Why is induction a 'horrible process'?

[Casi]

Hi,

Please forgive my ignorance but having read so many threads that claim induction is awful, then some others where people claim it's fine, I am confused! Is it awful because contractions are stronger or quicker? Are there other reasons? Am trying to decide whether to hold out, or go with the earliest induction date given to me (I am 40+4). Thank you!

[GwendolineScaryLacey]

I think it's because there is more chance of intervention (forceps etc), not my experience. And the fact that you go from 0-60 quickly so it's more intense and you don't have time to adjust. I've only had one baby so nothing to compare but my labour was 4hrs start to finish so pretty quick I think. Due another at Christmas, can't wait to see what happens there... :)

[GwendolineScaryLacey]

I was induced, should have said, hence the speed.

[Pudding2be]

My induction wasn't brill to be fair. I spent my labour on my back and had forceps in the end because I couldn't push her out. I had an episiotomy and 3rd degree tearing.

Yes the drip was painful, and i found that my contractions didnt build up, they werent there then suddenly they were painful. I had an epidural in the end, but I healed very quickly afterwards and my beautiful DD arrived safe and sound.

I do think if you approach it in the right frame of mind you'll be fine.
One piece of advice I would give is try not to stay on the bed like I did

[MaryThornbar]

For me there were a few problems with being induced, the main one being that my entire labour was in hospital, and I was kept on a ward until I was at 4cms dilated - which took 24 hours, was generally not comfortable in terms of surroundings, and bloody painful as my contractions were extremely close together and overwhelming. I felt very sorry for the people in the beds next to me!

I had no access to gas and air until being allowed onto the delivery suite at 4cms- the only pain relief I was allowed was paracetamol or pethadine. I think it depends how favourable you are in the first place though (I wasn't at all at 12 days overdue) and the whole thing lasted two days ending in EMCS - basically because my body just wasn't ready to go into labour at all.

I know others who have had really easy inductions though and have had straightforward births with no other intervention. I think it really depends on you personally and how ready your body is to go into labour. Your midwife should be able to check you and give you an idea of this which should help you make your decision.

[Bubbaluv]

Beacuse your contractions go from zero to hero. No slow build-up. It's probably not such a prob when you're overdue, but I was induced way before I was due so I was having end-labour level contractions for the whole time I was dialating. If your cervix is more redy to roll then hopefully it just kick-starts things and you won't have as much of a problem.

[libelulle]

For me it was the lack of buildup - 0 to 100 miles an hour in 2 minutes, ie from nothing to unbearable screaming hell in literally one contraction. That was beyond shocking. Also v fast labour that irreparably damaged my cervix and caused subsequent v prem birth. But I think i got a raw deal - I've had a lot if friends be induced with not nearly so much trauma. Like any birth it's down to the luck of the draw!

[JeelyPiece]

They can be fine. Mine was a bit rubbish as it took 4 full days start to finish and ended in forceps because baby was almost back to back and was held up by the cord wrapped round his body, stopping me from dilating naturally.

I suppose often if you're over 2 weeks overdue like I was there's a reason why it hasn't happened on its own and your body may need some persuading so it can take a while. I know others whose induction has taken less than a day though. The drip does bring on contractions strong and fast and you are obviously less able to move around. You would be monitored more closely too. It's a fairly medicalised experience. But it got my baby out safely, eventually.

It's just not as nice and natural as a spontaneous labour I suppose. I am hoping if there's a next time i'll get what I imagined for the first time, early labour at home then a pool in the midwife centre... I could happily give the two weeks of horrendous constipation a miss too! Don't think the induction can be blamed for that though.

[cory]

It wasn't awful for me and I was induced early in both pregnancies.

[ajandjjmum]

I was induced twice, and it was fine in both, although DD (2nd baby) was born within an hour and a quarter of the induction.

[Northernlurker]

I think it very much varies from person to person and is hard to predict. I have had one induced labour - gel and waters broken but not the drip and two spontaneous labours. Spontaneous was shorter and much, much easier to manage. I think induction has it's place but it should be something that you are giving informed consent to, not doing just because the doctors are offering it and so you feel you should. Personally with dd3 I was offered an induction date at 40 + 10 but I declined and asked for 40 + 14, same as dd1. In the event we didn't need it anyway.

[VivaLeBeaver]

Well firstly it could take days and days to get you going. You could have multiple gels, 24 hour rest periods, getting increasingly sorer, tightenings from the gel which are really painful but don't do anything and stop after a few hours. After 3 or 4 days of this they then decide your waters can be broken so you have this done. Then you may well need the drip which often makes it more painful and means that you have to be monitored for your labour, therby restricting your mobility.

Or you could have one lot of prostin, go into labour, not need any more intervention and have a baby a while later.

[Firawla]

i found it makes it more uncomfortable & painful than normal, but often they get you do have continuous monitoring so you end up stuck on the bed, which makes a huge difference from if you are able to move around normally. i think if you do get to keep mobile after being induced it would prob not be as bad, but of the both times i have been induced they wanted to put drips in and monitoring.
but if you end up needing to be induced i wouldn't worry about it too much, some people give really bad induction stories but for plenty of people its gone fine.
personally i found they are really quick to give you an epidural if you want one, due to being induced. so if you are worried about pain levels, atleast you can know they should be able to sort it out for you fairly quick?

[Aloha31]

I had a fantastic induction - but try to wait! See here

[Aloha31]

And stay upright/move/change lots - possible even with monitoring. Good luck!

[HappyCamel]

Try expressing colostrum if you can. Helps ready the body for labour. DD arrived at 39 weeks so I missed my induction planned for due date.

[fuckityfuckfuckfuck]

My problem with induction was that it felt like something that was done to me iyswim, not something that happened to me. Nothing was explained, in my naivety I didn;t know it was likely to be more shocking in it's pain and speed, and I do think it led to a very different outcome than had I laboured naturally. I was induced for being 10 days over, had I just waited I think I would have gone into labour naturally as the monitor they hooked me up to showed i was already having contractions, I just couldn't feel them. I found the pessaries painful and the woman giving them seemed to take more than a little pleasure in my pain and I was basically made to be immobile by all the monitors, ended up having an epidural and labouring on a bed with a posterior baby who didn't turn, I believe because I was in a bad position. I only narrowly avoided forceps.
The labour was no shorter than a normal first birth I believe (14 hours) and the second stage was almost 3 hours. Having said all that, I do think if you are informed about all that could happen, and have someone to advocate for you in the room there's no reason it has to be awful. But if it is only because you are overdue, then my advice would be to hold out. I wish I had. My second birth was the same amout of time overdue, but was spontaneous and it was a completely different, wonderful experience. I intend to avoid induction this time around too. I think I just cook my babies for a bit longer and remember, in many places you wouldn;t even be considered overdue yet.

[shagmundfreud]

I really like this description of what's involved in induction from the 'Midwife Thinking' blog. I think it gives you a good insight into why induced labours can sometimes be very difficult.


Induction: a step by step guide
In my old 1997 version of the ?Midwives? Dictionary? induction is ?causing [labour] to occur? ie. someone causes a labour to occur rather than allowing the baby/body to initiate labour. The dictionary goes on to say ?this may be carried out when the life or health of the mother or fetus is in danger if the pregnancy continues.? Of course this statement is open to interpretation and many inductions are not ?medically indicated? (link). However, I am not entering this debate here? I?m trying to stick to the process.
There are a few things you need to be clear about before choosing to be induced:
 That the risks involved continuing the pregnancy are greater than the risks involved in induction.
 You are committed to getting this baby out. Once you start you cannot back out, and a c-section is recommended for a ?failed induction?.

There are 3 steps to the induction process. You may skip some of the steps along the way, but you should be prepared to buy into the whole package when you embark on induction.
Note: If your waters have broken naturally the term ?augmentation? rather than induction is used to describe getting labour started. This is because it is assumed that your body has started the labour process itself. Step 1: Preparing the Cervix
During pregnancy the cervix is closed, firm and tucked into the back of your vagina. This means that you can have contractions without the cervix opening. In order for the cervix to respond to contractions it needs to make a number of complex physiological changes (Coad 2011). Relaxin and oestrogen initiate these structural changes, and prostaglandin, leucocytes, macrophages, hyaluronic acid and glycoaminoglycans are all involved in softening the cervix ready for labour. You don?t need to remember all of this scientific stuff (I never can). All you need to know is that it is a complex process, and prostaglandins are only one piece of the puzzle.
When you are being induced your cervix will be assessed by vaginal examination. If your cervix has already changed and is soft and open enough to get an amnihook in you can skip straight to step 2. If your cervix is still firm and closed, attempts will be made to change it so that step 2 is possible. This is usually done by putting artificial prostaglandins (prostin E2 or cervidil) on the cervix in the form of a gel, pessary or sticky tape. Artificial prostaglandins can cause hyperstimulation of the uterus resulting in fetal distress, therefore your baby?s heart rate will be monitored by a CTG after the prostaglandin is administered. You may also experience ?prostin pains? which are sharp strong pains sometimes accompanied by contractions.
Successfully completing step 1 may take a few attempts with re-insertion of prostaglandins. This can take hours or days because you must wait hours before re-assessment and re-insertion. You may respond to the prostaglandin by going into labour therefore skipping the following steps. However, you are still having an induced labour and will usually be treated as ?high risk?.
Step 2: Breaking the Waters
I realise that this step is not always part of US inductions but I have never experienced this approach, so will stick to what I know? Once your cervix has softened and is open enough to get an amnihook in, your waters will be broken. This is allows induced contractions to be more effective; the baby?s head to press harder on the cervix; and may trigger contractions avoiding step 3. I was also taught that it reduces the risk of an amniotic embolism (amniotic fluid getting into the blood system) but there is no good research supporting this. There are risks associated with artificially breaking the waters. Once your waters have been broken you can wait a few hours to see if labour starts, or go straight to step 3.
Step 3: Making Contractions
You now have a cervix ready to respond to contractions and no amniotic water in the way ? next you need contractions. In a natural physiological labour oxytocin is released from the brain and enters the blood stream ? it has two main functions:

1. It works on the uterus to regulate contractions
   
2. It works in the brain to contribute to the altered state of consciousness associated with labour and promotes bonding feelings and behaviour
   In an induced labour, artificial oxytocin (pitocin/syntocinon) is given via a cannula directly into the blood stream. It is unable to cross the blood brain barrier therefore only works on the uterus to regulate contractions. I have written about the risks associated with artificial oxytocin here along with references. Basically, it can be pretty nasty stuff which is why your baby will be monitored closely using a CTG. Women usually describe artificially stimulated contractions as being different and more painful than natural contractions. Having supported women during inductions I am also convinced there is more pain associated with induced contractions. Obstetricians will argue that the physiology of a contraction remains the same whether it is initiated by natural or artificial oxytocin ? which is true (see this post for an explanation of how contractions work). However, during an induced labour contraction pattern and intensity increases quickly compared to most natural labours. Women are not able to slowly build up their natural endorphins and oxytocin to reduce their perception of pain. In addition the circumstances and environment that often surrounds induction (intervention, equipment, etc.) can result in anxiety, increasing the perception of pain.
   Once your baby is born you will need to continue using artificial oxytocin to deliver the placenta. A physiological placental birth is not safe because you are not producing your own natural oxytocin at the level required. Basically medicine has taken over and must finish the job.
   In Summary
   Inducing labour involves making your body/baby do something it is not yet ready to do. Before agreeing to be induced, be prepared for the entire package ie. all the steps. You may be lucky enough to skip one step, but once you start the induction process you are committed to doing whatever it takes to get the baby out? because by agreeing to induce you are saying that you or your baby are in danger if the pregnancy continues. An induced labour is not a physiological labour and you and your baby will be treated as ?high risk? ? because you are.
   From ?Midwife Thinking? blog

[Casi]

Thank you everyone for your advice and experience. Am digesting it all and feel far more informed. Cheers!

[breatheslowly]

Two issues I had were:

1. The induced contractions were too close together and the drip was meant to control that but didn't. You are meant to have a certain number of contractions every 10 minutes and I had twice that (or something like that), so much so that when I had my birth debrief the MW looked at the traces and said "so from here to here you weren't in established labour because the contractions were too close together" and suddenly got to the comment about being fully dilated and realised that I must have been in established labour, but it didn't look like it should have done and was fairly horrible to experience.
   

1. High intervention rate. If I had realised quite how high the intervention rate is with inductions I would have considered asking for a CS. You can look at your local hospital's stats, but when you see a 25% induction rate and a 25% instrumental delivery rate and 30% CS rate you don't necessarily realise that the instrumental delivery and CS rates aren't evenly spread over the induction and non-induction births, but actually concentrated in the induction ones. So your chance of having a non-instrumental, non-CS birth is really very low. I had a preference for a CS over forceps before DD was born and I might have just as well gone for an ELCS rather than risk having an instrumental birth. In the end I did have forceps and quite signficant complications afterwards resulting in further surgery and an unbelievably horrible 3 months of misery.

[Casi]

Thanks breatheslowly - urgh, sounds like you had a horrible time. My consultant booked me in for an induction a week tomorrow if nothing has happened but we did not discuss an ELCS as an option. So you would recommend I go back and have that conversation? What do others think about the pros and cons of CS versus intervention with forceps or ventouse? Do I even have a choice in the matter at an NHS hospital?

[changer22]

Casi - do talk about leaving it a bit later. 2 of mine came when I was 40+14 and the one who came when I was 40+10 (my first) was because I had my waters broken. And then it ended with forceps and ventouse. I am clearly a 42 weeker and not a 40 weeker woman!

[posterofaquiche]

My induction was foul and unnecessary and resulted in every intervention possible without an epidural and ended in a EMCS under general. I wish I had made them leave me alone or had a ELCS.

Sorry if that's a bit negative but I really think you would be better knowing and taking control now rather than getting a nasty surprise later.

Good luck

[Northernlurker]

Shagmund - that's a really interesting read. I think that is really helpful to think about induction as somethng that should be done when there is a risk to life - all too often in British hospitals induction seems to be offered as a matter of principle at certain points and not because the specific parties - mum and baby have specific and obvious risk factors.

[kateyfer]

I was induced as my DD's heart rate was erratic, so I was hooked up to monitors for a day before they decided to try a pessary. for me, I went from 0-2 minutely contractions very quickly which was extremely painful and difficult for my body to adjust to as it hadn't had the opportunity to get used to early stages of labour with milder, more spaced contractions. on top of this, they wouldn't give me any pain relief except gas and air.

my DD was obviously also not ready, as despite the pessary, she did not descend down the birth canal for 23 hours of contraction hell, with me pushing for 3 hours (on advice of midwife) before she finally agreed to get opinion of consultant who took me straight to theatre for a forceps delivery.

I finally got an epidural - oh the blessed relief! and DD was born by forcep delivery, and no further complications, 15 minutes later.

So, my experience has taught me that unless you have to be induced for a medical reason, let nature take its course as induction is birth is difficult enough without making it more painful, and more likely to end in an instrument delivery.

[dinkystinky]

OP - I was induced at 42 weeks. It was a horrible process for me as spent the entire day waiting around in a room waiting for a bed to come free on labour ward, then had waters broken (already 2cm dilated and in early labour) then hooked on a drip and bam straight into full on contractions with no respite - and then the midwife changed shifts and got an evil midwife and all went a bit pete tong. But just because it was horrible for me doesnt mean its a horrible experience for all - I know pplenty of people who had perfectly happy inductions with no interventions.