Prostin induction question - advice needed please

[spalex]

Hi, as some of you will know I'm due to be induced on Monday, and I have some questions going round in my head that I should have asked at my midwives appointment, but as my head was all over the place - I forgot. Are you 'allowed' to go home after you have had some prostin gel, until either (a) labour begins or (b) a second / third dose is needed? It's just that I seem to remember from last time, 4.5 years ago now, I was waiting on the ward for hours (and even overnight at one point) in between dosages. Nothing happened and after 3 goes I was eventually taken to the delivery suite and put on the syntocin drip - 2 days after the 1st dose of gel. I found all this incredibly stressful, and would much rather have been in the comfort of my own home - we're only 5 mins away from the hospital anyway. Does anyone have any experience of anything similar, or are there any midwives out there with any advice? Of course I understand that by going home I'm doing it at my own risk, and all that goes with that.
I've also been booked in for midwifery care at the same hospital (hoping for a water birth), and was wondering if I would be allowed to continue with this if labour was brought on by prostin induction..? I had a terrible time delivering last time round, and am keen to try and avoid this as much as possible this time.
I know I may sound like a whinging idiot but unfortunately it's really a case of once bitten, twice shy (so to speak).

well of course you could 'sign' yourself out but i wouldn't think that was sensible

I was induced on a monday, baby born on thursday morning - I was less than 10 min drive away and didn't even consider going home - once youve been induced they monitor you fairly regularly , you and the baby.
maybe it will be faster this time
good luck

no..you cannot go home...they will leave you for a few hours, if it hasn;t worked , you have another dose, i think they are 6 hours apart.....

i think induction makes you more of an obstetric led case...as you will have more intervention...but the midwives will be looking after you..but there are certain protocols that will have to be followed , re time limits and monitoring...

you could ask for ARM instead of synto, after the prostin gel..or even ARM alone instead of prostin, if your cervix is ripe and dilated.which gives you more chance of being allowed to walk and move

if you have a synto drip, you cannot have a water birth as far as i know, and you will be monitored continuously

you can refuse that and have intermittent monitoring, and ask to be given as much time as possible to stay active, moving , upright , which gives you a better chance of a straightforward delivery.....

how over your date are you on monday?

BTW . you could have gone spontaneously by then !have you had a sweep?

lots of sex and nipple stim for you this weekend !

I like you had a prostin gel and had 3 attempts at it. I eventually went after the third one but I don't think that's what started labour. I would definately not have been allowed home as I live about 30 mins away from hosp. I wouldn't have thought it would be normal practice to allow you home.

On the bright side with my second I didn't need inducing so you may not need to be induced

I live 5 mins from our hospital and begged to go home for a couple of hours decent kip after my first prostin. They said no way (I did also have high BP though). 24 hours and two more prostins later they were able to break my waters. Although that gave me decent contractions they insisted on hurrying me along with syntocin which immediatly rules out even getting in bath let alone a full water birth. In my hosp they insisted on constant monitoring once the drip was in. If I do it again I will refuse that drip as I found it unbearable and really wanted to get in water even if it was just a bath.

Good luck.

I heard recently that there are a few hospitals trialling doing exactly this - giving the first dose of prostin and then sending women home (after a stint on the fetal monitor to check everything was OK). They then come back for more prostin and the rest of the induction process the next morning or when they go into labour, if before.

You could try posting this on the uk midwifery yahoo group and see if you get some responses from the midwives on there.

FWIW I wish I'd discharged myself when I was induced with ds1.

Can I ask why you're being induced, because you sound like you're really dreading it and it might be an option to postpone it to see if you go into labour naturally?

are they really daisymoo! that would be good.... did you see the recent thread re VBAC after two c.s?

Hospital in Brisbane does the first dose of prostin and lets 1ST time mums home to return next day - haven't heard of anyplace letting 2nd time mums home though - its deemed too risky in case baby comes quickly.

Induction can take a long time as most hospitals wont give a second / third dose of PG if you are contracting at all on the CTG, irrespective of cervical change and this is the most usual reason for delays.

Once you are ready for ARM (breaking the waters), there has to be a bed / midwife in labour ward before they will take you - different if you go into labour yourself - they will have to take you anyway. This can also delay things if L/W is busy.

Most Birth Centres rule you out if you have an IOL, but you could try to negotiate them taking you if you have the ARM and no synto, but I think there would still be more monitoring than the BC would be happy with. This also probably rules out a waterbirth etc also, for the same reason of monitoring, although some telemetry CTG machines are waterproof, but staffing for waterbirth can also be an issue in L/W.

As for synto, its much easier for you to refuse a treatment offered than to demand a treatment. No reason to start synto straight away, in fact most hospitals would consider it reasonable to wait a few hours, its up to you to 'extend' it by negotiation.
If nothing happens after ARM and mobilising in the corridor and stairs etc, maybe a 'bump start' with low dose synto might be worthwhile, as you will start getting really exhausted.

As Lulumama suggests, sex / nipple stim might be the go first. Remember too that for most people, second birth is a good bit easier than first time!

Hope this helps and sorry about the long post.

Thanks so much for all your thoughts. On Monday I will be 11 days overdue and the policy with our local health care is for women to be induced after 10 days. You can negotiate this with the doctors, but apparently they are generally reluctant to agree - according to my midwife (however she has said she will support me if I choose to do this).
Last time I was so red raw and in pain inside after 3 doses of prostin that I couldn't even get my legs open when the consultant tried an ARM (by this point I had already been hooked up to the synto drip). This resulted in having an epidural, which I really didn't want, and the whole lovely business culminated in a forceps delivery after 14 hours of being hooked up (3 days after 1st getting prostin)!
This time round I had a sweep on Wednesday, when I was apparently 1.5 - 2 cm dilated, but nothing since. Had a hot bath and sex last night (yay! at last!) and nothing - nice enough way to pass some time though, but I did feel quite sorry for dp as it must have been quite a vision for him !

Spalex, our local hospital is trialling this as well (letting women go home after first prostin gel), but I think it's quite unusual in the UK and if your hospital doesn't do this, there's not much you can do. On the plus side, it might all happen really quickly, especially second time round. Prostin gel made me start immediate contractions 2 minutes apart, so it can happen!

both my labours were induced with prostin. it doesn't do very much for me....

second time around, i had the first dose in the morning then had to wait for 6 hours to see if it had worked. we had to stay in the hospital but not in the labour ward. actually, it was quite nice, dp & i drank coffee & sat around outside (it was june!). didn't make my labour start though.... nothing really kicked off until they broke my waters about 7 in the evening.

if i were to do it again (noooooooooo ), i think i'd refuse prostin & ask for my waters to be broken initially. if you are 1-2cm dilated already it might be possible to break your waters when you go in?? hth & good luck.

Many hospitals now wait till 42 weeks to offer induction for post dates pregnancies as many believe that induction at 41 weeks increases the risk of cesarean. You absolutely don't have to do anything - you can discharge yourself after the prostin, you can decline induction and wait for a few more days, it's really your decision. The risks of stillbirth are generally quoted as being 1 in 3000 at 37 weeks, 3 in 3000 at 42 weeks (ie 1 in 1000) and 6 in 3000 at 43 weeks (1 in 500) so if you waited till 42 weeks your risk would still be very low.

How sure are you of your dates? Did you have an early dating scan?

FWIW I was induced at 41+3 with my first baby, followed by 2 elective CS. I went into labour natrurally at 41+4 with the fourth baby and I'm gutted that I didn't wait just a few days longer with the first

what daisy said !

prostin can irritate you internally. therefore, might well be worth waiting until 14 days over, to give you every chance to go spontaneously

also, if you are already a little dilated, might well be able to break the waters , then let you go off for a walk around the hospital,to encourage labour that way, without prostin.....

Hmmm, plenty to think about there. I didn't realise you could push for having waters broken before they had tried prostin - if this is the case then I may do that. The prostin definitely irritated me internally last time, I felt as if I was on fire! I'm pretty sure the dates are right - I had very regular periods and a dating scan at 11 weeks.
I'm also going to have a think about whether or not to leave it a few more days anyway.
However I guess there's still a (slim) chance things may happen naturally before Monday morning - more sex then tonight, if I can manage it!

I doubt they will give you prostin if they can break your waters anyway, but do bear in mind this has its own risks in itself and they will normally start you on syntocinon unless you go into labour pretty quickly or decline it.

Let us know how you get on and I've got my fingers crossed that you will go into labour before Monday!

in my local hospital they use a prostin pessary rather than the gel.the gel was used on me first time i was induced (at a different hospital)and i was also in agony,but the pessaries(and i have been induced with my subsequent 3 babies)didnt irritate.i had an awful time being induced with my first(i was 39+5 weeks induced due to pre-eclampsia)with 6 lots of prostin,ARM and syntocin drip.i was induced at 38 weeks with no.2 and went into labour a few hours after the first prostin.
i have spent alot of time on maternity wards due to my problems with PIH and have seen many women being induced cos they were overdue,and every one of them went into labour after one or two prostin,with the second time mothers it was usually a matter of a couple of hours after the first prostin.
i've heard that nipple tweaking is very effective though...

Hi Spalex,
Just wanted to add my experience really. I had Prostin pessary x2 about 6hrs apart and then I also had the gel as nothing was happening. I wasnt allowed home at all. I didnt experience any discomfort with these at all. I also had my waters broken at 1.5cm dilated as nothing was happening and went on to have the drip that induces you. Right up until I had the drip all was well. The drip is awful and speeds things up considerablly however I ended up having a C section (18hrs later) because DD just didnt want to come out. I think that I was too overdue so it made life difficult. If i had my time again I would have insisted on being induced before. By my dates I was 3+2 days late!!! ANyway, best of luck to you - remember you are in control and can ask for whatever it is you feel you need. Let us know when you can. x

My first baby was induced and it was a dreadful experience. So much so that I was a quivering wreck when I realised that I would have to be induced with my last baby. The midwife reassured me that because I had already had a previous birth it was unlikely that I would have a similar experience with induction this time. I didn't believe her completely but it sort of took the edge off my terror. Had one lot of gel and then a second lot 6 hours later. Monitored for 20mins each time. Teatime came and dh went home. Everyone said get a good sleep and tomorrow we'll start again on labour ward with drip. Had niggles from about 9pm. Contractions started around 10pm. 20 past 11 baby born. No problems at all apart from the last half hour when then rushed me up to delivery and put me on my back which turned uncomfortable contractions into unbearable ones.
Although this was no.9 for me the midwife did say that in the main induction is a lot easier if you have already had one vaginal delivery.

Hi Spalex

I hope you dont get to read this because you are in labour.

Firstly something that occured to me when you said you were sore, is there any chance you could be allergic to the latex gloves? have you ever had a similar reaction to condoms? Dont answer but if you have then mention that to the midwife who is caring for you they can then use latex free stuff. Also I have seen a woman have an allergic reaction to the prostin. Its definately worth mentioning the soreness tothem though. It wont make any difference if they use latex free gloves, just a thought.

Im not sure about the protocol at all hospitals but where I work the process is that you come to hospital in the moring if a bed is available, have like an antenatal check, then baby is monitored for 30 minutes providing all is well and delivery suite are not to busy the pessary is given baby is monitored for another 30 minutes and you are encouraged to mobilise, if nothing happens a 2nd prostin is given 6 hours later, if nothing then its a doctors review and depending on the findings could be more prostin or membrane rupture. If at the first examination you are a bit dilated usually a membrane rupture then leave you 2 hours then its the drip. This is the procedure where I work and they would not want you to go home.

I have had 4 inductions and apart from the one where they tried to induce me 3 weeks early they were all fine and it happened fairly quickly.

Wishing you loads of luck for tomorrow, anything you are not sure about or worried about ask any good midwife will be more than happy to explain anything and everything to you how ever many times you ask. Will look out for your announcement!!

Hi had 4 inductions (3rd one nearly failed fortuntely ARM did the trick). ARMs are dangerous I'm sure this one will go better than the first (my first was horrific too) the reason why my 3rd one was tricky was because it was on my due date rather than 14-16 days over! My last birth was perfect 1st gel did not a lot apart from the gel pain down my legs the 2nd got it going and delivered about 3 hours later with no other intervention just gas. Hope you're already in labour love!