Options in induction

[Orenishii]

Hi all :)

I posted yesterday and the lovely badgerina gave me some information but I didn't want to derail the other poster's thread. I am 41+1 and had a sweep yesterday to no avail - cervix is too high up right now.

I had booked a homebirth with our own pool. When the MW couldn't complete the sweep, she immediately assumed an induction at 42 weeks, with no explanation of what an induction entailed, what pain relief would be available to me, or asking or discussing with me what I wanted other than telling me it would be straight to the labour ward - no HB, no pool, no mlu. I managed to get another sweep booked for Friday, with an appointment to be be made with the head of MW care if that didn't work.

I am trying to shrug off this concept of what they will allow. They talk very much in terms of what they will allow, and the way they are handling this is really upsetting me - not the prospect of an induction itself, if that's right in the end then so be it. But their complete lack of information and shutting down all my options is making me so upset.

So - in your experiences, opinions - since I am low risk, good blood pressure, strong baby heartbeat, excellent movement, a low risk pregnancy so far:

Would it be an option to go home after they insert a pessary - if indeed that's what they do? Not that I know because they haven't told me!

Would this be a really stupid thing to do, or would it be an option for us - to see if I start contracting on my own, get in my own pool, if the induction is successful?

I have to add - I am not very good - or I suppose more accurate - not very confident at enforcing my choices. I can be assertive but I struggle with getting to that point in the sense that I can lack confidence I am doing the right thing. I feel my care is being very pushy and shutting me down - getting information is like pulling teeth. Any help, advice, sharing of experience would really help me come to some kind of place of resolution for my situation.

I read somewhere that you can go home after a pessary, I can't remember where, and I certainly wasn't able to when I was induced due to pre eclampsia but with a low risk pregnancy I can't say.
What I would suggest, however, is to research the hell out of everything you want to know. It will give you more confidence to politely, but firmly, say thanks but no thanks. Look at things like induction and home births, going post dates and going into labour naturally etc.
Hope someone else is more helpful!

I was induced with my DS and I really regret it - not because it wasn't the right thing to do (I don't know if it was or not) but because it felt so out of my hands. Like you I had a HB planned and really wanted to labour at home in comfort (well relative comfort anyway!)

In the end I had a pessary and was told I had to stay in but was categorically told I would not go into labour and my family was sent home. I then went in to labour and was told it wasn't and just to rest. I'm not telling you this to make it seem like all inductions are unpleasant, just that my feeling about being told what was happening to me continued into may labour and my delivery (I was moved into a position that I really didn't want to birth in and was incredibly painful, I then ended up with a ventouse delivery). Now maybe all these things were necessary, but if I felt I'd been involved in the decision making and had an opportunity (or the confidence) to ask questions about my options then I think I would feel less uneasy and uncertain about the whole process.

Like Waiting suggested do as much research as possible and this may help you to be more confident and 'hold your own' in the conversation. In the Natal Hypnotherapy book that I have just finished Maggie Howell suggests asking questions using BRAIN:

B-What are the Benefits? How will this be helpful?
R - What are the Risks? What are the advantages and disadvantages?
A - What are the Alternatives? What other approaches are there?
I - What does your Instinct tell you?
N - what if we do Nothing? Why must this be done now? What might happen if we wait?

Don't know if any of this helps but good luck and I would definitely see if you can discuss routine checks (instead of induction) to check baby's heartbeat and an ultrasound to check the amniotic fluid depth. This will give you more info about the actual risks to YOU rather than following a procedure. Good luck.

(Sorry for the super long post!).

Is there the option to have another sweep over the next few days. Just because the first didn't work, doesn't mean that it's not worth having another go.

I wasn't allowed home after the pessary.

If the pessary (and you can have more than one over a period of time) does it's job then your labour will continue along the lines of natural labour. You will be able to be mobile and you or may not need pain relief.

If you need intravenous syntocin to get you labouring, you will have a cannula in one hand and they will won't to monitor the baby's heartbeat via a monitor strapped to your belly. Babies don't always tolerate the speediness of syntocin contractions, so the hospital does like to keep an eye on them. While you are being monitored, you will be stuck in one position to keep the kit in the right place to measure baby's heartbeat.

You can have all the usual pain relief: paracetamol, tens, gas and air, pethedine or an epidural. The labour started by the pessaries isn't any different from non-induced labour, but your MW might recommend you have an epidural if you are going on syntocin as some people find the contractions get big very fast.

I was induced with DC1. I was in hospital from the Wednesday evening (had my first pessary then) and finally had DD on Sunday evening. I was being induced about 10 days early which might have caused a bit of a delay. I really felt empowered by my experience giving birth to DD. I went into a very calm, slightly euphoric state for the whole time I was in hospital. I spent a lot of time walking (and walking and walking) and chatting to people on the ward. I felt very focussed and in control. The birth wasn't what I originally planned, but it was still amazing and wonderful.

I agree with what everyone else has said about doing your research. You will feel so much better equipped to deal with the situation if you have some idea as to how the process works and what your options are.

Good luck.

Sorry - massive post. Feel free to ignore my ramblings.

You need to find out what your unit uses for induction of labour.

If it's pessaries or gel, it is probably not a good idea to go home - because there is a small risk of uterine hyperstimulation - where the uterus is contracting far too quickly - and that is a dangerous thing.

Some units use Propess - where the drugs are within a sort of tampon - so the woman can be given the information about danger signs, and if anything happens she can remove the tampon before returning to hospital to be checked out.

You could discuss with a supervisor of midwives or the head of midwifery the option of expectant management after 42 weeks - this should be presented as one of your options but never/rarely is - instead of induction you adopt a wait and see approach with regular checks of your baby's wellbeing. You always have the option of then changing your mind if your gut instinct suggests your baby should be born soon.

You also have the option of discussing the possibility of having an induction, and if the gel/pessary/Propess is all that is required to get you into labour - there is then no reason why you can't be treated as a low risk labour - provided you and your baby are well - I know one couple who had induction of labour like this, she started labouring and requested transfer to the midwife-led unit and to use the pool for pain relief. Baby was born safely in the water later that night!

If you accept induction and need more interventions like the drip to get labour going then you also have to accept that your labour is now high risk and needs to be more closely monitored.

Fingers crossed that you start labour spontaneously very soon and this all becomes academic!

This may be useful:

archive.ahrq.gov/clinic/epcsums/prolongsum.htm

Sorry if not a link but from my phone. Basically as long as you know the risks and the monitoring you need to do then nobody can make you do anything.

I read somewhere that multiple sweeps more likely to be successful but they can also bring on fake symptoms and long latent labour but maybe booking in 2 more is a good place to start. I had 3 and in the end only needed my waters breaking to get labour going. My cervix was soft and favourable and already 2-3 CBS after the third.

Weigh up the risks, be informed and make your wishes clear and at least you will feel you have some control. I was induced twice. It was not my choice either time but I trusted my HCp's and I got my babies at the end of it. Both quick labours. Ask them why they want to do things though so you know the reasons and most of all trust your instincts.

Good luck.