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Helen Dandurand (Host): Welcome back to The Well Within Reach podcast. I'm your host, Helen Dandurand. And today, I'm going to be joined by Holly Krone, a nurse in our Riverside Family Birthing Center to talk a little bit about induction.

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Host: And we're back with Holly. Thanks for joining me today.

Holly Krone: Yeah, thanks for having me.

Host: Of course. So, you've never been on the pod before, could you go ahead and start by telling us a little bit about yourself?

Holly Krone: Sure. I'm a Labor and Delivery nurse, born and raised here in Kankakee County. I still live in the community with my husband and three children who are all born at Riverside. So, it's safe to say our Labor and Delivery team holds a special place in my heart, both personally and professionally.

I started my journey in Obstetrics and Gynecology back in 2011, working in an office setting until I finished nursing school. And since 2017, I've specialized in Labor and Delivery. I am certified in Inpatient Obstetrics, and I've also worked as an agency nurse in higher risk facilities, which has really given me a broader perspective. No two births are the same, and I strive to help patients feel informed, supported, and empowered throughout their journey.

Host: Great. That's great. Sounds like you have a lot of good experience. And, you know, we need a lot of good nurses who have that philosophy of care behind them. So, we're going to talk about induction. I feel like there are a lot of questions around induction, things like that. So, we're going to try to address those here. First, let's start with the basics. What does it mean to be induced, and why might someone need to be?

Holly Krone: Being induced means that labor is started artificially rather than beginning on its own, which can be done using different medications, breaking the water, or by other methods to encourage contractions and cervical dilation. Induction may be considered for medical reasons, but it can also be elective in other cases.

Host: Okay. So, what are some of those common medical reasons for recommending an induction?

Holly Krone: So, some of the medical reasons would include being past your due date, there are risks associated if your pregnancy goes to 41 weeks or beyond; premature rupture of the membranes, which is when the water breaks before labor begins and can increase the risk of infection; other health conditions like high blood pressure, gestational diabetes, or preexisting diabetes; cholestasis, which is a buildup of bile acids in the liver and bloodstream; or if there are any concerns about the baby's wellbeing, if the baby isn't growing properly or there's too little amniotic fluid. Induction can also be considered for non-medical reasons starting at 39 weeks, which is considered an elective induction.

Host: So, how does the induction get scheduled, like here at Riverside? And does it start actually prior to the day of induction with, you know, office visit, those kind of things?

Holly Krone: The decision to schedule an induction is something that your provider will discuss with you during your appointments. If there are any medical concerns or indications, then they'll go over the recommendations and the safest course of actions. If you're considering an elective induction, then you can always bring it up with your provider. And if appropriate, they'll schedule it for you in Labor and Delivery. In some cases, patients come to Labor and delivery with specific concerns or for additional monitoring. And based on their overall clinical picture, then the provider may recommend moving forward with an induction at that time.

For example, if someone comes in with elevated blood pressures and abnormal labs indicating preeclampsia, then the provider may determine that admission induction are the safest option. At that point, the risks and benefits would be discussed to ensure the best plan of care for both mother and baby.

Host: Okay. Can you walk us through then what a scheduled induction day looks like for a patient from kind of their arrival to Labor and Delivery and the start of that process?

Holly Krone: Sure. So when you arrive to Labor and Delivery for your scheduled induction, we'll start by just getting you changed into a gown and settled into bed. Then, we'll monitor your baby's heart rate for at least 20 minutes to ensure that everything looks good. We'll go over your admission paperwork, discussing your medical history, and any preferences you have for your labor experience. We'll start an IV and send lab work followed by a cervical exam to assess your current dilation.

The induction method we use will depend on that exam. Once the induction process starts, then we do need to continuously monitor your baby and contractions to ensure that everything progresses safely. We do have portable monitors though, so you're not confined to bed. You'll still be able to get up, move around, or walk to help encourage labor.

Host: You mentioned the different methods of induction. Could you tell us a little bit about what those different ones might be and how they're decided upon like, which one to use?

Holly Krone: Yeah, so like I mentioned before, the method of induction depends on that cervical exam, and that helps us assess several different things like the dilation or how open the cervix is, the effacement or how thin it is; its consistency, whether it's firm, medium or soft; its position, and fetal station or how high or low the baby's head is in the pelvis.

If the cervix isn't quite ready, then we start with cervical ripening. This can be done using cervidil, a vaginal insert that looks like a flat tampon and stays in place for 12 hours, or Cytotec, which is a pill given orally or vaginally every four hours as needed. Both of these medications work to soften the cervix. I like to describe cervical ripening using a simple analogy. It sounds kind of silly, but I always tell my patients to imagine their cervix is like a stick of butter straight out of the fridge. It's firm and difficult to work with. The goal of these medications is to turn it into butter that's been sitting on the counter for a while, soft, pliable, and ready for labor to progress.

Another option is a balloon catheter where the provider inserts the balloon into the cervix and then fills it with saline. The pressure from the inflated balloon encourages the cervix to soften and dilate over time, which is typically over 12 hours. For patients who are already dilated and whose baby is positioned low enough, the provider may rupture their membranes or break their water. This can stimulate stronger contractions by releasing hormones and without the cushioning of the amniotic fluid, then the baby can move lower into the pelvis, putting that direct pressure on the cervix to help it dilate further.

We can also use Pitocin, which is an IV medication that mimics oxytocin, the natural hormone responsible for triggering contractions. The Pitocin is gradually increased to help establish that regular contraction pattern. Contractions may start about 30 minutes later, but build and strengthen frequency over time. Kind of starting out like mild period cramps and then gradually becoming more intense.

Host: Okay. Would you say there's one thing that's kind of the most common thing to expect?

Holly Krone: We usually use Pitocin more than any other method.

Host: Okay. Great. We are going to take a quick break to talk about primary care at Riverside.

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And we are back, talking about induction here. So, how long can the process of induction take, and is it usually quicker or longer than spontaneous labor?

Holly Krone: Yeah. So, the length of induction process varies widely. Some inductions move quickly, while others take longer to establish that consistent contraction pattern. Many factors, like the method of induction, the body's response to medications and whether it's a first time birth, all play a role in the process. If cervical ripening is needed, then the process can take longer. Sometimes even stretching over a couple of days before active labor begins. For first time moms, labor tends to be longer.

Overall, whether it's spontaneous or induced, induction may take more time because the body hasn't gone through that process before, and the cervix may need additional preparation before contractions become regular and effective. But for those who have given birth before, then labor often progresses more quickly, whether induced or spontaneous.

Host: Okay. What should patients know or expect in terms of pain management during induction?

Holly Krone: So, pain management is something that I think every patient should think about ahead of time. Labor is unpredictable, so preparing yourself with knowledge about different options can make the experience feel more manageable. When it comes to medication-based pain relief, we offer two options. One is stadol and IV pain medication that can help take the edge off contractions and make them more tolerable. But it can cause drowsiness and dizziness and is best suited for the earlier stages rather than active labor.

Another option is an epidural, which provides longer lasting pain relief. With an epidural, Anesthesia places a small catheter into your lower back to continuously administer medication that numbs the lower half of your body. You'll still feel pressure, but the pain is significantly reduced.

There are also non-medication techniques that can make a huge difference in managing discomfort, such as breathing exercises, movement and positioning, counterpressure and massage, and guided relaxation.

Host: Are there any risks or misconceptions about induction that you think are important to clear up that you hear maybe from a lot of people?

Holly Krone: So, I actually find that people underestimate how long they might be in labor, especially with an induction. Labor can certainly progress quickly, but it's not always the case, especially when cervical ripening is needed. In those situations, patients may spend a few days with us in Labor and Delivery.

And then, as far as the risks, when we use medication or any other method to induce labor, there are risks to consider, such as uterine overstimulation where contractions become too frequent or too strong, or the possibility that baby doesn't tolerate labor well. And that's why we closely monitor and adjust as needed to ensure labor progresses safely.

Host: Awesome. That makes sense. Is there anything important maybe that you would pack for an induction at the hospital versus going in naturally that someone might not know of?

Holly Krone: There's one thing I could recommend bringing, it's your own pillow. Hands down.

Host: Okay.

Holly Krone: Hospital pillows just don't compare.

Host: So, you would bring that either way no matter what?

Holly Krone: Oh, yeah. Regardless.

Host: Okay.

Holly Krone: And then, since some inductions can take a while, entertainment options are also good, whether that's a book or streaming device just to help pass the time. And extra large charging cable is also convenience. But you can actually keep the car seat and most of your other postpartum and newborn things in the car until after the baby's born. I feel like those entertainment things seem like it would be a good big one. I feel like a lot of people might just like think of all the basics necessities, and then you get there and you're like, "Wait. Now, we're just sitting here." That's a good one to bring up.

Host: Yeah. So to wrap things up, what advice would you give to someone who just found out that they're going to be induced? How can they best prepare?

Holly Krone: Finding out you're going to be induced can bring a lot of emotions, excitement, nerves, maybe even uncertainty. Patients should have open conversations with their providers about that process, including why it's being recommended and the anticipated method to do so. The best way to prepare is to educate yourself about that process so you feel more confident going into it. And go in with flexibility and patience. Labor can be unpredictable. And inductions don't always follow a set timeline. Trust yourself. Ask questions. And remember that every step is designed to support a safe and healthy delivery.

Host: Is there anything else that you want to add that you feel like we didn't touch on today that might be important for anyone to know?

Holly Krone: I think this is a great starting point. People can always ask questions as we go along. Great.

Host: Well, thank you so much for joining us today, Holly.

Holly Krone: Thanks for having me.

Host: Of course. And thank you listeners for tuning into the Well Within Reach podcast, brought to you by Riverside Healthcare. For more information, visit riversidehealthcare.org.