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ARM or gel for induction? Waterbirth still an option?

(29 Posts)
Princesitalinda Mon 31-Jan-05 14:35:53

Hi everybody. I am new to the net, and I was reading all your posting for weeks. For the first time though, I need to ask some questions....

I am 41 weeks pregnant today (first baby), feeling (like all the overdue-mums) very tired and anxious. Today I had my second sweep. My midwife said I am 2 cm dilated (same as one week ago when first sweep was done) but babys head has dropped even further, cervix is efaced and thin.

I have an induction date set by the hospital (Frimley Park) on next thursday (if still not labouring). The midwife said that everything looks good for me to have my water broken instead of the prostanglandin gel... I am confused about it.... does it mean that ARM is better than the gel as an induction? is it more "natural"? could someone give me an easy answer? if I have more information, I could feel more empowered to take decisions then....

An other question is about water birth.... As this is still my preferred method of labouring (and if possible giving birth), if induced (either by ARM or gel) could I still have this option?

Any help will be sooooo appreciated!! thanks and good luck to all the overdue-mums in the net!!!

Princesitalinda

galaxy Mon 31-Jan-05 14:38:07

I had my waters broken by the midwife at Royal Surrey and was booked in for a water birth but the contractions came on so fiercely after, I ended up screaming for pain relief and had an epidural. Regret it to this day.

You must be local to me - am in Farnham.

Slinky Mon 31-Jan-05 14:41:43

I was induced with my 2nd child at 39 weeks. They used the gel and resulted in a waterbirth which was fabulous.

I had no intention prior to the birth of having a waterbirth - it was actually the lovely midwife who suggested it - and I'm so glad she did

Wanted a WB with No 3 but I was almost on the point of delivering on arrival at hospital, so no time.

galaxy Mon 31-Jan-05 14:43:15

I have to say I didn't know about the gel and the more I learn about other possibilities, the more angry I am about my birth experience. Almost makes me want to get pregnant again to have it the way I wanted to 1st time

oatcake Mon 31-Jan-05 14:44:51

have you all seen www.infochoice.org?

this is all aimed to give you tip top info that is evidence based so you can all [supposedly] be empowered.

it's a great site.

HunkerMunker Mon 31-Jan-05 14:45:38

Hiya - welcome to MN. I had a waterbirth with DS (was 41+3 and no sign of labour till my waters broke in the wee hours). Was due to be induced at 41+5 and they said I could still have a waterbirth if they used the gel (not sure if ARM was mentioned - don't remember).

(I was dreading being induced, so got DH to 'help' with a particular method of bringing on labour... Two hours later...my waters went.)

Princesitalinda Mon 31-Jan-05 14:53:50

Hi, thanks for your replies... that was quick!

It makes me happy to think that Waterbirth can still be an option (although as galaxy says, maybe I will be begging for pain relief instead )

Are labour with ARM better (less painful, quicker, etc) than the ones with the gel? The way the midwife put it today, it looked like in the "lucky" position to be offered ARM instead....

The infochoice website looks great, BTW.

pupuce Mon 31-Jan-05 16:58:37

If you get an ARM you get NO drugs into your body and it could be "like" if your waters had broken naturally.... though it is always preferable to keep the waters intact as it softens labour and your baby is better protected.
The gel is used only in women who have a cervix that is still thick and closed, it is for ripening ther cervix. Your cervix is already so. From what you are describing you have every chance to go into labour BEFORE Thursday anyway.
Don't go imagining the gel being a soft option, it isn't!!!! It can be as nasty (or nastier) as an ARM.
Usually once you get an ARM you are expected to get contractions within 2 hours and if not they add the syntocynon drip to start you off. At that point (the drip) your chance of a water birth will have evaporated UNLESS they have a protocol which is very unusual. Once you get the drip you usually end up on the bed as you need full monitoring and if things don't progress super quickly you'll beg for an epidural !
However if they do all of this and you get contractions on top op each other you are probably dilating at the speed of light and an epidural will be too late (which to a degree is not a bad thing as it will help with your 2nd stage).

At this point you could try either accupuncture or reflexology before Thursday. Accupuncture would be my 1st choice. One of the things these 2 therapies will do is actually stimulate your endorphins system (natural pain killer) and that could be quite handy!

Princesitalinda Mon 31-Jan-05 22:47:42

Pupuce, thanks so much for the clear explanation. This afternoon I had a long nap after midwife left and I was awaken by very strong Braxton Hicks contractions (I assumed there were braxton hicks as they were not painful, just tight1). Shortly before, during and after dinner I kept having strange kind of pains, like wanting to go to the loo, having a bad stomach ache, but nothing happens! Sometimes they are very intense, and I have to stop doing things (but still don't think these are proper contractions - not painful, not regular, just intense). I just had a warm bath and will see how I feel during the night... I hope I can go to labour before thursday, but I don't want to hold my breath...

I would try either reflexology or accupuncture, but I am new to my town and I guess I don't know where to go, or if someone will fit me in with such short notice... so I will just keep praying and hoping it will happen naturally...

Do you reckon I should wait past thursday (aiming for a natural labour?) or I should just go with the flow and have the induction done...?

pupuce Mon 31-Jan-05 22:50:32

If you are aiming for natural, avoid sweep or any other induction! Your odds would dramatically change !

Princesitalinda Mon 31-Jan-05 22:59:20

Will I be allowed to postpone induction? Is not dangerous for us (me and baby) if I wait a bit longer? How long can we wait (to be on the safe side?)

Hope I am not being a pain.... thanks for helping

misdee Mon 31-Jan-05 23:02:37

someone i know didnt have an induction, and gave borth at 44weeks.

Mosschops30 Tue 01-Feb-05 19:45:52

Message withdrawn

Princesitalinda Tue 01-Feb-05 20:49:15

Hi Mosshops 30, yes I did follow your thread about the two sweeps. While reading it, I also felt for you and now I am in a similar position. I dread going for induction, but at the same time I am afraid of harming the baby. As my induction is booked just 10 days after my EDD, I wonder how long can I wait and still be on the safe side (for both mum and baby)?

Also, I guess because my cervix is already soft and thin that means that I can no longer have the prostanglandin induction? If I have to be induced then I would prefer to have the more gentler of methods...

pupuce Wed 02-Feb-05 13:29:53

Sorry I was away
Gentler induction???? That's a contradiction in termns
You can waut 42 weeks EASY.... some hospital have a policy of 10 days and others 14 days.... WHY???? Clearly if many feel 14 is fine than those doing 10 are being a bit too intervention happy?
If you are not keen to be induced you can request a scan to check your fluid levels and placenta activity.... this will give ammunition OR would indeed confirm that you need an induction.
When you go past 42 weeks you should be scanned every other day. BEWARE you will be offered a CTG trace (those 2 belts) and you lie on bed .... this is not the same as a scan and is not the bestway to know if you should continue with this pregnancy or not.
There are women who indeed have pregnancies of 44 weeks (clearly they refused inductions) and are in the minority as many people get fed up or frightened.
Agin... 1st time mums often go to induction as many are not ready to give birth 10 days past EDD.... mine came at 11 days !

Princesitalinda Thu 03-Feb-05 00:45:02

Pupuce - thanks God for your reply. I was so doubting what to do re: induction (scheduled for tomorrow). Now I feel a bit more empowered, and my plan is to phone / go to hospital tomorrow morning and tell them I am having second thoughts about the induction and if I could request a scan to check my fluid levels and placenta activity before taking any decision. I guess that if they allow me to go ahead with this tests first, I would then be happy (as I hope they also would) to either continue waiting or have the induction as scheduled tomorrow.

As you seem to understand the procedures, I have one last question. My midwife said that she would recommend to go straight for the ARM, instead of using the gel because I am already 2 cm dilated and cervix is thin and soft... I heard that after ARM they just would give me 2 hours to start labouring otherwise they would put me straight onto oxitocin drip (which I dread).... why is that?? Are really two hours enough?? I heard than when other women's waters break (spontaneously) they normally wait at least 24 hours or more to induce labour... why just two hours if artificially breaking them?

I hope you can reply soon. Thanks!

mears Thu 03-Feb-05 00:56:29

Princesitalinda - don't know if pupuce is around but I will give you an answer to your question. You may know I am a midwife and agree with Pupuce most of the time

The reason you are left only 2 hours before starting the drip once your waters have been broken is because it is the start of the induction process. The breaking of the waters artificially is sometimes enough to get you into labour, but to be honest when it is your first baby it is not usually enough. Once the decision has been made to start induction, there is no point waiting for longer than 2 hours. When the waters break spontaneously, that is a sign that the body is making it's own preparation to go into labour which can happen over a few days.
Since your cervix is thinning and is 2 cm dilated, things are beginning to start on their own. Ideally, your waters do not break in labour until just before the baby is born. It would be much better to wait and see if you go into labour yourself. If all is well, there is no reason to induce you before 42 weeks.

Princesitalinda Thu 03-Feb-05 02:10:31

Mears - thanks a lot for your reply (specially so late - or early - in the morning )

I am from South America and this is my first baby. I am married to an English man, so we decided to have the baby here (we also live here). The whole birthing process is new for me, but even more because I have to understand the English traditions, systems, etc. That's why I am asking so many questions....

I am very anxious about this birthing. I had an ectopic pregnancy before and lost my left tube. It was not easy to get pregnant again, and hope to see my little miracle very soon.

However, I do not want to rush things if not necessary (for the sake of the baby or my health). It is good to know that I can't be forced to have an induction. Tomorrow I will try to speak to someone at the hospital to see wether they could tests what they have to test to check that we both are fine and let us wait a bit longer for things to happen naturally...

What is the criteria they use in hospitals to decide wether to are making progress naturally or you would eventually need an induction? If they check on me and I am at least 3 cm dilated, would that be enough proof of progress?

thanks again for your help!!

mears Thu 03-Feb-05 09:26:46

If they check you and you are 3cm that would be a definate sign to leave you alone - you will go into labour yourself

My own hospital does not like to go beyond 42 weeks however womens wishes are taken into account. The longest I personally have seen was 43 weeks before induction but that was because the mum was really determined.

Your cervix is favourable for labour and I think it is reasonable to leave you to 42 weeks. Try not to be swayed by being told we can easily break your waters and start your labour. You never know before you do that whether it will actually work. Then you end up on a drip and monitor etc. Sounds as though, with a bit of patience, you will go into labour yourself.

pupuce Thu 03-Feb-05 10:21:09

Hi princess
Let us know how you get on....
Mears and I understand how hard it can be to fight an induction, what is worse is for one woman's situation one MW would not induce and yet another would.... so this isn't a black and white picture !

Slinky Thu 03-Feb-05 10:30:40

I had the opposite problem with DD2 - I was DESPERATE for an induction but Consultant refused. He was keen to let "nature take its course" and booked me for induction at 42+5 - despite the fact that I had severe SPD, had 2 other kids under 4, could barely walk, spent most of my days crying due to pain, AND both my midwife and GP tried to argue my case to be taken in.

As it was, I went into labour at 42+3.

pupuce Thu 03-Feb-05 10:32:56

Slinky - was it a good labour ?
You know with bad SPD.... a good labour is really important ! You can serioulsy hurt yourself especially if labour is bad and you have an epidural.

Slinky Thu 03-Feb-05 10:36:21

Yes it was - very quick (fully dilated on arrival at hospital) and easy.

My SPD did start up during 1st pregnancy, but doctors brushed it off as "normal". I then went on to have a forceps delivery, and was then told after by the physio team that it was the worst thing they could have done.

My 2nd was an induced waterbirth which was fabulous and really eased my joints.

I'm still suffering some (obviously nowhere near like it was) pelvic pain and my youngest is 5

pupuce Thu 03-Feb-05 10:39:41

What induction did you get for your 2nd ?

Slinky Thu 03-Feb-05 10:41:23

1 dose of Prostin gel and went into labour very quickly after.

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