Are your children’s vaccines up to date?

Set a reminder

Please or to access all these features

Childbirth

Share experiences and get support around labour, birth and recovery.

Induction timescale

14 replies

cookingfat · 03/02/2011 09:34

DC1 is due tomorrow, but I've got an MW appointment on Monday to discuss induction and to book a sweep for 41 weeks (next Fri).
My question is, what happens next, assuming sweep doesn't work? Local policy is to induce at 10 days - do you think this means pessary or full-on drip? And is this common, or did I mishear in antenatal class?
And if pessary, where does DH go overnight? Home or hospital?
Thanks Smile

OP posts:
Are your children’s vaccines up to date?
antz1 · 03/02/2011 09:40

My waters broke and had contractions for 24hours only to go into hospital to be put on drip and properly induced. I went in at about 8pm and gave birth at 6am, it's a bit of a waiting game when on drip but all well worth it!

DP was there with me all the time though, which helped.

Good luck!

pearlgirl · 03/02/2011 10:03

I have been induced 3 times - at 3 different hospitals and the procedure has been different at each. The last time (April) my dh was there all the time and went in at 11am, gel in at 8pm, drip in at 1am, next morning baby at 4am.
we had quite a wait before they did anything and if it does get to induction i would recommend that you take stuff to do - we played cards lots. the hospital's policy was just to feed the mum so my dh had to go off and get food - i hadn't checked so hadn't packed more than snacks and drinks.
I had had a couple of sweeps before this induction and my baby was just determined to stay in.
I have friends who have just had the gel to start them off, so i don't think you always have the drip.

Good luck!

KikiJane · 03/02/2011 10:06

I think it depends on how your cervix is (I could be wrong!). With my first baby, I was put straight on the drip. With my second, I was given the pessary, as my cervix was soft and I was 3cm dilated. Waters were broken later and no drip was required (which was great, as I loathed the drip).

It also depends on your hospital's policy. With my local hospital, you go in at 7am or something, but with most hospitals it seems that you go in in the evening.

Provided your baby is doing well and you're ok, you do have a say in this, though. Sometimes you have to be pretty forceful, but if you have a preference and there are no contraindications, they should respect that.

systemsaddict · 03/02/2011 10:09

It was all quite gradual for me. Went in on the Friday morning and had pessary put in, nothing happened all day (dp was with me), then another pessary in on the Friday afternoon, contractions started Friday late evening, but weren't doing much so dp was sent home 10pm. Contractions all night in the hospital, but only 30 seconds long so not doing much, then the next morning dp came back, they took me down to delivery suite - more for pain relief than anything. Broke my waters to try and speed things up mid-morning, then onto the drip I think mid-afternoon.

Our local policy is 10 days too but I wanted to avoid induction 2nd time round and didn't see the consultant till I was 11 days over Wink

I would say ask the midwife as much as possible about it, about hospital policies and what to expect. We assumed going in for an induction on Friday would mean baby by Friday night, he ended up being born at about 1-ish Sunday morning! So it can be a bit of a waiting game and you need to be prepared. Definitely take stuff to do, food, etc. - I missed lunch because I was walking around to try and get contractions going so ended up having to buy stuff at the hospital canteen which wasn't particularly nice. For some people it happens much quicker, though.

Mahraih · 03/02/2011 11:07

Would be interested to see what everyone says on this!

I was due yesterday and went for a midwife appointment - she already had gloves out and was offering me a sweep right then and there! I said no. She then explained that I could have a sweep, pessary or drip but didn't say when, or under what circumstances. I'm to go back next Friday.

Ask the midwife - try to get timescales out of her!

breatheslowly · 03/02/2011 12:08

Our hospital's policy is 12 days over. I had pessary, gel x 3 then on day 15 ARM & synto. DH had to go home each night, but on the last night he stayed in a hotel as he was to tired to drive back and forward. That was quite good as I got rushed up to delivery due to a dodgy heart trace after the last lot of gel, but then nothing happened after that. After the first lot of gel I asked to be left over night to get a decent night's sleep as otherwise it is gel every 6 hours and lots of time on and off the monitor, even in the middle of the night. And it was all quite boring (until the last day).

debka · 03/02/2011 20:14

They won't put you on the drip until your waters have broken. And if you have ARM (artificial rupture of membranes), they give you 2 hours to see if contractions start before putting the drip on.

If the gels don't work after 2 days and they haven't been able to break your waters they will give you a day off then start again. It can be a looooong process. I know this because I've just been discharged after 3 days of attempted induction. Going back on Tuesday to try again (I get a longer break because they're inducing early due to GD).

Ah, and DH goes home and you go to bed with a sleeping pill.

breatheslowly · 03/02/2011 20:59

My experience wasn't like debka's - I didn't get a day off and got the drip even though my contractions had started pretty well. I think every hospital must be different.

mondayschild · 03/02/2011 21:21

I had a sweep at 41 weeks, which did nothing. The standard policy was to induce at 40+10, but I was really unsure so instead I was booked in to see the consultant at 40+12 to discuss options and go ahead with induction if that's what I decided.

Had to get to the hospital pretty early (7.00 am IIRC). Another lady was there for induction too, and as she definitely wanted to go ahead she was admitted to the ward straight away. DH and I waited until about 11 to see the consultant (was on the monitor for a short while before this). Decided that I was going to be induced, as I didn't think my paranoia about how DS was moving was really compatable with expectant management. It then took quite a while to be admitted, but I think that this was due to waiting for a bed rather than normal practice.

I had a pessary at 4.00 pm and was told that if that didn't work, they'd let me get some sleep and try again in the morning. By 8.00 pm I was getting some period-type cramps and by midnight I was in established labour. DS was born 4 hours later, no drip required.

They did boot DH out at 8.00pm (just when the cramps were starting, but they told me they'd just be 'prostin (sp?) pains.' In actual fact, everything went really quickly from then on and I was 6cm by the time they examined me at midnight.

DH being sent home was the major downside of the whole experience, as I was on my own for the first stage of labour because they wouldn't let him come back until I went to the delivery suite. Had I just gone ahead with induction in the morning, he would have been there throughout - oh for a crystal ball Grin. Don't want to be too negative though as on the whole I had a great experience, and feel v. fortunate that the first pessary worked so I didn't need any further interventions.

Good luck

Loopymumsy · 04/02/2011 06:48

This reply has been deleted

Message withdrawn at poster's request.

KikiJane · 04/02/2011 09:41

"They won't put you on the drip until your waters have broken. And if you have ARM (artificial rupture of membranes), they give you 2 hours to see if contractions start before putting the drip on."

This is not true as a blanket statement.

littleyellowchicken · 04/02/2011 12:01

I was called in for induction yesterday at T+12. As baby was well and happy I decided to just have a sweep. Midwives were very clear to make sure it was my decision and I could be swept, induced or just left alone, whatever I wanted.
But they did insist that I go back at T+14 to be induced saying "They won't allow you to go later than that." Not sure who 'they' are or how far I could push it while the monitors show baby is happy, healthy and well.

It is really hard to decide. I don't like the idea of all the drugs and poking around, but then also don't want to prioritise that over health of the baby. Why can body not do it by itself?

Cleofartra · 04/02/2011 12:22

"They won't allow you to go later than that"

No - they'll send the biggest, scariest midwife from the labour ward round to your house to force you to go in and be induced. Hmm

Have to say, for me reading this thread makes me profoundly glad I didn't accept induction with ds2 and ds3 (gestational diabetes in both pregnancies) and that I had a good independent midwife who validated my choices and gave me the strength to say 'no thanks'.

"I don't want to prioritise that over health of the baby. Why can body not do it by itself?"

In the vast majority of cases it could, and always has. Medics are usually unable to identify the very tiny number of babies who actually benefit from induction, so they induce every mum post-term 'just in case'. As far as I see it, it means that hundreds and hundreds of mothers and babies are paying the price of a harder labour, higher rates of c/s (at least for primips) and more instances of fetal distress to save a very tiny number of babies. I understand the justification for it because every baby life is precious beyond measure, but I still wish there was a better way, and also that doctors and midwives were a bit more honest about the problems associated with induction instead of just focusing on the risks of going over 42 weeks.

C&P'd this article on induction - makes very interesting reading.....

"Induction of Labour

This article was published in THE PRACTICING MIDWIFE (2004 Jul-Aug;7(7):45-6)

Thousands of women in this country with normal pregnancies and healthy babies are being put at risk every day in maternity units across the country. Yet like lambs to the slaughter they pack up their bags and head for the hospital in the belief that the doctors, who instigate the barbaric treatment they are about to undergo, are saving their babies lives.

Many of them then spend the next few days in excruciating pain over and above that what is experienced in normal labour in an effort to drag their unready and unwilling bodies into labour. Their bodies are filled with drugs that may compromise their long-term health so they begin the spiralling cascade of interventions that all too often culminates with entry through the theatre doors.

The women and their families thank the doctors and hospital guidelines for saving them from the problems they had, problems that are often itrogenic in origin. And so the myth, that their bodies are failing them in the one thing women are best at, procuring a future generation, is perpetuated.

To add insult to injury my colleagues, midwives, who by definition of their title should be the protectors of women and babies, help daily to continue this unnecessary practice. Induction of labour for no medical reason has become a socially acceptable procedure.

The N.I.C.E. (National Institute for Clinical Excellence 2001) Guidelines are the gold seal that have been adopted with open arms and are now governing practice in maternity units throughout the country. The Induction of Labour (IOL) is one such guideline and one that recently instigated a rather heated conversation between a hospital antenatal clinic midwife and myself. Her role as head of the clinic involved speaking to many women who were booked for induction and therefore she was in a very responsible position to give true and unbiased information about IOL to large numbers of woman.

I had telephoned the clinic to arrange an ultrasound scan for a client who was 42 weeks pregnant with her second baby. The pregnancy was normal. The client was very well informed and despite knowing there was no evidence to support fetal surveillance had decided on a scan to check the well being of her baby. Social pressure had made her feel that she needed to "do something" and this course of action, she felt, at least appeased her family, friends and neighbours. What she did emphasise to me was that she did not want to be put under any pressure by anyone to be induced and this I clearly explained to the midwife I conversed with. I asked her to pass that information on to the midwife in charge; an appointment was made for 2 days hence. The following morning I received a letter from the midwife in charge. The letter informed me that a review of the hospital notes made the clients dates "wrong" and stated "in accordance with N.I.C.E Guidelines on post maturity, no woman should go over 42 weeks".

After reading the letter my client, feeling that was this was just the pressure she did not want to subject herself to, lost all faith in the maternity unit. She understandably felt that she would not be given the respect to make her own decisions especially as, without meeting her, judgment had been passed on her by the professions from which she had requested help. Also she must be a stupid woman after all if she knew when she got pregnant! She cancelled the appointment.

The guidelines of course do not say what the midwife had stated. The letter left me in no doubt that this head of antenatal clinic not only had not read the guidelines but also more worryingly had put her own interpretation on them. If this is but one example of how they are being used to manipulate and lie to women what hope do women and society have of knowing the truth and making an informed choice?

Following the publication, in Canada, (Hannah 1992) of the largest Randomised Controlled Trial (RCT) to date concerning induction of labour and further meta-analysis of other RCT The Royal College of Obstetricians and Gynaecologists (RCOG) adopted of the policy of offering induction at 41 weeks. This is now the recommendation of what is regarded as gold standard, The National Institute for Clinical Excellence (N.I.C.E) Guidelines.

However what is not widely known by obstetricians and midwives alike is that all the studies used to govern today?s practice was and is based on 8 babies! In the case of induction of labour, the number of babies that died following their mothers being induced versus the numbers of babies that died following their mothers left to proceed with pregnancy beyond 41 weeks. There were approximately 3000 women in the IOL group and 3000 in the expectant management group.

One baby died in the IOL group and 7 died in the expectant management group.

Hey presto it is obvious then many babies? lives will be saved if we offer to induce every woman over 41 weeks.

Does anyone care about looking at the wider picture?

I was taught as a student nurses on diploma courses at the very beginning of my education not to use research that is more than 10 years out of date to underpin my practice. Yet to govern and recommend practice affecting thousands of women and babies, many of the RCT in the Meta analysis used to compile the N.I.C.E Guidelines are more than 20 years out of date, some of the studies even 40 years old. Whilst the way women grow and birth babies has not changed in millions of years, the ways our health as a nation and the ways in which maternity care is delivered and received certainly has. Never more so than in the last 40 years. We now have testing and screening so that abnormalities can be detected earlier fetal surveillance is available for at risk babies and the appropriate care free and accessible to all women.

If we do indeed look at the wider picture we see a whole new one emerging. Of the seven babies that died, two occurred in the 1960?s one of which had a suspected diabetic mother. Hardly a good inclusion criteria in a controlled trial by today?s standards. One baby had pneumonia that is irrelevant to induction of labour. One from a Chinese study that the baby had Meconium aspiration following refusal of induction of labour by its mother after a positive amnioscopy. Another from Meconium aspiration at 43+3 weeks, which would not have any bearing of induction at 41 weeks. One was from a placental abruption, which could occur at anytime. One was a baby of 2.6 grams and clearly growth retarded and the mother had received no antenatal care, (Menticoglou and Hall 2002).

Based on these finding where is the evidence that there is an increased risk of unexplained still birth at 41 weeks? How are the benefits to the 20-25% of women and babies that are being daily induced being demonstrated?

How are we as professionals informing women of the risks of induction of labour versus continuing the pregnancy? Are women given the information in a true and unbiased manner? I doubt it. Just as women are only told the "risks" around birth when they are planning a home birth but conveniently not told the many more risks associated with going into hospital. A woman screened for having a Downs Syndrome baby is informed that if she has a risk factor of less that 1:250 she is a low risk and further action not recommended and yet at 41 weeks gestation she is offered (if indeed it is an offer) IOL because the (very dubious) risk of increased stillbirth is 1:1000.

In a detailed review of the literature Menticoglou (2002) also highlighted details of a women who died in a hospital awaiting treatment for what appeared to be fulminating eclampsia. She was waiting because the wards were full and busy. As many midwives know the wards are often full to capacity and often due to the amount of routine induction of labours that are on going at any one time. Where do women and babies such as these two who died feature in the calculation of risk?

Other than the Hannah trial no further studies were looked at in depth for taking into account when devising the N.I.C.E guidelines. There are other good retrospective studies looking at this subject. Many that shows a substantial increase in the caesarean section rate for routine induction of labour and no significant difference in neonatal outcomes for women and babies that are left alone to continue with healthy pregnancies. The cost to the maternity services must be phenomenal. A cost that could be put to far better use. Money that could spent on improving services so that midwives come back to the profession. Then women and babies who ARE at risk from on going pregnancies may well be highlighted appropriately through good antenatal care instead of a hurried 10 minutes at each antenatal visit and routine induction for all!

We also must not forget the baby in the whole process because it too plays its part in the instigation of labour. The baby is not a passive receiver of the labour process and induced earlier may not have the readiness for labour itself. The biggest reason of all (22%) given in the National Sentinel Caesarean Section Audit (RCOG 2001) was fetal distress. Even given the many wrong diagnosis of fetal distress that exist how many of these babies were induced before they were ready to be born.

Routine induction of labour has become a socially acceptable norm. It is time we professionals, we who are the instigators of what over time becomes "normal" in women and societies eyes, stop this barbaric treatment and give back to women the respect that they and natures deserve."

ssmile · 04/02/2011 12:51

WOW interesting reading. Thanks. I was induced at 40+13, after 2 days being held as the 3 sets of gel didnt work and they couldnt break my waters I was offered a C-sec at 40+15. I was relived to be offered an 'out' to be honest. But I had resisted going in at 40+10 and my midwife supported me because I was fit and healthy. I do wonder what would have happened if I had been left. ... but we do have a vhealthy DD.

Don't the babies get too big if left in too long??

New posts on this thread. Refresh page
Swipe left for the next trending thread