3 years and 9 months ago I was researching my planned home birth for my second baby. I had booked under a home birth team, borrowed a pool and had even asked a good friend to have my daughter for a sleep over if it should happen in the day. But that little plan all changed at 37 weeks when I was diagnosed with Obstetric Choleostasis. BIG SAD FACE. I still find it difficult to accept that I was induced. That I agreed to being induced despite everything I believe in, and wanted for my birth. Ok so I did have a relatively quick induction (5 hours) and ok I did give birth in the pool with no tears but that doesn’t mean it was what I wanted. And I have been known to say to my husband after getting home from a beautiful home birth ‘Oh please can we have one more baby just so I can experience a home birth?’.
As a midwife of a few years now, I have worked in both hospital and home birth settings. I have seen hundreds and hundreds of births and many of those have been in the form of an induction. When discussing induction with my women at 38 weeks, I go through the check list in their notes and explain the process and what each stage means. Most women are surprised at how long each stage can take, I try to be realistic and manage their expectations. After all the unknown can feel scary – I should know. So this blog post is to help you if you’re being induced. It’s not to scare you, or give you false expectations. Try to remember that not every induction is the same and what might work for one person, might not work for someone else. As always speak to your midwife if you have any further questions.
So the basics. Induction means to start your labour artificially either with synthetic hormones administered into your body or by having your waters broken (artificial rupture of membranes ARM). You will be offered an induction if the risk of prolonging your pregnancy is more serious than the risk of your baby being born sooner. You may have been recommended that induction is the safest option for you and your baby if:
- you are diabetic
- you have pre eclampsia
- the fluid around your baby is too much (polyhydramnios) or too little (oligohydramnios)
- your placenta is not working effectively
- your baby is not growing at a normal rate
- your waters have broken but labour has not started naturally within 24-48 hours
- you are ‘over due’
- or any other medical reason which an obstetrician has agreed
Depending on why you are being induced will vary where you will actually be induced. For example if you’re over due but ‘low risk’ you will most likely be induced on an antenatal ward. This ward usually consists of a 4 bedded bay (with curtains around you for privacy) with other women who may also be being induced or are being kept in for observations. Occasionally when the postnatal ward (where you after you’ve had your baby) is full, some of these mums and new babies will be admitted to the antenatal ward. It’s a good idea to take with you a pillow, some ear plugs and eye mask as induction may take a day or two before anything actually happens and hospital wards are noisy at night. You want to get as much sleep as possible when you can so you’re not too tired when the real work starts! If you’re being induced for a medical reason and are being considered ‘high risk’ you will most likely be induced on the labour ward. Depending on the hospital you may have a shared bay or a single room. It’s always good to ask your midwife/obstetrician about this.
Other good things to pack in your bag if you are being induced are:
- a hot water bottle
- A TENS machine
- something to read ie books which include positive birth stories, a magazine, an ipad
- comfortable shoes for walking around in (walking is really good for getting yourself into labour)
- personal head phones
How is induction carried out?
A Sweep: A membrane sweep is when a midwife or doctor sweeps their finger around the opening of your cervix. This action can stimulate labour. Your midwife may offer you a sweep if you are full-term and waiting for labour to start. She’ll suggest a sweep at your 40-week appointment if this is your first baby, or at your 41-week appointment if you’ve had a baby before. During a sweep, your midwife carefully separates the membranes that surround your baby from your cervix to stimulate the production of prostaglandin. If your cervix is not dilated enough to do a sweep, she may stretch or massage your cervix instead. You may be offered two or three membrane sweep. It can be uncomfortable if your cervix is difficult to reach, and you may need to have several membrane sweeps before labour starts. If you are unclear about anything, ask your midwife to explain. (babycenter.co.uk)
Prostaglandins: Prostaglandin is a hormone-like substance that causes your cervix to ripen, and which may stimulate contractions. Your midwife will insert a tablet, pessary or gel containing prostaglandin into your vagina. The slow-release pessary, Propess, looks a bit like a small tampon. If you are given Propess, try to lie on your side for 30 minutes so it has time to absorb moisture and swell. You’ll then be able to move about. While you wait for prostaglandins to work you can usually go for a walk around. You may be able to go home for up to six hours or until your contractions start. How you are given prostaglandin depends on whether this is your first or second baby. If this is your first baby, you may need a second dose of a tablet or gel after six hours.
Artificial rupture of membranes (ARM) Artificially rupturing the membranes (ARM), also called breaking the waters, isn’t recommended as a first method of induction unless vaginal prostaglandins can’t be used. However, some doctors or midwives may use ARM as part of the induction process or to speed up your labour if it’s not progressing. This procedure can be carried out during an internal examination. Your midwife or doctor makes a small break in the membranes around your baby and she’ll use a long thin probe (amnihook). An ARM often works when the cervix feels soft and ready for labour to start. It can be quite uncomfortable, so you may be offered gas and air to help you to cope. ARM doesn’t always get labour started, and once your waters have been broken, your baby could be at risk of infection. That’s why it’s no longer recommended as a method of induction on its own and is best used after labour has started. If your midwife or doctor suspects an infection, she will give you antibiotics.
Syntocinon is a synthetic form of the hormone oxytocin. You will only be offered it if a membrane sweep or prostaglandin hasn’t started your labour, or if your contractions aren’t effective. Your waters have to be broken before you can be given Syntocinon. Because Syntocinon has several disadvantages, if other methods of induction haven’t worked, you may be offered a caesarean instead. You’ll have Syntocinon through an intravenous drip, allowing the hormone to go straight into your bloodstream through a tiny tube inserted into a vein in your arm. Once your contractions have begun, the rate of the drip can be adjusted. This allows contractions to happen often enough to make your cervix dilate, without becoming too powerful. Syntocinon is started at a very low dose and increased gradually to prevent it from stimulating your uterus or causing stress to your baby. Syntocinon can cause strong contractions and put your baby under stress, so you will need to be monitored continuously. The contractions brought on by Syntocinon may be more painful than natural ones. So you may choose to have an epidural for pain relief.
Other Things To Remember: Some hospitals may have the option of using a telemetry monitoring (wireless) so you can walk around and not be confined to the bed. Ask for the use of mats, balls, a birthing stool, remember you DO NOT HAVE TO LIE ON THE BED. Not every induction means the use of syntocinon but you may want to consider trying the drip without an epidural to give your baby a good chance of getting in a better position for birth (epidurals increase the rate of having an instrumental delivery). Discuss each stage of your induction with you midwife/doctor to make sure you and your birth partner understand all options and that you can make an informed choice. And if that doesn’t make you feel empowered read this amazing birth story by Lucy who had the syntocinon drip for her first labour and totally blew the midwives mind!