induction of labour and birth plan

[KatAndKit]

I'm booked for induction at 40 weeks in 3 weeks time on the advice of my consultant (have been on blood thinners all pregnancy and the plan is to avoid having to worry about placenta going wrong)

I'm hoping the baby decides to come early to avoid the induction and so I can perhaps have my planned waterbirth or at least have more options for avoiding interventions.

However, I know that first babies have a habit of coming a week late so the induction is statistically likely. All I have so far from the hospital is one diddly little leaflet. What sort of things should I be thinking about for the birth plan? Any tips from people who have experience of this? I'm generally one for thinking that the baby hasn't read the plan but I do want to get some preferences down on paper in advance, as much as anything so that my partner has an idea of what I do and don't want.

Continuous monitoring - do you agree to it or would you consent to doppler readings every 15 minutes or so? With CFM you can be left on your own for longer periods of time until someone comes in and checks the trace, for low risk women it's not been shown to improve outcomes but it does increase intervention and CS rates (I understand you'll not be low risk). Most women struggle to stay active with CFM because of the wires, you might be able to get away with bouncing on a birth ball if you're lucky in most cases. Some hospitals have wireless monitoring equipment but it doesn't seem to be the norm.

Syntocinon drip If you agree to going on the drip, would you consider an epidural? If so, do you want it sited before the drip goes in, or do you want to see how you manage without and then hope that there's an anaesthetist available should you need one later?

Forceps/Ventouse Do you consent to forceps in the event that baby is high enough up the birth canal for a CS to still be performed?

Is continuous monitoring only necessary if you have to go on the syntocinon drip or do they still do it even if you just have the pessary and possibly ARM? I would definitely prefer not to be hooked up to the monitor all the time.

I'm not "high risk" as such for the birth. The pregnancy is higher risk because of my antiphospholipid syndrome but that shouldn't necessarily make the delivery higher risk, only that avoiding a prolonged pregnancy seems to be prudent.

Good point about the anaesthetist, would be awful to be on the drip and then finding it horrendous but having to wait ages. I'd rather not have an epidural at all but I am aware that I am much more likely to want one with an induction so if it's going to happen anyway I'd rather not piss about with getting off my tits on pethidine or whatever first.

Each hospital's policy on CFM is different, but the fact is that you are not bound by hospital policy and have to consent to any action they want to take. So if you don't want to be on the monitor all the time, then you can ask for monitoring every 15 minutes by hand (for example) or agree to the CFM for 15 minutes and then go off for 45 - whilst it's handy to see what's happening in there, if someone's not monitoring the monitor what's the point?!

If you're active you're less likely to need an epidural for pain relief and you're letting gravity help you along the way.

I didn't have pethidine or diamorphine, and having read posts on here about it not taking away the pain but just taking away your ability to express that you're feeling it, I am glad!

Hi Kat!
I'm in a similar situation as you, will be induced around 40 weeks if baby hasn't made an appearance beforehand as am on the blood thinners AND have gestational diabetes.
I wasn't induced for DS, but I think in general for doing a birth plan, there are some basics to include -

• about the induction itself.

Might want to discuss non-hormonal methods first (foley catheter rather than prostaglandin gel) Whether artificial rupture of membranes would be tried before/after syntocin drip? Whether you want to have pain relief in place BEFORE syntocin is started or see what happens?

• about choices of how long to persist with induction? Some women might feel happier with a lower threshold to move to c-section if it's taking a while to get things going doesn't look like labour will start up without using syntocin? Others feel happier keeping on with the induction process in the hope that they get a normal vaginal birth at the end of it.

• Pain relief options if labour gets going without augmentation. If you have strong feelings about not wanting to be offered (certain types of) relief until you ask for example it's worth writing that.

• If you are using hypnosis techniques, maybe worth putting that down, especially if that means you don't think you'll want to be talked to, or want the room darkened, or whatever.

• if you think you'll want to labour in water, worth putting it down even if monitoring/policy is usually against it...you never know, you might still be offered it if things are looking like they're going normally.

• if you want verbal support and encouragement and suggestions. Worth putting down

• if you want to be told how dilated you are or only if you ask (some people thrive on the information, sometimes it can be disheartening)

• if you think you might have a preference for particular positions for 2nd stage (pushing)

• If your labour got underway without syntocin, then I believe the option of a physiological 3rd stage (placenta delivery) is available, so if that is something you want rather than a managed 3rd stage, it's worth putting down. (Not sure what happens if labour was augmented with syntocin already, might just always be managed?)

• Once baby is out, your preferences regarding clamping/cutting of cord, whether you're planning to breastfeed, whether you want baby to have intra-muscular vitamin K (although again, with blood thinners, I think they would recommend it - check with your consultant though, might be ok with oral vitamin K, or you could choose for baby not to have it unless symptomatic).

Can't remember if you know your babies sex or not, but if you don't, you could state whether you want to be told or discover it yourself.

I personally think it's also worth putting any preferences regarding c-sections into a birth plan...

e.g. whether you want drapes lowered when baby is delivered, whether you want to try get baby skin-to-skin in theatre, or preference for music on/off in theatre.

I also put stuff like how to pronounce my name (it's not a common one although not difficult to say, and knew it would piss me off being asked about it over and over), my husband's name.

It sounds a lot, but I did it in bullet points and it wasn't a page. Every MW read it (I had several shift changes) and everything that happened in my labour with DS was discussed with me.

BTW, I think it's a good idea to put a separate sheet together for your DP/DH - stuff like: things to remember to offer/do/say, as it can be a long time and once you're underway you might not be able/want to ask for drinks/a cloth on your neck/verbal encouragement and they may well just forget/not think/be a bit panicked about what to do to help.

Hmmm, having written all this out, I guess I should start putting my own ideas down in a plan too....

If you have syntocinon then you can't have a physiological third stage - the drip stays in place until the placenta has been delivered.

Also I think the use of foley catheters for induction is pretty rare, it's not something I've heard anyone on here discuss before. I think it's more common in the US, but I may be wrong.

Much of the advice above is handy for a general birth plan though, and worth considering regardless of whether you have induction or not! Definitely agree with the separate page for your birth partner :)

Yeah, I'm in NZ and Foley is standard for induction here if prostaglandin gel/pessary is contraindicated for whatever reason (eg. VBAC in my case), but I'd never heard of it in the UK. Having done quite a bit of reading about it, I'm very happy about it, as it appears to have similar success rates and low risks for uterine rupture. Of course, there's no guarantee that catheter will prompt spontaneous labour, so would then be followed by ARM and 24 hours on clock to get started.

The thing about induction is that it's not just one thing. It's a series of procedures, any one of which may or may not get labour progressing. And like any labour, it doesn't just depend on what is happening to your uterus/cervix but how your baby is positioned and able to turn/descend etc. My personal feeling is that in an induction, being given enough time and space to allow labour to start at each point is quite important. And I guess that just means asking one of those 'informed consent questions' - "does this procedure have to happen now or can we wait?" at each stage...

Definitely with you on the asking a question at each stage (having had a rather intervention-heavy induction myself) and asking about what other options are available.

Thanks for the help - given me plenty to think about.

I was induced with dd. Found the contractions fine until I had my waters broken and then I needed an epidural. However, after 30 odd hours of slow progress, the epidural allowed me to relax enough that things finally got moving. I don't have anything to compare it to as she is our first, but I really didn't think it was that bad, and although the increased likelihood of cs was made clear, I never felt as though I was being pushed towards having one. Good luck!