, in an induction conversation, it is very likely that some people will have a very unfavorable cervix, and sometimes we just have to deal with that, okay?

But I still want you to hear what this is so you can have those conversations that we just talked about.

Now, we can't do anything about that unfavorable cervix when we need to have this baby delivered for whatever reason, and so we'll get into the methods, the alternatives, the things in part two that we can do to kind of get the body ready before we go ahead and start something like a Pitocin, right?

In an augmentation conversation, should you be inside of your labor process and someone saying, "Hey, let's move things along a little bit," well, this Bishop score conversation becomes really valuable there because if they're wanting to introduce a Pitocin, you're not feeling great about it, or you're just unsure, and you have an unfavorable cervix, well, then maybe there's a different method to use before Pitocin.

So you can really see how just having this knowledge and this awareness as well as that understanding of moving things along versus starting things from zero is gonna be really valuable for your decision-making process and then help you feel really aware of these different methods that they're going to start suggesting as well as give you kind of that strength and confidence to say, " Hey, what are some alternatives?"

Particularly in a scenario where the cervix might not be as favorable as everybody's hoping, and we do have some leniency about, about what we do next.

So if you're planning an induction or if you're considering an elective induction or if one becomes medically necessary or Going back to what I said when we started, if you're simply going to have labor and birth, I just want you to know and understand the stuff that we just went through, right?

So consider asking these questions.

What's my Bishop score?

How favorable is my cervix?

Certainly in an elective conversation, you would want these things to be lined up really well, right?

So if you're making this choice purely because you want to, or let's say you don't have a super strong reason aside from maybe like, "I just really want this baby out," well, maybe you wait if you're not super favorable, right?

So understanding what the Bishop score is, and then understanding in this conversation, how does this change your plan of care?

What are the methods available to me?

Do I feel better with one than the other, particularly knowing what I know now or knowing where I'm at in my labor process?

What are the alternatives if one's being suggested?

Are there other options?

And again, particularly related to that Bishop score and how ready your body is for labor.

So before we talk about the Foley balloons, the side attack, the Pitocin, right, some big topics that pop up all the time, I really wanted you to understand all of this, what this induction stuff is, why it's needed, how it pops up for all of us, and then how you can kind of show up really ready to make these decisions.

Part two, which again is the episode immediately following this one, we're gonna get into those actual induction methods.

So you can take this awareness that I just gave you here in this part one, and then you can apply it when people start throwing options or possibilities at you, or if someone mentions your Bishop score, then you're gonna say, " Okay, cool.

Like I know what some of my options are.

Let's talk through them together."

Thank you so much for listening to the Lo and Behold podcast.

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