Talk to me about induction (options and pain levels) especially for second child

[minipie]

I'm pregnant with DC2 and have been diagnosed with gestational diabetes (just over the borderline, gah). My hospital's policy is to induce at 40 weeks assuming blood sugars and growth look normal.

DD1 was born vaginally, gas and air, at 34 weeks after pprom and spontaneous labour - I've been told there's no reason premature labour should happen again (any more than anyone else) and family history is all overdue babies, so am hoping/assuming I will get to term and be induced.

Please can you tell me what are the different "levels" of induction? I guess they start with a sweep. I have also heard of waters being broken, a gel (don't know much about this), a pessary and an oxytocin drip. What's the difference please? Is it possible to start with the gentlest option and then work up from there if it doesn't work? Are there different levels of drip, ie can they give you a tiny bit to start with?

Please also tell me about pain levels? Most of the tales I've heard of being induced sound horrifically painful, well beyond what I experienced with DD. I am wondering if I should request an epidural. On the other hand induction + epidural seems to be a recipe for interventions and EMCS which I'd rather avoid of course. And the tales I've heard are mostly of first births. I'm wondering if an induced second birth is not quite as bad and perhaps I could manage without an epidural?

(I could take the "wait and see" approach re epidural, but seems my hospital often doesn't give epidurals unless you've requested one from the outset )

Much appreciated

[numberjack99]

I was induced with my first (only) birth. I hadn't had the sweep, I refused it as I was being sent for induction the next day and thought the drugs would sort me out.
I had 3 pressaries which only gave me mild labour pains. I was in a ward with a lady who was being induced with her second child and she went a lot further than I did with it. Hers was a quicker labour than mine and she had a vaginal delivery.
I had my waters broken, was left for a while then got put on the pitocin drip, it was increased gradually and I had Diamorphine and G&A which was fine. You get hooked up to all the monitors when you get put on the drip. I can't remember when exactly I got put to bed, if it was the Pitocin or Diamorphine that instigated it.
If I was in the same position again I would opt for an epidural, not necessarily for the pain but you get put to bed anyway and it might allow your nether regions to relax more. I don't know but I would look into it more. I was never offered an epidural.
I ended up having a c-section as I was told my labour was not progressing. If it gets to that stage you have a spinal and not a full epidural.
Everything went well with the birth itself, labour with pitocin is pretty intense but the Diamorphine and gas and air do help a lot but I haven't got anything to compare it to. It was also nearly 4 years ago! :)

[numberjack99]

Start getting sweeps @ 37 weeks if you can!! :)

[ajandjjmum]

I was induced with both of mine.

DS had pessary around 6 pm, started feeling twinges in the night, phoned DH around 6 am and DS arrived just after 10 am. It was pretty manageable - the only thing that upset me was the midwife saying I wasn't in proper labour, and 10 mins. later finding I was 7 cms!

DD was induced just after 10 am and arrived at 11.29 am. Was a bit of a rush - and did make my eyes water, which is not really surprising.

I don't get all these horror stories about induction, but maybe I was just lucky.

Good luck!

[McFox]

I also had GD. I started with sweeps every few days from 38 weeks and had a good bishops score by my due date, but there was nothing happening so I was induced at 40 +4. Because everything was favourable they broke my waters but nothing happened. Once your waters we broken you can't get the pessary, so it was straight to drip after 3 hours of waiting. I managed 8 hours of labour with the drip, 2 on the max dose of oxytocin, using hypnobirthing, so don't go into it thinking that it will be worse! The consultant did say that he'd never seen anyone on it for that long without an epidural before though, so I now definitely trust in the power of hypnobirthing

Good luck!

[ISolemnlySwearImUptoNoGood]

I agree that you should start getting sweeps as early as the midwife will allow. With my third, I was 'allowed' my first sweep at 40 weeks, which is absolutely ridiculous if you ask me. Have no idea why the midwife was so keen to keep me waiting. (My fourth baby, I started sweeps at 37 weeks.) Anyway, I inevitably went over and was induced 11 days over. It's usually an early start, I was at the hospital for 7:45. Obs done and first pessary. I had to sit for half an hour being monitored, then for another half an hour to give it time to work then I was allowed to start pacing the wards! Six hours later I was given another pessary. It worked. Contractions started immediately. The only thing was my labour was extremely intense and fast. Came as a bit of a shock!

[TarkaTheOtter]

I was induced for both my births at 38 weeks because of GD.

Was pretty much the same for both.

Went in first thing. Examined. Pessary type thing or gel put in (can't remember which each time but they are pretty much the same thing. Left in for 24hrs. During that time had occasional monitoring but otherwise free to potter about hospital/bath/sleep. I did some laps of the hospital to help things along (stairs were particularly good). Had some mild contractions but nothing major. After 24hrs I was examined again. Both times they decided I was dilated enough (about 1-1.5cm) to break my waters. Then both times a long, boring wait (48hrs first time!) whilst they waited for a free bed and midwife to start the next stage.
Both times they took me across to delivery suite after evening shift change. The midwife then broke my waters with a crochet hook thing and started the syntocin drip. They offered an epidural at this stage which I declined both times.
First labour I found ok for a few hours then asked for an epidural. Once in, I was pretty much immediately fully dilated and went in to deliver without intervention. Second degree tear which healed fine really quickly. I could still feel to push but was delivered by a student and she didn't give a lot of feedback as to when I should push so I pushed at the wrong time.
Second labour I planned to ask for an epidural but asked too late and so didn't get it. It felt more out of control and ended with the same outcome so I would say my experience with epidural was better.

[AliceinWinterWonderland]

I was induced with 2nd and 3rd births. Had GD with 3rd pregnancy. Scheduled induction 1 wk early with 2nd, 2 wks early with 3rd.

On 2nd, it was with pessary. Within 4-6 hours labour started. Baby born just over 8 hrs after pessary given, after 2 pushes. No pain relief. Poor midwife in labour ward surprised with delivery, as no time to move down to delivery room.

On 3rd, pessary given 2 days in a row, labour started but stalled. On third day, waters broken to get labour started. Ended up on drip to get labour started, with epidural. Male consultant was trying encourage me to go without epidural, saying it would be tough, but doable. The moment he left the room for something, female midwife stepped up and said "I'd recommend the epidural. Really." I took her advice. Soooo glad I did. First one didn't work properly, and I was glued to the (not horribly helpful) gas and air. Second one worked, and sooo much better!! Ventouse (sp?) delivery about 7 hours after labour started.

[minipie]

Thanks everyone! Really useful stuff. It doesn't sound nearly as bad as some of the stories I've heard.

I guess they would let me have sweeps from 38 weeks if not before, since all the advice for gestational diabetes is to get the baby out early. So that sounds sensible.

I'm confused about the drip, I've heard of pitocin, syntocin and oxytocin (though I might have made that last one up ) are they different? do they have different effects? might need to ask the midwife I guess.

Never heard of diamorphine before, I will have to ask about that too! I thought morphine wasn't allowed in labour but may have the wrong end of the stick.

Anyway I feel well armed for asking lots of questions of the midwife next week so thanks very much!

[Wishingtimeaway]

All names for the same drug, pitocin is more American I think. Syntocinon I believe is a brand name, while oxytocin is the name of the drug.

If you get the diabetic clinic/ consultant to write in your notes for stretch and sweeps from 37/38 weeks, then your midwife should do it. Some won't before 40 weeks without a Dr telling them!

[TarkaTheOtter]

Think diamorphine is the same/similar to pethidine.

It's also worth asking about antenatally expressing colostrum in case baby has low blood sugars when born and needs topping up.

[ChocolateBiscuitCake]

This is my take on the whole induction process (I had an 'elective' induction at 39 weeks with DC3 due to SPD).

If you were to do an elective induction privately the process would probably follow these stages (from speaking to friends!):

1. Arrive at hospital and be put in a nice comfy bed.
   
2. Anaethastist arrive and site the epidural.
   
3. Doctor arrive and break your waters.
   
4. Drugs administered by IV and ramped up when necessary.
   
5. You sleep/rest until the midwives examine you and say you are ready to push.
   
6. Baby pushed out (unless sadly it is decided that intervention is required)
   

My experience on the NHS, given that it was third baby so all midwives certain that the gel pessary would work wonders was:

1. Arrive at hospital and after a fair amount of waiting, put on an antenatal ward.
   
2. Lots of traces for hours because they forgot about me and was not high priority
   
3. Gel given. Feel nothing.
   
4. 2nd gel given about 12 hours later. Few mild contractions. Lots of traces left for hours
   
5. Another 12 hours later (?) another gel given. I now haven't slept in 24 hours due to noisy ward, excitement/anticipation and half hearted contractions. I am still on an antenatal ward. I email the consultant who talked me into this process to complain!!!
   
6. 30 minutes later, they have found me a room to labour room (about 30 hours after arriving at hospital.
   
7. Follow steps 2-7 above for private elective induction process!!!!
   
8. Sadly I ended up in theatre, prepped for EMCS but thankfully just had the vontuse.
   

My point is, it is very rare for the gels to have much effect. I really felt that they were "buying time" for the hospital. The birth itself was "fine" and I had a happy outcome with a healthy baby. However, for many women, it is a lengthy and exhausting process because it just takes SO LONG!

Good luck

[knowler]

It seems like everywhere has slightly different induction procedures, so just ask what they do at your hospital. I just had pessary and waters broken with ds2 and after that, it was really quick and really intense. I had been worried about induction before but because it was so quick, gas and air was fine and it was actually a brilliant experience!!

Just find out the procedure and you'll be fine :)

[PenguinsandtheTantrumofDoom]

" I've heard of pitocin, syntocin and oxytocin "

As a previous poster said, all the same thing. Syntocinon is what we call it in the UK, Pitocin what they call it in the US and they are both synthetic oxytocin.

[PenguinsandtheTantrumofDoom]

I don't think it's massively rare for the gel to kick you off with a 'proven cervix' (is previous vaginal birth). My friend had the gel, was put in a ward to sleep, woke up with strong contractions and had a baby 2 hours later.

[sleepwhenidie]

My experience was almost identical to Chocolatebiscuits NHS one with DC3 except no epidural before the drip. Having given birth twice without any pain relief the labour with drip was a huge shock and I was begging for an epidural (there were no ebbs and flows to the pains, it was unremitting),but by the time the anaesthetist was available I was in too much agony to keep still. I also ended up in theatre ready for EMCS but I went from 7cm-10cm dilated just during the trip down the corridor from room to theatre and DS2 emerged just in time still needed spinal block to remove placenta but another story.

So I would say ask for an epidural if they are putting you on the drip, however I do think my midwife was terrible and kept turning up the drip well after labour was established and should have been left alone and drip turned down, if not off .

[McFox]

I agree with Tarka about expressing colostrum beforehand. I managed to get quite a bit and my parents had to go and get it out of my freezer on a milky mercy dash!

[elliejjtiny]

I was induced at 36 weeks with DS5 because my waters were infected and I was developing sepsis. I don't think it's normally that fast. I wasn't allowed to have the pessary because of previous C-section so I went straight to the drip. They put the monitor on the baby's head and set the drip going. It was more painful than 2 of my previous labours but less painful than my back to back labour. I had no pain relief for the first 3.5 hours and then gas and air. I could get off the bed and move a little bit, bounce on the birthing ball etc. I ended up having an EMCS as DS5 had developed sepsis as well and was getting very distressed but if he'd been ok he'd have been born in another hour or so I think.

[TarkaTheOtter]

McFox you've reminded me - ignore them if they tell you to just bring a bit to hospital and leave the rest at home. I brought about 15ml with me when I was induced and left the rest in the freezer at home. DS was hypoglycemic and the consultant wanted me to top him up with 40ml per feed until his sugars were back up to normal, starting immediately. I might as well not have bothered. I was trying to avoid formula because of the weak link with type 1 (which I have in my family).

[theshooglypeg]

I was induced with my first and so far only birth. The most unpleasant bit was that they gave me the first pessary at about 4pm and the second about 10pm just as my partner had to leave, which meant I spent the night in increasing pain on my own as the contractions intensified.

In the morning they took me down to the ward and things progressed for a few hours. Then they put me on the drip and broke my waters (or possibly the other way round, that bit is hazy). The pain had been intense but manageable up to the point of the drip, but then got a lot worse very quickly and I asked for an epidural.

Epidural was completely wonderful and my daughter was born a couple of hours later with a ventouse. Staff were all great and very supportive.

So based on my own experience, I'd say if you possibly can, try to get your induction booked in for early in the morning, and be open to the idea of an epidural.

Good luck!

[NickyEds]

My labour wasn't induced but augmented. My waters had broken and I'd gone into spontaneous labour but 24 hours later hadn't progressed enough so had to have the drip. If I have to have the drip again I'll definitely ask for an epidural first-as with pp was begging for one with ds. You need to be constantly monitored so I had to stay on the bed and ds was back to back so it was very, very painful (sorry!).

I had diamorphine and was told it was similar to pethadine but increasingly used instead, can't remember why now(I think it's less likely to make you sick???). It made me incredibly drowsy in between contractions but it didn't kill pain. It made it very hard for me to concentrate and I felt like everything was happening to me and around me but i couldn't make myself heard. It was very frightening and I'd avoid it next time. It also passes to the baby and, whilst not causing any harm it makes them drowsy for a few hours.

[irregularegular]

I was induced with my second child. The first had been an elective c-section do to breech, so the second was my first vaginal delivery.

I was approaching 42 weeks and (arguably) showing sings of pre-eclampsia, so I was induced. They couldn't/wouldn't use a pessary because it was a VBAC and the pessary increases the chance of uterine rupture. Some hospitals won't induce at all in a VBAC. So I went straight to the drip (I guess my waters were also broken, I'm not sure).

I think we started early/mid afternoon, took a couple of hours to kick in, baby born 11pm. Not particularly painful I don't think - no problem managing just with G&A. I hadn't ruled out an epidural but it really wasn't necessary.

[minipie]

Thanks everyone! more great info.

Expressing colostrum antenatally is interesting but I had ruled it out because I am worried it might bring on another prem birth. I really want to go as close to term as possible. But maybe it doesn't have that effect?

[TarkaTheOtter]

I think for it to bring on labour you have to be doing it for hours. I did 15mins hand expressing a day for the last few weeks and was getting 5ml a time by the end pretty easily. Maybe ask the midwife. I think they do to advise you start too early anyway.

[TarkaTheOtter]

do to = don't