Please can you advise me on methods of induction

[vanillacremebrulee]

I'm hoping to be induced next week and I'm after some advice on how much say I can have into how things will go when I talk to the consultant next week.
Basically DC2 was also induced with pessary + ARM which caused a very fast and intense labour without any pain relief whatsoever. Needless to say I'm hoping not to repeat the same birth this time round. I'm hoping for a calmer birth and that's why I'm keen on having an epidural very early on.
The consultant suggested a sweep the night before followed by ARM on induction day if I haven't gone already by then. No pessary as that would be too much stimulation. So I'm wondering:

1. Can I refuse the sweep? I'd rather get to induction having had a decent night sleep rather than hours of painful false labour (which I've had for 4 weeks anyway without going into labour spontaneously). I know the point of the sweep is to give me one last chance not to be induced but I'd rather not have it because of what I just explained.
2. Can they give me an epidural at the same time as ARM? There's not much chance there'll be time for one otherwise.
3. Can they rupture the membranes if I'm not 2 cm dilated?
4. Can I go straight to syntocin drip plus epidural instead of painful sweep + ARM?

I know I'm a coward but this is my last child and after two very traumatic VBs I'm keen on having a calmer, pain free experience that I can actually enjoy. Any advice is greatly appreciated!

Why are you being induced? Waiting for spontaneous labour will usually give you the best chance of a calmer experience TBH.

Epidural very early in labour will reduce your ability to be mobile and upright - mobile and upright really helps to get labour moving so that is not usually wise.

Sweep will only help if you were about to labour anyway. You can refuse anything - sweep, ARM, drip, you name it.

Once they start inducing you with one method the clock starts ticking, and then if you are not progressing they will want to do more interventions. I would think very carefully whether a very managed labour is what you want?

Thank you for your reply but that's not what I was asking really. Not everyone can have what you describe.

Yes, you can refuse the sweep.

There's no reason for an epidural not to be sited early, especially if you laboured really quickly last time. You can refuse ARM until the epidural is in place if you suspect the same will happen this time.

I don't know if they can do ARM if you're not 2cm dilated, or if they'd progress to syntocinon without first breaking your waters. I'd imagine ARM would be necessary first as it's the less medicalised option and therefore means you could avoid the risks involved with syntocinon.

And MoaningMinnie's response is correct, so although it may not suit your situation (although it is helpful to know why a poster is being induced because obviously that has a bearing on what responses you'll get) hopefully it will help someone else who comes across this thread in the future :)

So I can insist on epidural at the same the as ARM? Thanks for your reply!

I'm not saying you'll get one, but it's within your rights to refuse any procedure until it's in place. Some places won't do one before you reach X cm but if you discuss it with your consultant and they say you have to be so many cm first, then you tell them no epi, no induction, given you expect to birth super-quick again.

I was induced last week, i dont know what ARM is.

You can ask not to have the drip untill after the epidural is in place, my delivery midwife suggested this option to me.

Im pretty sure they wouldn't be able to brake your waters at less than 2cm

I was given a 24 hour pessary to open my cerix so was in hospital a lot longer than anticipated, they did a sweep when incerting it to give it the best chance.

Im sure you could refuse the sweep the night before

ARM: artificial rupture of membranes
lucky24 did they break your waters or just put the pessary in and then the drip? Anything you would do differently?

yes the broke my waters an hour before the drip
the anesthetist was in theatre when i needed her so they turned the drip down which helpped a little till she arrived. so ask for an epidural earlier rather than later

Yes you can refuse a sweep - you don't need to explain your reasons, just say no thankyou!

Epidural with ARM - can't see why not

Cervix needs to be dilated a bit in order to break the waters - not sure it has to be 2cm, if it was nice and stretchy then they might be able to without it being exactly 2 cm

Can't use synotocinon without breaking the waters, mainly because it just doesn't work but also because of risk of amniotic embolism. Yes you can ask for the epidural to be sited before the drip goes up.

HTH

Thank you for your post. Im going in tomorrow at 10 am to discuss and possibly book date. I'm feeling more positive now and i know i need to stand my ground

Hi
I had an induction 10 days ago. Firstly it is very unhelpful when people reply saying you can refuse an induction- this is not always practical and not an option in my case and just shows profound medical ignorance.

Induction ( I have had 3!!!) can be a very positive experience.
I would have thought you can certainly refuse a sweep - they tend to only work if you are really ready anyway. I had 24 hr propess pessary followed by an ARM. Immediately after the ARM I had an epidural prior to starting synto. Many aneasthetists ( just checked with husband who is one) are happy to do Epi prior to ARM and would certainly advise prior to synto. I had a low background infusion epi and did not require much top up so remained with good feeling and was able to push quite easily and had a straightforward birth. I hope this is helpful and feel free to ask any more questions. Good luck - I had 2 really good inductions and early analgesia is the way forward.

holidays thank you so much for understanding so well.
I have just come back from a hospital appointment with a senior midwife who examined me to see if my cervix was favourable for ARM. Apparently it's not because although soft, slightly dilated and effaced, it's still tucked in behind baby's head so she thinks they can't reach to break the membranes. Because they cant use prostaglandin on me, the cervix needs to move forward naturally so I need to be seen again on Wednesday to see if anything has changed. I don't know what will happen if they still can't rupture the membranes on Wednesday.
In terms of pain relief, she said epidural ok only if you're in established labour so not before or immediately following ARM. I'm
going to ask again on Wednesday though because I really want that epidural and I'm pretty sure there won't be time once waters have gone.
Again thank you very much for sharing your experience and for your kind words.

Forgot to say that I didn't have to refuse the sweep. They decided it's not a good idea due to my history of precipitous labour. This however leaves natural cervix ripening as my only chance to have the ARM.

Vanilla - hi there, we have met on previous threads. Just to say that I have had the same concerns about an epidural. Perhaps it depends on hospital policy, but the consultant I saw said she would advise that I meet with an anesthetist when I arrive at the hospital to be induced - it is a Monday morning so she said the hospital will be full of them!!! I am hypermobile so it makes sighting one a bit harder but in principal, the consultant suggested that the canula etc can be set up before labour is established?

It is so draining and exhausting to be 'fighting' for what you want at this stage of pregnancy - can you book to see a consultant and have the 'epidural before ARM' written in your notes? I just walked in and booked the appointment - no questions asked. Also, you need to ask the midwife what she suggests if you think there will be no time after ARM - will an anaethatist agree to a spinal instead?

chocolate what is the difference between epidural and spinal? I will try to be as persuasive as I can with the consultant on Wednesday! Trouble is, at my local hospital epidurals are almost exclusively for first deliveries (according to midwife) so can you see how I'm going to have a real job convincing them to give me one before I'm even in pain? You're right, it is exhausting having to fight for the birth you wish for at this late stage and tbh I feel a bit defeated already.

I don't know the medical difference but a spinal in a 'one shot jab' that numbs the right places - it only lasts for a couple of hours. The epidural requires accurate siting to work and can take time to put in the right place - it can be topped up so it lasts for however long is required.

DC1: Epidural failed. Taken to theatre - they gave me a spinal in preparation for a EMCS. DC1 delivered 10 mins later by vontouse.

DC2: Requested an epidural on arrival at hospital but anesthetist busy. Waited 5 hours by which time I was 10cm dilated and no chance of sitting still. He gave me a spinal and then was able to site the epidural as I had stopped screaming and writhing in pain.

Good luck with the meeting.

Hi again

With regards to epidural - when you are admitted ask to speak to the aneasthetist as they may be happy to do the epidural even of it is not the midwifes preferred course of action - worth negotiating as that is what we did.

To increase the chance of a successful ARM take on lots of gas and air. I had a very unfavourable cervix this time but with the help of alot of gas an air I was able to relax sufficiently for them to reach my posterior cervix. I think without the gas and air it would have been too uncomfortable and would have prohibited the obs reg.

Ps as a compromise some anesthetists
Will site the epidural but put saline down in ie not analgesia until you need it. At least then it is in situ for when needed

holiday thank you again for the tip. Must admit midwife trying to feel my posterior cervix today was quite uncomfortable and it felt like it lasted for ages! I kept thinking "don't be silly, this is nothing compared to what's coming....epidural or not"!

Hi all, just wanted to say that DS3 was born 1/2/2012 at 3 am weighing 9lb 1oz. I was induced a couple of days earlier than planned (39+3) due to reduced fetal movement. They didn't give me the prostin, just broke the waters at 10 pm (did take in g&a to relax while she was finding my cervix which was still posterior). I started contracting at midnight. Baby was born 3 hours later with no need for the drip, no tears or episiotomy. Midwife was brilliant and I couldn't have wished for a better delivery. really induction doesn't have to be terrible! Thank you very much for your help and advice. I feel you have made a difference!

Congratulations, I am so pleased it went well for you welcome baby brûlée!

Congratulations, enjoy x