What Happens If You Don’t Dilate After An Induction?

By: Jennifer Cole | Induction | August 15, 2021

If your care provider has recommended that your labor be inducedwhich technically means that your cervix and uterus will be artificially stimulated to kickstart laboryou probably have a lot of questions. Aside from whether or not your doctor can force you to be induced, you may wonder about the induction process itself. 

Your care provider may have walked you through the basics, explaining that they usually begin the process by giving you a cervical softener and perhaps inserting a foley balloon thereafter to mechanically open the cervix. Depending on whether or not your contractions start on your own, you might be administered a synthetic version of oxytocin that stimulates the uterus to contractvia an IV drip, and then if all goes according to plan, you’re “off to the races”.

But what if things don’t go according to plan? What if your cervix is closed shut and doesn’t want to open up, despite whatever coaxing it’s given? What does the term “failed induction” actually mean? What happens if you don’t dilate after an induction gets underway?

The Statistics About Failed Induction

According to the Mayo Clinic, approximately 75 percent of first-time birthing people who get induced will go on to have a vaginal birth. So if ten pregnant people are checked in for an induction, we can expect that six of them will experience “successful” inductions which, by definition, means they will give birth vaginally.

What that means of course is that 25 percentor 4 of themwill end up with a cesarean section instead, also known as a failed induction. 

So why is it that you only have a 3 in 4 chance of vaginal delivery, which is hardly the best odds? It’s often because you’re beginning the induction process with a completely unripened cervix and there’s no guarantee that the artificial interventions care providers use to soften and thin it will work. 

One measure of cervical readiness you can request your care provider perform prior to the induction is called the Bishop Score. In order to make an assessment, your care provider will need to perform a vaginal exam and will assign a number between 0 and 3 to each of the following five conditions to determine your overall Bishop Score: 

  • Cervical dilation in centimeters, i.e., how far the cervix has opened (e.g., closed to 5+ cm)
  • Cervical effacement, i.e., how thin your cervix is based on a percentage (e.g., 0%-80%+)
  • Cervical consistency (e.g., firm, medium, soft)
  • Cervical position (e.g., pointing posterior, mid-position, or anterior)
  • Fetal station, i.e., the position of the fetal head in relation to the pelvic bones (e.g., -3 – +2 cm)

Aside from cervical readiness, there are other risks associated with the induction process that can increase the likelihood of a cesarean section.

Other Risks Associated With Induction

If synthetic oxytocinlike Pitocin, or prostaglandinlike Cytotec is used at any point during the induction, it can cause your uterus to contract excessively or in an abnormal way. This in turn can decrease your baby’s oxygen supply and lower their heart rate. Otherwise known as “decels”, dips in baby’s heart rate can be one of the leading causes for a cesarean section.

If you’ve had a prior C-Section, you should be aware that the methods of induction mentioned above can increase the risk of uterine rupture, a rare but serious complication in which your uterus tears along the scar line from the previous surgery. If this were to happen, you would have to have an emergency C-section and there’s a possibility your uterus would need to be removed.

Moreover, if at some time during labor your care provider ruptures your membranes to induce labor, this could increase the risk of infection—known as chorioamnionitis—for both you and your baby. One or both of you could develop a fever and need a course of antibiotics.

After baby is born, your risk of heavy bleeding increases because in some instances your uterine muscles won’t properly contract back down. 

Do Your Homework

If your care provider has told you at an appointment that they routinely induce labor at 39 weeks in order to “reduce the chance or c-section” you should definitely ask some follow-up questions about the data. They may cite the ARRIVE study, however, given the inherent risk of an induction and the fact that 1 out of 4 first-time parents who are induced end up with a cesarean, a further discussion is in order.

In today’s health care system, the recommendations that care providers make pertaining to childbirth cannot be taken at face value. While there are definitely instances where the inherent risks of inducing labor are far lower than the risks of not inducing labor, it is up to you to be well-educated in this subject so that you can be assured you are making the best decision for yourself as well as your baby.

The Birth Education Center offers an online Induction 101 Course. Click here for more information.

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Resources:

  1. https://www.mayoclinic.org/tests-procedures/labor-induction/about/pac-20385141#:~:text=Labor%20induction%20carries%20various%20risks%2C%20including%3A%20Failed%20induction.,with%20an%20unripened%20cervix%2C%20might%20need%20a%20C-section.

About the author:
Jennifer Cole CD(DONA) DONA Certified Birth Doula and Hypnobabies Certified HypnoDoula supporting families throughout San Diego County.

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