In part two of our induction series, I'm walking you through the entire toolbox - because induction is so much more than "just Pitocin." We start with the more natural methods like membrane sweeps, nipple stimulation, and AROM (breaking your bag of waters), then move into mechanical cervical dilators like the Foley bulb, Cook catheter, and the lesser-used Laminaria and Dilapan rods. From there we get into cervical ripening medications - Cytotec and Cervidil - and finally Pitocin itself, including how it differs from your body's natural oxytocin and what that titration process actually looks like in the hospital. My goal here is for you to understand what each tool is actually doing: is it ripening your cervix, or is it creating contractions? Once you know that, you can ask way better questions in your own birth.

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The biggest takeaway I want you to walk away with is that induction is almost never just one step - it's usually a sequence, tools layered together based on how your body responds. There's no single "right" combination, and every pathway looks a little different depending on where you're starting from. What matters most is that you understand each tool being offered, know that informed consent is ongoing (you can always ask questions or say no), and that you feel confident walking into your own induction or augmentation conversation. If you want the full deep dive - including all the evidence behind these tools - that lives inside the induction module of Your Body Your Birth.

Mentioned in this episode:

• Listen to episode 59:Induction Part 1: What You Need to Know Before We Talk About How it's Done
• Listen to episode 47:Should You Say Yes to a Membrane Sweep: Pros, Cons, and Things to Know
• Listen to episode 46:Induction Myths & Truths and Why He Chose to Be an OBGYN with Dr. Ahan Hunter
• JoinYour Body Your Birthcourse & use the code PODCAST to save 20%!

Helpful Timestamps:

• 00:00 Induction Tools and Methods
• 05:12 Natural Induction Methods
• 07:51 Membrane Sweeps Basics
• 09:32 Nipple Stimulation
• 10:27 Breaking the Water - AROM
• 12:53 Foley Bulb and Cook Catheter
• 17:29 Laminaria and Dilapan
• 20:23 Cytotec and Cervidil
• 25:39 Pitocin Explained
• 32:37 Putting It All Together

About your host:

🩺🤰🏻Lo Mansfield, MSN, RNC-OB, CLC is a registered nurse, mama of 4, and a birth, baby, and motherhood enthusiast. She is both the host of the Lo & Behold podcast and the founder of The Labor Mama.

For more education, support and “me too” from Lo, please visit her website and check out her online courses and digital guides for birth, breastfeeding, and postpartum/newborns. You can also follow @thelabormama and @loandbehold_thepodcast on Instagram and join her email list here.

For more pregnancy, birth, postpartum and motherhood conversation each week, be sure to subscribe to The Lo & Behold podcast on Apple Podcasts, Spotify, or wherever you prefer to listen!

👉🏼 A request: If this episode meant something to you, would you consider a 5 star rating and leaving us a review? Yes, we read them, and yes, they help keep L & B going! ♥️

Connect with Lo more on: INSTAGRAM | TIK TOK | PINTEREST | FACEBOOK

Disclaimer

Opinions shared by guests of this show are their own, and do not always reflect those of The Labor Mama platform. Additionally, the information you hear on this podcast or that you receive via any linked resources should not be considered medical advice. Please see our full disclaimer here.

Additionally, we may make a small commission from some of the links shared with you. Please know, this comes at no additional cost to you, supports our small biz, and is a way for us to share brands and products with you that we genuinely love.

Produced and Edited by Vaden Podcast Services

Mentioned in this episode:

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Induction is actually this whole toolbox of different medications and procedures and things that you need to know before you have the induction conversation and before you have any sort of augmentation conversation.

Some people only need one induction or augmentation tool.

Some people need multiples.

We're going to get into all of that here.

I want you to know the tools.

I want you to know the absolute breadth of your toolbox because there is a big toolbox here.

I want you to understand all of that so that you know what you're doing

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

It's a privilege of being your child's safest space and watching your heart walk around outside of your body

The truth is, I can be having the best time being a mom one minute, and then the next, I'm questioning all my life choices

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.

With a mix of real life and what the textbook says, expert insights, and practical applications, each week we're making our way towards stories that we participate in, stories that we are honest about, and stories that are ours.

This is the Lo and Behold podcast.

Welcome back for our induction conversation.

Ideally, you are listening to this episode because you've also listened to episode 59 first.

So this is all things induction, this little part one, this is part two, and I mentioned in episode 59, "Hey, I'm just laying a framework here for you, a foundation." I want you to have really good knowledge, really good awareness of kind of induction terms, kind of the roots of the foundations for making induction decisions, and then in this one, part two, we're gonna get into the actual different induction methods.

Now, if you've ever heard someone say, " I was induced," you're probably picturing one medication, and that's Pitocin, right?

And that is the one that gets used really often, and we actually get into this in part one.

It gets used for augmentation purposes as well.

So if you are curious what that term means, again, I need you to listen to episode 59, right?

Because we're gonna be utilizing the term augmentation in here as well, and you're gonna hear that come up again.

But like I said, Pitocin, that's what a lot of people are thinking about because it's being used for a majority of inductions, not all of them, but a vast majority of them, and then it's also being used for the augmentation process.

And I mentioned this in part one, I'll say it again because it's just kind of so shocking to me, but over 50%-ish of labors here in the US utilize Pitocin in some form.

So not surprising that Pitocin is where our brain immediately jumps, right?

But induction is actually this whole toolbox of different medications and procedures and things that you need to know before you have the induction conversation and before you have any sort of augmentation conversation, possibly inside of your labor process, too.

So every labor looks different.

We don't always know why we may need an induction.

Certainly, we're sometimes choosing them electively.

Some people only need one induction or augmentation tool.

Some people need multiples.

Sometimes we're using them in combination.

We're gonna get into all of that here.

I want you to know the tools.

I want you to know the absolute breadth of your toolbox, 'cause there is a big toolbox here when it comes to kind of moving labor along, that kind of air quotes, " moving labor along" suggestion, right?

And so I want you to understand all of that so that you know what you're doing.

And this is my last shout-out again.

Please listen to episode 59 to give you the foundation, the frameworks, the vocabulary.

It's short and it's sweet, so we could get to this part, too.

That foundation and that framework is really gonna help you understand a lot of what we're talking about today, and you need to put both of them together to make really good choices inside of your labor, to understand why this is a labor and birth conversation, and this is not just a conversation for people who want an induction, are going to choose one.

It's for all of us, okay?

So I'm glad you're here.

Listen to the episode 59 first, okay?

So when it comes to induction, let's just summarize real quick.

There's kind of these two main goals.

We want to ripen the cervix if it is not ripe, ready, if it's not favorable.

We get into the Bishop score conversation in part one, so we get into all that there.

I'm not gonna touch on that again.

We want to ripen the cervix, have it ready for labor if it's not ready yet, and then we want to create effective contractions.

Why-- And by effective, I do mean we want them close enough together, strong enough together to cause cervical change, right?

'Cause that's the goal.

Uterus kind of applying, helping, pushing, puts pressure on that to cause cervical change.

Baby can move down and through the birth canal when the cervix is out of the way, et cetera, et cetera, right?

So that's the goal, this vaginal delivery, all of this stuff working together.

So ripe cervix, effective contractions.

There's your big picture overview.

So when we walk through all these tools, we're gonna jump right into them.

I want you to think about, "Hey, what is this tool's purpose?

What is it doing?

Is it ripening my cervix?

Is this tool creating contractions?" Okay?

Those are the two questions I want you to consider because it's just, again, it's going to help you make good choices and have really smart conversations in your own labor and birth scenarios.

Now, really quickly before we get to the tools, I want to interject that natural induction method conversation, right?

So a lot of the time- All of those tools, we're talking about things like have sex, eat pineapple, spicy food, sometimes people talk about positioning exercises, eating the dates, all of these things, right?

People go, "Oh, these are natural labor induction processes," right?

And so immediately, if you listen to the last episode, 59, you understand, oh, induction means we're getting labor started.

We're starting contractions, right?

These things, first of all, whether or not they even work is its own conversation.

We could have a podcast episode about all of those different tools, and we could talk about all of them.

I cover all of them inside of Your Body Your Birth, so you do understand the evidence and research behind them, and then you can also ask really smart questions about them if you want to, and then you can decide if you want to utilize them.

Well, so that's module five inside of the birth course.

So if you want that full rundown on all of these things, you can get that inside of there and figure out how you want to utilize them, or if you want to ignore them, or some combination.

Right?

But these natural induction tools, a lot of times they're sold as something to start your labor, and a lot of them simply get your body ready for labor.

And so you can see that dichotomy that I just brought up of sometimes we're talking about getting a cervix ripe, sometimes we're talking about actually getting contractions going or making them stronger.

And so even in the natural, air quotes, right, induction conversation, people are misusing the term induction, misunderstanding what some of those tools might do.

Again, module five inside the birth course walk through all of that.

It's great.

We walk through all the methods, all the things that you are possibly hearing right now as you're googling, " How do I get this baby out of me?"

Okay?

So big picture overview when it comes to these induction tools, they are often used in combination, not in isolation.

Not always true, but often, particularly in the induction conversation, and I would say particularly when we're starting maybe from zero centimeters or one centimeter, or maybe it's a medically necessary induction at 35 weeks, so it's really early.

Typically, we're gonna use tools in combination, and typically, you can expect to use more than one tool.

Maybe they're not used in combination, but often, like, you'll have step one, a step two, a step three, and so these tools that we're about to go in through or these methods, they do different things, which is great because the body is going to continue to, let's say, need different things.

Right?

And so we can say, "All right.

We've gotten to this place or this X, Y, Z space.

Now let's go ahead and add step two and see where that gets us as well." So we're gonna go through kind of all of those options and alternatives, and remember, I want you thinking, "Is this ripening?

Is this causing contractions?

How are these working together?" And then you can also ask questions with that understanding, too, of, "Hey, what do I need next?

Do I need this next?

Is there another option if I'm already ripe?

Could we do something else?" I want you to be thinking about those type of things in your own birth conversations.

Okay?

So first thing, we're gonna talk cervical ripening, some of these earlier tools.

Okay?

Membrane sweep I'm gonna throw in this conversation.

It typically is talked about in a natural induction conversation, but it is an induction tool, and it is an induction method.

So my big thing for you, and we have a full episode on membrane sweeps as well.

We'll link that one in the show notes, but my big thing when it comes to membrane sweeps is that you just understanding it is an induction tool even though it's much more natural than some of these more medical things we're gonna talk about, and it is intended to start labor contractions.

And so if that is not what you want, if you do not want someone intervening, well, then you're gonna say, "No thank you" to a membrane sweep.

Right?

So I just really want you to hear that when it comes to sweeps.

If that's what you want, go for it.

Right?

But it is an induction tool, but sometimes because it's more natural, it kind of gets Kind of dismissed or overlooked or kind of providers can just say, "Oh, let's just go ahead and do it, no big deal."

And this is a tool that you need to understand you're saying yes or no to that could kickstart your labor and things could move on from there, right?

So membrane sweeps are done during your cervical exam.

I'm not gonna deep dive this.

Again, listen to the episode that we just dropped in the show notes for you about it.

But essentially, they can release prostaglandins.

Prostaglandins might help ripen your cervix and kind of, kind of kick things going.

You can get some irritability, maybe a little bit of contractions.

It can just kind of kickstart your labor, and again, it's rooted in kind of this prostagl- glandin release that happens during a membrane sweep.

These are uncomfortable for a lot of people, but I would say that typically it's a very low intervention thing that is worth it for a lot of people, too, particularly if you're saying, " I would like to choose this membrane sweep at my 41-week appointment versus coming in and starting Pitocin tomorrow," right?

And so I'd see a lot of people choose that sweep, particularly at a later date, before they choose something, let's say, more medical.

So that is a membrane sweep.

Another one I wanna tack in here that's a little bit more natural but still is an induction technique as well is nipple stimulation.

So this can be done manually or with a pump.

It can be done in the hospital.

I've seen it done as a part of an induction process coinciding with other things we're doing.

I've seen patients do it at home, and so they chat with their provider about utilizing this at home, and then they do some sort of protocol at home, right, where they say, "Hey, put your pump on.

Utilize it.

You know, turn it up to an appropriate strength so we're not hurting ourself." That's a whole breast pump conversation.

And then what we're hoping is that that nipple stimulation will actually kickstart some oxytocin release.

The oxytocin acts on your uterine receptors and actually causes contractions.

And so protocols will often be like, "Hey, do this for 30 minutes or until you have three contractions that are each five minutes apart," something like that.

They'll give you some sort of boundary, and then you can go home and utilize some sort of nipple stimulation protocol like that and see if that will kickstart your labor as well.

So that's another kind of more natural-ish technique.

I know I keep throwing that word around, or maybe early labor technique.

Last one that I want to mention before we get to the let's say really more medical sounding or medication type things is breaking your bag of water or an AROM.

So if people say, "Oh, let's go ahead and AROM you," they should explain this to you, but if they were not to, that stands for assisted rupture of membranes.

So we're talking about someone going in and assisting the breaking your bag of waters, assisting the rupture of your membranes.

If someone ever were to mention it that you have SHROMed or you are a SHROM, I'll just throw this in here as a little extra, that means you've had a spontaneous rupture of membranes, and that means your bag of waters have broken on their own.

So AROM, again, might feel like a little bit more natural because it's not introducing any type of medication or something into the body, but it is a very intentional breaking of your bag of waters, we could say kind of before the body was going to, right?

And so this can be used to speed up labor, though evidence doesn't really support that, but they often suggest it, right?

It can be used kind of as a step, I would say like a step two or a step three once we've gotten you dilated to a certain place and we think, "Okay, let's go ahead and break the bag now and see if that'll be the final step." It just feels like a lot of pressure when they do it, right?

And they go in and they hook the bag, or they use this thing called an Amihook, and it, it, it's not painful at all.

It shouldn't be painful at all to you unless there's pain associated with a cervical exam.

But yeah, they just go in during a cervical exam, break the bag of water.

There's usually a bigger gush when it's broken or when it's this assisted rupture of membranes, whereas sometimes with a SROM it can be a little bit more of a slow leak.

So they break the bag of water.

Ideally, the baby's head can come down, apply a little bit more pressure on the cervix, release more prostaglandins, kind of all these things kick in.

That's the ideal.

And so these uterine contractions get stronger, more effective, baby's station moves down lower, all of that, right?

So that's kind of the goal with the AROM, but there are pros and there are cons, and there are risks and there are benefits, and this is just one possibility or one thing that might be utilized in combination.

So that too, like so much of what I've said, an AROM and what, you know, what the research and evidence says about all of this, it could be an entire podcast episode as well.

We deep dive it inside of the birth course too, so you have all of that information, but it is a possibility, definitely part of an induction conversation, and definitely part of an augmentation conversation.

I often feel like I saw this one used just as much in the augmentation process to, quote-unquote, "move things along" as I did in an induction process, okay?

So very, very possible that this AROM would be brought up in the labor and birth process for many of you.

Okay?

So let's move to kind of some of these more medical things now, particularly some of these ones that you might be less familiar with or certainly not as familiar with as the Pitocin.

So the first one is mechanical cervical dilators.

The first one you'll probably be more familiar with than the other two that we're going to talk about really quickly.

So that's going to be the Foley bulb or the Cook's catheter is another type of Foley bulb.

So essentially what this is, is it's a balloon catheter that's placed through the cervix.

So you have to be dilated a little bit, at least a centimeter or so, so we can slide the catheter through the cervix.

And if you've ever had a urinary catheter, think about that.

That's essentially what it looks like.

Okay?

And then there's just this balloon on the end.

They look very, very similar.

It's just not draining urine.

Obviously, we're going in a different hole, right?

But they look really similar.

So if your cervix is dilated, we're sliding that balloon in.

This is placed by a provider.

Nurse is more an assist in this situation.

We slide the catheter through.

Once we know it's through the cervix, we go ahead and we fill up the balloon so that's inside, that's gone through the cervix and it's kind of inside the lower portion of the uterus.

We fill that balloon up with sterile water, and then we go ahead and we kind of tape, typically, not always, we often tape the catheter, like the bottom part where the ports are.

We're going to tape that to your leg, and it's going to apply this mechanical pressure to the cervix.

And what I mean by that mechanical is it's literally like pushing down on the cervix And helping, encouraging, forcing, you choose the vocabulary there, but forcing it to open up with, again, mechanical pressure.

So no medications on board in this scenario when we're talking about just the Foley bulb.

Now, the Cook balloon is a dual balloon.

It looks really similar.

It works really similar, but we blow up the balloon inside of the cervix, like I just mentioned, and we also blow up a balloon on the outside of the cervix.

And so it's kind of like the cervix is pinched.

A lot of this vocabulary kind of sucks, you guys, but it's kind of pinched in between the two balloons, again, applying mechanical pressure.

Again, can be used alone or can be used with medications.

This Foley bulb or the Cooks, they can be placed in the office, and sometimes people are sent home with that.

They certainly can be placed during labor.

Many times I've seen them placed, like, at night to start an induction, and the thought is, like, overnight it starts to do the work and then let's say things, like, really can kick in in the morning.

Lots of uses, lots of possibilities.

I don't know how your provider specifically would choose to utilize it, and I would also say that I mentioned the vocabulary surrounding this kind of sucks, right?

But I do think people have pretty strong feelings about these balloon catheters.

There are some people who find them incredibly painful, incredibly uncomfortable.

There are people who do not care about them at all.

The insertion can be uncomfortable, and this is kind of the way I like to describe it to my patients and my students is that essentially if we're utilizing a Foley bulb, it's because we have a unfavorable non-ripe cervix.

Again, if that's unfamiliar, please go listen to episode 59.

And so typically what that means is the cervix is not anterior in your body.

It's not soft.

It's not dilated yet.

And so inserting these balloons can be really hard because the provider kind of has to go back there pretty far and kind of fetch the cervix and get to it and get this balloon placed, and it's just uncomfortable.

Like, this is not, an easy access, if you will.

And so I think that insertion can be pretty tough for a lot of people.

I think it's important for you to know so that you can be prepared and you can understand that if someone tries to downplay it.

And also that you understand that they are really valuable and really helpful.

We're gonna talk about this, but often used in conjunction with other tools, and they can be really helpful when we're starting an induction, particularly from, you know, like one centimeter, two centimeters, like I said.

These balloons typically till about three or four centimeters, and then they come out, and then you can move on to step two if that is necessary, okay?

Hey friend, quick pause for just a second.

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It is about helping you understand what's happening in your body, what your options actually are, and how to walk into your birth feeling grounded, excited, ready, instead of overwhelmed and scared.

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

So that is the first mechanical dilator.

Again, probably the one most people are most familiar with is that Foley bulb.

Now, I wanna talk to you about two other ones, and that is going to be laminaria and Dilapan.

I have never seen these used in practice, but I want you to hear me when I say that that doesn't mean I don't think we should be using them.

I think they're really, really cool.

I think that they're-- in my head, they seem that they could be a lot more comfortable than the use of a Foley bulb, particularly if you're responding to its insertion or it's tough like the way that I just laid out.

So I, I hope we see these more.

Ask about them, then come tell me what you learn about them.

But I think that these, yeah, these just sound really cool to me, too.

So essentially, they're these rods.

I know that sounds weird.

But you insert them inside of a dilated cervix, and they actually kind of grab the fluids from around themselves, so inside of that cervical canal, and they swell up.

So it's like these little gel-filled rods, and then they slowly swell up.

It's, it's cooler to see on video.

I have some, and I have some different videos and stuff of what it looks like when they swell up or what they look like when they go from nothing at insertion and then swell up.

But essentially, yeah, they grab that fluid, and they swell up, and then they're gonna fall out once you are dilated to a certain place.

Again, like the Foley bulb.

We're not getting you to ten centimeters.

We're just getting you a few centimeters in and getting you more ripe.

So that is laminaria and Dilapan work similarly, and if you have stories about them, I would love to hear them.

So please find me and track me down and talk about them ' cause I would love to see these used more or hear, hear more about why we're not utilizing these as well.

All right.

So those are the mechanical dilators or the mechanical tools, the bulb and those two rods that kind of grab that fluid and swell up.

So those are ways to, again, kind of Tell the cervix it doesn't have a choice and it needs to open, right?

then we also can utilize medications as well, and we're gonna talk about how these can be used in combination with some of the stuff we just talked about.

So cervical ripening medications, again, we're trying to make the cervix soft and more available and excited about and willing to labor with these good, effective contractions.

And so we're, we're less so saying, "Let's get these really strong contractions going with ripening medications." We're more trying to get the cervix ready and willing to want to or to be in labor.

So the first ones that I want to talk about, these are prostaglandin medications.

And if you are paying attention, I mentioned that prostaglandins are what can get stirred up when we do a membrane sweep, and so these medications that we're talking about now for cervical ripening, similar, right?

We're trying to kind of stir things up and ripen that cervix.

So these prostaglandin medications, the two big ones are Misoprostol, brand name is Cytotec here in the US, and so that's probably what most people are gonna be familiar with.

And then there's Dinoprostone, which is, the brand name is Cervidil.

So again, possibly your providers are gonna call them Cytotec or Cervidil, and they are talking about these prostaglandin ripening medications.

Now, these two medications are different, so let's walk through them.

Misoprostol, the Cytotec, is a tablet typically given orally or it can be placed vaginally.

There's different dosages depending on, where it's going or the route, but they're tiny dosages.

One important note that I like to make here is the Cytotec is also the medication that is used if someone has gone in and had a loss, and they give you medication for your body to deliver your loss.

It's often gonna be a Cytotec.

And I think that that's important to hear because that is obviously a really painful process for a lot of people or one that they don't want to relive or maybe they don't ever want to hear, you know, the word Cytotec again or utilize Cytotec again.

And so if that were to come up in your induction conversation, I want you guys to know that there's other options, but that medication would be a part of that conversation or maybe put in front of you again.

And so I want you to know that so that you can kind of walk through that with less of a shock, right?

If for some reason you didn't realize that the two were the same, often many people don't, then now you have that knowledge and so you can know that stepping into that.

So just a little caveat, but I think it's really important, but it isn't discussed very often.

And again, going back to what I talked about, dosages in these situations are remarkably drastically different.

And so we're talking about here again that oral or vaginal dosage, and then it's usually given in spaced out dosages, right?

And so every four hours is a very common duration or frequency.

And then typically most hospitals are going to have a policy where they can give up to, you know, three doses.

And so it's possible that you could have kind of this 12-hour stretch where you're getting some Cytotec every four hours to try and kickstart things in labor.

Cytotec is often used with that Foley bulb that we talked about with the mechanical dilators.

I have seen that used in combination over and over and over again.

So you place the bulb, we give you your dose of Cytotec, and then the hope is that that Cytotec starts causing some contractions and kicking things along, and that combined with that mechanical pressure that the bulb is causing or is, is doing, is that then we can get you to that three, four, five centimeter dilation with the combination of those two.

Another important thing to know when Cytotec is being used is that it requires some form of fetal monitoring for a certain amount of time.

And so if you're walking into your process thinking, " I don't want to be monitored at all," but you are being induced, understanding that there are some rules about induction and fetal monitoring, how those go together.

And so when we add on a medication, depending on the medication or what's going on, there are different associated rules for monitoring baby's heart rate.

Now, you can also do wireless monitoring and all of that.

And so that is another conversation.

Don't forget that's an important conversation.

But typically, they require like an hour or two.

There's some sort of guideline of monitoring before they could remove them and switch over to more intermittent monitoring.

So I would expect that if you were to be induced and if we were doing maybe this Foley bulb combination with a Cytotec, that you're going to have some monitoring required before they are able to take them off And then to give you some more freedom of movement, barring if you have the fetal monitors that allow you to ambulate and move around, and then hopefully you have your ideal movement regardless.

Okay?

I want to make you aware of one last little caveat about Cytotec, also related to an additional way that it's used, and that is that it's also a medication that is used in the management of postpartum hemorrhage.

So it is possible that if you were to be a part of a postpartum hemorrhage or if you were bleeding more than normal, if the care team felt like, "Hey, we need to do more than what kind of the initial standard of care is after birth for this bleeding," that Cytotec is the medication that would be given.

It's one of the ones that could be given in that scenario, and it's typically one of the ones that is moved to first if you've received the third stage Pitocin.

That is also a recommendation.

I don't want to get too far into the postpartum hemorrhage conversation, but I just want you to know that this medication has another use case that is relatively common or that might pop up during the labor process, and that is in postpartum as well.

So if you hear them throw that around after, the hope or the goal there is, first of all, I hope they're talking you through what's going on after birth of baby, and then the goal is that it, that Cytotec will cause your uterus to kind of contract and clamp down and help support that process to stop or minimize or slow down the bleeding that's going on.

Okay.

The other prostaglandin medication that I mentioned is that dinoprostone or that Cervidil.

So also prostaglandin, right?

We talked about this.

It's more of a slow release idea.

That's what it makes me think of.

So it's a vaginal insert, kind of looks like a tampon.

It's not nearly that thick, but I just want you to get this idea of there's this little insert and this like stringy shoelace like thing that comes out, and you place that.

A nurse can place this one as well.

They can place that kind of up behind the cervix, kind of get it up there as, as much as we're able to, and it could be left in place for 12 to 24 hours.

That prostaglandin release again is supposed to stimulate and cause contractions.

This one I do not see used with the Foley bulb.

It's usually Foley bulb and the Cytotec, right?

But the Cervidil is often used on its own.

You also aren't going to use a Cervidil and a Cytotec together.

But when we want to ripen your cervix, when we want to get your body more ready for labor, these are the tools that are often going to be jumped to first is those prostaglandin medications.

These tools cannot be used with a VBAC.

So if that is something you're working towards or thinking about, just know that those are not available to you.

The Foley bulb is or those mechanical dilators are, but not in combination with these prostaglandin medications.

So important note for my VBAC mamas.

All right.

Let's move on to one that we said already everyone is so familiar with, and that is the Pitocin.

This is the most common induction medication, augmentation medication, let's move things along medication.

You guys have all heard of Pitocin, and I also just mentioned that it is utilized in the third stage of labor, right, to help with postpartum hemorrhage management.

So Pitocin and the conversations about it, they are everywhere.

Now, Pitocin is an IV medication.

It is a synthetic oxytocin.

When you are in labor, your body makes Lots of oxytocin.

It's making oxytocin leading up to labor.

There's these cool ways it, like, pulses and flows during labor, right?

So that's your, your natural or your innate oxytocin that's supporting your labor process.

Pitocin is a synthetic form of that.

It's an IV medication given via a pump.

It requires continuous monitoring when your Pitocin is flowing.

It stimulates uterine contractions just like oxytocin would.

It has a lot of commonalities with your natural innate oxytocin.

It lands on those oxytocin receptors that are all over the uterus.

It is then supposed to cause that uterus to contract and typically to cause it to contract more effectively and with more strength.

So sometimes when we're augmenting and introducing Pitocin into a labor process, it's not that you're not contracting at all.

In that situation, we're saying, "Hey, we need these contractions to be stronger or closer together." And so Pitocin itself is able to support that, or we are hopeful that it will support that process.

Now, I mentioned this in part one when I was saying, " Hey, this is not an induction should you or shouldn't you have an induction conversation."

Similarly, here in part two, this is not a should you or should you not utilize any of these tools or particularly Pitocin conversation.

That is a full, a personal, unique, specific kind of conversation that you should be having in, throughout your labor and birth scenario and depending on what the need is or the suggestion is.

I just want you to understand Pitocin and understand some of its uses so when you are in that space or if you are having these conversations, you can have really smart conversations.

Okay?

So Pitocin, like I said, it's supposed to cause contractions, make them stronger, more efficient, all of that.

It's also supposed to kind of stimulate what's going on in the body with the natural hormones that are circulating around.

Now, there are some differences, and I don't wanna get into the weeds right now about the difference between Pitocin and oxytocin, and I'm calling them their two names because I want you to hear that they're different.

But the way that Pitocin itself, the medicine, does not c-cross your blood-brain barrier, but oxytocin, the one innate inside your body, it does.

And so that can cause some differences in the way your body labors, in the way your body handles labor, in the way your body processes labor, some of the different hormones that are released because of the ability of natural oxytocin to cross the blood-brain barrier and the ability that normal Pitocin does not have to cross the blood-brain barrier.

So again, it's a really big conversation.

I know that probably causes more questions than answers.

But Pitocin is not exactly the same as oxytocin.

I think that's important for you to know so you can lean into that more and you can learn about that more.

I do cover that very deeply inside of the induction course that's inside of the birth course, so certainly zero in on that because it's interesting, I love the science, and it is very relevant for the way you handle your Pitocin contractions, what's going on in your body, tools that you utilize, et cetera.

So just know that that info is out there and available to you, though I'm not gonna fully get into it here So when it comes to, again, clinically, what's going on with this Pitocin?

If your cervix is favorable and ripe and the decision to start Pitocin has been made or this is what needs to be utilized, I know I mentioned VBACs, but often VBACs utilize Pitocin because they can't utilize these other tools or there aren't as many other tools, so Pitocin enters the scene earlier.

So if that's the goal, know that Pitocin is titrated very slowly and titrated over time, and it's increases over time or it is able to be increased based on the protocols that the hospitals have in place.

Now, I can tell you what the protocols have been where I have worked, but they are different in other places.

So that's kind of tough for me as a provider, I think, just feels frustrating, so I know it's tough for you as a patient as well.

But typically, Pitocin can be turned up by a certain amount, they're called milliunits, every thirty minutes or so.

Typically, there's a maximum boundary and upper threshold for how high the Pitocin can be.

And then I would say typically again, ideally, you have hit the labor pattern we're hopeful to see or that we want to see or the one that is causing dilation and baby to descend and all of that.

We're seeing it before we hit that upper threshold, right?

And so it's titrated, it hits the body quickly, and it can be turned off quickly and also leaves the body quickly.

So that's one thing I do really like about Pitocin, is if we were to think this is causing an issue or something's not working, we gotta turn it off.

When you turn it off, it's out of the body quick.

Basically, it has a very short half-life, if that, if that term makes any sense to you, and so it leaves the body very quick.

The goal is usually contractions every two to three minutes, and that those contractions are strong enough as well to be causing cervical change and dilation and descent of baby, all of those things.

So regular contractions every two-ish to three minutes is what that nurse is looking for on the monitor.

Ideally, baby's tolerating it well, so they can titrate it up until that pattern has been met or is reached and then see what happens.

Okay?

So that's overall goals on what's going on with Pitocin and when it's being utilized, what the care team is looking for as well Your RN is continuously monitoring your fetal heart rate.

I mentioned Pitocin requires continuous monitoring, right?

So they're monitoring those two things together, the heart rate and the contraction pattern.

They're moving it up and down every half an hour or so, charting all the time on that Pitocin, looking for tachysystole, which is too many contractions.

They have the ability to turn it back down.

They have that autonomy.

They have the ability to turn it off if they need to, and there's a lot of communication usually happening between the RN and the ordering provider, you know, that, that OB or that midwife, and then letting them know what's going on, if they're calling, checking in.

Your providers can pull up your fetal heart rates and look at what the nurse is seeing as well, but lots of communication about where you're at, how things are working, what's going on.

So big takeaway here that I want you to hear, again, understanding that this is not a should you use Pitocin conversation.

It's, "Hey, here's some things to know Pitocin so you can decide if it's the right thing for you." Pitocin is a very, like, titratable, let's say, kind of controllable drug because of the ways it can be turned up, turned down, turned off, et cetera.

It's closely monitored in hospital settings, and then the dosing and the protocols do vary a little bit by facility.

And I-- That's something I really want you to hear just with that idea of, like, autonomy.

This is something I talk to my students about a lot is finding out how do you use Pitocin, how do you turn it up, having conversations with them about can we go low and slow, utilizing your voice in that conversation and knowing you don't have to just do the protocol that they have and/or you can ask questions about that protocol Kind of see what's inside of that protocol, and then speak up for sure about how you feel about what the answers are in those conversations.

So if we're gonna put all of that together, right?

We have all these methods, all these possible tools, I think it's important to go back to induction is rarely one step.

It's often a sequence and things used in conjunction.

So example pathways, there's many, right?

But it's that Foley bulb, maybe Foley bulb and Cytotec together get you to four centimeters, and then break your bag of water, and then start Pitocin.

Seen that happen before, right?

Maybe it's Cytotec first, then the Foley bulb once you're dilated enough to insert a Foley bulb because maybe you were zero centimeters when you came in, and then start the Pitocin.

Maybe it's just straight to break your bag of waters and start the Pitocin together.

I can't tell you what the pathways are.

I just want you to know that there's a lot of them, and typically, the goal's gonna be that each step is building on the progress that was made with the last step.

Now, can there ever just be one of these tools and that be the thing?

Absolutely.

I have seen inductions where literally break the bag of waters, and that's all that happens.

I have seen inductions where it's just two doses of Cytotec, and the body just takes over and that baby comes out.

I have also seen inductions that use every single one of these things.

We start things, we stop things, we take a 12-hour break.

I've seen kind of all the scenarios, so I just really wanted you to know there's no right combination.

But the right thing, I think, is that all of you know all the possible combinations, so you can kind of make choices inside of this, understand alternatives, understand why something is being suggested, et cetera.

So my encouragement for you is always ask really good questions and understand each step before you're agreeing.

Even when and even if you feel perfectly fine with a plan of care, or you know it's necessary, or it feels really good and right to you, still ask questions.

Understand the tools that are being utilized, and know that kind of that informed consent is an ongoing thing.

Yes, you get to decide if you want the AROM.

Yes, you get to decide if you want a membrane sweep.

Yes, you get to decide if you wanna go ahead and start Pitocin.

Yes, you get to ask if there are other options.

So just know you continually get and have that privilege of agreeing to or asking questions about the plan of care.

The induction conversation can feel super layered.

I know it can be really spicy.

I know that we left a lot of it out in part one and part two.

I do want you to know that there's a way more inside of the induction part of the birth course as well, full course on induction, where we go through the process, how to make this decision, why inductions are needed.

We kind of touch on the actual induction process, so it's not just the tools, but what does this look like when you get checked in?

We talk about that induction versus augmentation, how to make that decision or how to understand that decision.

It is all in there for you.

And I know I've mentioned this prior, but again, so many births utilize these tools, even when we think we are not going to or we have written them off or we have said we're not going to.

So I'm so glad that you are here and that you have heard this because it is very likely that this stuff might come up.

Will you utilize it?

Do you need to?

I don't know, and I can't tell you that, but it's very likely those conversations are gonna come up, and so now you are gonna have so much more understanding when or if you need to step into those conversations

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

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