Is induction for me?
Your doctor may want to jump-start labor for many reasons: You're past 41 or 42 weeks, your blood pressure is high, your water has broken (infection risks rise if delivery doesn't follow within 48 hours), or you're full-term and your husband has taken next week off. Induction might entail the doctor breaking your water by rupturing the amniotic sac with a plastic tool or "stripping," a.k.a. performing a rough pelvic exam; she may also use Pitocin, a synthetic version of the natural hormone that starts labor, or Cytotec, a cervix-softening prostaglandin. "Contractions normally start mild and build up," Dr. Shanahan says. "With Pitocin they are strong from the start. Some think Cytotec better mimics natural labor." (For a vaginal birth after a cesarean, Cytotec is never used, since it ups the risk of uterine rupture, which, although rare, can be deadly.)
What's my stand on forceps and other instruments?
During about one tenth of births, doctors turn to forceps or a vacuum extractor to get the baby out. This is often the case when the baby's heartbeat becomes slow or erratic in its journey out of the womb, you're too tired to summon that final push, or you've pushed for hours with little progress. These tools don't necessarily cause problems, but they have been known to bruise the baby's head or tear the vagina or cervix. It's rare, but the use of these instruments during delivery can also increase the risk of tears to the anal sphincter, which controls bowel movements.
"Forceps are wonderful in the right hands," says M. Kelly Shanahan, M.D., an ob-gyn and chief of staff at Barton Memorial Hospital in South Lake Tahoe, California. "Unfortunately, a lot of physicians coming out of training don't have the experience." Vacuum extractors, she notes, are softer and can be more forgiving to the mother, but they carry some of the same risks to the baby as forceps do.
Ask your physician about his or her qualifications for delivering with forceps or a vacuum. That way, you'll hopefully feel less anxious should the need for them arise.