What to Expect When You're Induced: A Doula's Honest Guide
From the Desk of Maddy the Doula Lady
What to Expect When You're Induced: A Doula's Honest Guide
So your provider mentioned induction. Maybe you're scheduled already, or maybe you're just trying to understand what it actually involves. Either way — let's walk through this together, step by step.
I'll be straight with you: induction wasn't what I imagined before I started attending births. I thought it was simple — show up, get some medicine, have a baby by dinner.
Then I became a labor and delivery nurse. Then a doula. And I learned that induction is its own kind of birth experience — one that comes with its own timeline, its own challenges, and its own opportunities.
If you're facing an induction, you deserve to know what's actually coming. Not the sugarcoated version. Not the horror story version. The real, practical, this-is-what-happens version.
Let's get into it.
First Things First: Why Are You Being Induced?
Induction isn't one-size-fits-all. The reason behind your induction affects everything — the methods used, the timeline, even how your body responds.
Post-dates pregnancy — You've passed 41 weeks and your provider recommends delivery
Gestational hypertension or preeclampsia — Your blood pressure is elevated and delivery is safer than waiting
Gestational diabetes — Blood sugar management may warrant earlier delivery
Low amniotic fluid (oligohydramnios) — Baby needs to come out before it becomes a problem
Premature rupture of membranes (PROM) — Your water broke but labor hasn't started on its own
IUGR (intrauterine growth restriction) — Baby is measuring small and may do better outside than inside
Elective induction at 39+ weeks — You and your provider have decided it's time, based on the ARRIVE trial or other factors
Understanding your "why" helps you ask better questions and feel more in control of the process. Don't be afraid to ask your provider: "Why are we recommending induction, and what happens if we wait?"
The Bishop Score: Your Cervix Gets a Grade
Before we talk about methods, you need to know about something called the Bishop Score. It's basically a readiness report card for your cervix.
Your provider checks five things: how dilated you are, how effaced (thinned) you are, how soft your cervix is, where your cervix is positioned, and how low baby's head is sitting.
Score of 8 or higher: Your body is "favorable" — already showing signs of getting ready. Induction is more likely to be straightforward and faster.
Score of 6-7: You're in the middle. Might need cervical ripening first, but things are moving in the right direction.
Score below 6: Your cervix is "unfavorable" — closed, firm, not ready. You'll likely need cervical ripening before Pitocin, and induction may take longer.
A low Bishop Score doesn't mean induction won't work. It just means your body needs a little more prep time. This is information, not a verdict.
Induction Methods: What They Might Use
There's no single way to induce labor. Your provider will choose methods based on your Bishop Score, your medical situation, hospital protocols, and sometimes your preferences. Here's what's in the toolbox:
Cervical Ripening (Getting Your Cervix Ready)
Cervidil (dinoprostone) — A thin insert that looks like a tiny shoelace. Placed near your cervix and left for up to 12 hours. Can be removed if contractions get too intense.
Cytotec (misoprostol) — A small pill placed vaginally or given orally. Usually dosed every 4-6 hours. Cannot be "turned off" once given, so your team monitors carefully.
What to expect: Cramping, period-like discomfort, sometimes irregular contractions. Some women dilate significantly from ripening alone; others need additional methods.
Foley balloon (or Cook catheter) — A small balloon inserted through your cervix and inflated with saline. It applies gentle pressure to encourage dilation. Falls out on its own once you reach about 3-4cm.
Pros: No medication involved, can be used alongside other methods, gives your body a physical nudge.
What to expect: Insertion can be uncomfortable (some women say it's the worst part), followed by cramping and pressure. Once it's in, most women tolerate it fine.
Starting and Strengthening Contractions
Pitocin is given through your IV. It's started at a low dose and gradually increased every 15-30 minutes until you're having regular, effective contractions.
What to expect: Contractions from Pitocin often come on stronger and closer together than spontaneous labor contractions. Many women describe them as more intense, with less rest time between.
The upside: Pitocin can be turned down or off if contractions are too strong or baby isn't tolerating labor well. Your team adjusts in real time.
Also called "breaking your water." Your provider uses a small hook to rupture the amniotic sac. This releases prostaglandins and often kicks labor into higher gear.
What to expect: The procedure itself doesn't hurt (no nerves in the membranes), but you'll feel a gush of warm fluid. After AROM, there's usually no going back — you're committed to delivering.
Note: AROM is often done once you're already a few centimeters dilated and in active labor.
Real Talk: The Induction Timeline
Here's where expectations often crash into reality. Induction takes time — sometimes a LOT of time.
If your cervix is favorable (Bishop 8+): Could be 8-12 hours from start to baby. Sometimes faster.
If your cervix is unfavorable (Bishop under 6): Plan for 24-48 hours. Sometimes longer. Cervical ripening alone can take 12-24 hours before Pitocin even starts.
First-time moms: Generally take longer than moms who've given birth before.
I know that's not what you want to hear. But here's what I tell my clients: pack for a marathon, hope for a sprint. If it goes faster, amazing. If it takes two days, you were mentally prepared.
A Sample Timeline (Unfavorable Cervix, First Baby)
Evening, Day 1 — Admission
Check in, get your IV placed, baseline monitoring. Cervical check reveals Bishop Score of 4. Provider places Cervidil or Foley balloon to start ripening overnight.
Overnight — Cervical Ripening
Try to rest (easier said than done). Mild cramping, some irregular contractions. Nurses check on you periodically.
Morning, Day 2 — Progress Check
Cervical check shows you're now 2-3cm and softer. Foley falls out or Cervidil is removed. Time to start Pitocin.
Daytime, Day 2 — Active Labor
Pitocin is gradually increased. Contractions intensify. You work through them with movement, breathing, maybe the tub or shower. At some point, your provider may break your water.
Afternoon/Evening, Day 2 — Transition and Pushing
You reach 10cm and start pushing. Baby arrives!
That's roughly 24-30 hours from start to finish. Some inductions are faster. Some take even longer. The key is flexibility.
Comfort Measures During Induction
Just because you're being induced doesn't mean you're strapped to a bed for 24 hours. (Well, it shouldn't mean that.) Here's how to stay as comfortable as possible:
During cervical ripening: You can often move around, walk the halls, use a birth ball. Ask what's allowed — some hospitals are more flexible than others.
Once on Pitocin: You'll likely need continuous monitoring, but that doesn't mean flat on your back. Ask for wireless monitors if available. Try hands and knees, side-lying, sitting on the ball, standing and swaying.
Change positions every 30 minutes — it helps labor progress AND reduces discomfort.
Non-medicated: Breathing techniques, counter-pressure, massage, warm shower or tub (ask if available during induction), cold washcloths, dim lights, music, visualization.
IV pain medication: Options like Stadol or Nubain can take the edge off but may make you drowsy. Usually used in early labor.
Epidural: Available whenever you want it (usually after you're at least 4cm). Many induced moms choose an epidural because Pitocin contractions can be intense. No shame in that — it's a tool, not a failure.
If you have an epidural, ask for a peanut ball. It goes between your legs while you're side-lying and keeps your pelvis open. Studies show it can shorten labor and reduce cesarean rates. It's a game-changer.
Questions to Ask Your Provider
Going in informed makes everything less scary. Here are questions worth asking before your induction date:
What's my Bishop Score, and what does that mean for my timeline?
Which induction method do you recommend starting with, and why?
Can I eat during early labor / cervical ripening?
What are the hospital's policies on movement and monitoring?
How long will you let the induction continue before recommending cesarean?
What would make you decide induction isn't working?
Want to feel prepared?
Our free Birth Vision Builder helps you think through your preferences — including what matters to you if you're induced.
What If Induction Doesn't Work?
Let's address the elephant in the room: sometimes induction doesn't result in vaginal delivery.
If your cervix doesn't respond to ripening, if labor stalls despite Pitocin, or if baby isn't tolerating contractions well, your provider may recommend a cesarean birth.
This doesn't mean your body failed. It doesn't mean you did anything wrong. Sometimes the safest path to meeting your baby is through the operating room — and that's still birth. That's still your story.
Packing for an Induction
Since you know you're going to the hospital (unlike spontaneous labor), you can pack strategically:
Entertainment for the long haul: Phone charger (long cord!), tablet, books, card games, downloaded shows
Comfort items: Your own pillow, cozy socks with grips, lip balm, hair ties, essential oils if you use them
Snacks for your support person: They need to eat even if you can't. Granola bars, crackers, nuts.
Labor tools: Massage oil, tennis balls for counter-pressure, a portable speaker for music
Mindset: Patience. Flexibility. The understanding that this might take a while — and that's okay.
You Can Still Have a Positive Induction
I've attended beautiful inductions. Peaceful inductions. Empowering inductions where the mom felt informed, supported, and in control of her decisions.
Induction doesn't automatically mean traumatic. It doesn't automatically mean intervention cascade. It doesn't automatically mean you've lost your chance at a good birth experience.
What makes the difference? Information. Support. A team that communicates with you. And the understanding that even when birth doesn't go as planned, you still have choices.
Induction is a different kind of labor — often longer, sometimes more intense, but still YOUR birth. Know what's coming, ask questions, bring your support team, and remember: however your baby arrives, you did that. You're doing that.
Love,
Maddy the Doula Lady 💙
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