Thoughts from a labour ward midwife… inductions
So, you need to be induced? Or you want to be induced? Either way, I’m sure you’ve got plenty of questions.
I want to be induced….. what are my options?
First of all, you need to chat to your midwife or obstetrician. Think about why you want to be induced. What you have to remember is induction comes with its own set of risks. Does the reason you want to be induced outweigh these risks? When you’re at the end of your pregnancy and maybe at the end of your tether with whatever it is that’s going on, it’s easy to say “yes”…. But your midwife or obstetrician might be able to help you in a safer way than by interfering with your pregnancy. It’s best to consider all the options.
I’m told I need to be induced, but I don’t want to be, what are my options?
The best thing is to discuss all the options with your midwife/obstetrician as ask the question, why? Why exactly is induction the best thing for me? What will happen if I decline? What are the risks to my baby? Also, importantly, is there any compromise? Can we wait longer? Can I be monitored more regularly instead? Remember, whatever the scenario, you always have a choice, you’re the boss!
So I’m being induced, what’s going to happen?
Everyone is different, and every hospital is different…. The best person to answer this is your midwife or obstetrician. But here is an idea…
1. You arrive in hospital with your birthing partner(s), bags ready to go!
2. The midwife checks you over, including the position of your baby, and puts the baby on the heart rate monitor to make sure all is well!
3. If all is well, the midwife will perform a vaginal examination – they are trying to find out how ready your cervix is to go into labour. The cervix starts off as long and firm, and to go into labour it needs to become shorter, softer and start to dilate. Unless it has already done all of this work quietly without you noticing, the midwife will insert a prostaglandin tablet (types vary depending on the hospital) into the vagina. If this is your first baby often this stays in for 24 hours, and if it’s your second (or more) baby it often stays in for 6 hours. Either way, you’ll then be reassessed in the same way again after the prostaglandin has been given some time to work.
The key at this stage is to STAY PATIENT! Inductions can be SLOW!! Especially if your body isn’t ready to go into labour. Some people need up to 3 prostaglandin tablets (of varying types) and these can take days to administer, especially if you start contracting (which means they can’t give the next one) then you stop again.
4. (Unless you have already gone into labour yourself at this point!) All of this is leading to the point where a midwife is finally able to break your waters! Usually the tablets are all administered on the antenatal ward, whereas this bit is often done when the labour ward have space for you! When the cervix is open enough, something that looks very much like a crochet hook is used to make a hole in the amniotic fluid sac. Many people worry that this bit is going to be painful, but more often than not it is nothing worse than the usual discomfort of a vaginal examination.
5. (Unless you have already gone into labour yourself at this point!) Next step… the syntocinon drip! You are put on the baby heart rate monitor again, but this time it won’t be coming off! A cannula is put into your hand/arm and a drip is started very slowly into it. This is a hormone to make contractions start. The rate of this drip is then increased until you are having around 4 contractions every 10 minutes, lasting around 60 seconds each.
6. Vaginal examinations usually then occur 4 hourly to ensure the cervix is dilating as it should. Once you get to 10cm, it’s time to have a baby!
That all sounds rather complicated and medicalised!
It is! That’s why if you don’t need to be induced, we really discourage it! However, if it needs to happen, and the benefits outweigh the risks, it can be the best option.
Is being induced more painful than natural labour?
Some people say it is, but everyone is different. In natural labour, the contractions tend to build up slowly, but in induced labour they can come on a lot quicker. You are more likely to want an epidural with an induced labour than with a natural labour. However, plenty of people that don’t want an epidural manage without.
Will I need a caesarean section?
The risks of needing a caesarean section are higher when labour is induced than when labour is allowed to come on naturally.
Can I still have a pool birth?
Your baby will need to be continuously monitored if you are being induced, so this is where a pool birth can be a little more complicated. However, many units now have ‘telemetry’ monitoring, which doesn’t require cables and can be used underwater. Ask your midwife if this is possible at your unit.
Why does my baby need to be continuously monitored?
The syntocinon drip (discussed earlier) can stress the baby, so we need to know if the baby is still happy! Continuous monitoring shouldn’t stop you from being upright and mobile though, ask your midwife for help!
For more information, including bespoke antenatal classes, hypnobirthing and postnatal support visit www.therealbirthguide.co.uk