Different methods of induction?

[Twiga]

Trying to make a decsion as to wether or not to allow induction at 41wks - not allowed to go over this due to previous CS. Last time had pessaries then ended up having waters broken and put on syntocin drip. Had bad reaction to pessaries and was so sore needed G&A to get through the VE and further pessaries.

If induction this time means pessaries i've a mind to wimp out and go for ECS as can't face being that sore again - in fact the thought of any kind of VE just now makes me feel sick - def won't be having a sweep which was another bad eperience!

Anyway what I was wandering is, when I was at the hospital monday for a scan (34wks) the reg I saw spoke about tablets for induction - did she just mean pessaries or are there other forms that I could request (didn't think to ask at time) - really keen to have a VBAC if at all poss.

your best chance of a VBAC is going into natural spontaneous labour

prostoglandin pessaries or tablets might be your only option of induction, as syntocinon can increase the risk of scar rupture....having your waters broken might also be an option..but often that is followed by syntocinon if contractions to not start

did the pessaries irritate your vagina last time? is that why the thought of a ve makes yo anxious?

your consultant can best advice you, but you might be worth waiting until 42 weeks, then having a c,s rather than an induction at 41 weeks....IFYSWIM

Hey lulumama, yes the pessaries really irritated things - remember the mw joking with dh that the G&A would make me a bit silly and giggly, it did the opposite and made me cry buckets. Exactly why thought of VE is making me feel sick and panicky - sweep was rough going a few days earlier too, mw who did it said cervex high and far back couldnt' really reach but still had a good rumage which was just sore. They def won't let me go over 41 weeks according to the reg although I was considering pushing for extra time if it gets to that raher than be induced. Looks like this baby is OP like dd was according to scan on Monday, so waters being ruptured not the best option either from what I've read. Are the tablets taken orally?

i don;t think prostoglandn tablets are widely avaialable , if at all >>

anyhoo

you can try self induction as you near term, with your DHs supply of prostoglandins..!

sex , orgasm and nipple stim naturally produce the hormones that are given to you in synthetic format when you are induced.....

if the midwife was not able to reach the cervix easily, then might have been better to leave well alone

a ripe cervix is to the front, and should not need rummaging for

you are quite within your rights to decline induction and c.s before 42 weeks....you can certainly agree to extra monitoring of the baby and the placenta, to make sure all is well..but if you wish to go to 42 weeks, then it is your decision to make

you might well go into labour spontaneously, the longer you are left to it, the more chance there is!

If I mentioned the problem with the pessaries to the reg/consultant at my 38wk chat, do you think there's any chance they could order tablets in via the hospital pharmacey - maybe worth asking? Will they still offer induction at 42 wks or will it then be a case of ECS or nothing?

hummm, just been googling misoprostol induction and mixed reports on safety etc. Heck, really looks like my options are narrow - need to hope for spontaneous labour, although never happened last time - ECS was after failed induction over 54hrs.

Got to nip out but will check back later - thanks for chat so far .

I am fairly sure that there are no oral tablets appropriate for induction at term +. The idea of pessaries or gel is to ripen the cervix to make it easier to break the waters, unfortunately very few induced women go in to labour without having their waters broken so this would have to be done anyway. Why are they so keen to induce you at 41 weeks? Is there some other problem too? In my opinion it is dodgy trying to induce someone who has had a caesarian before, the risk of the scar rupturing is much, much higher if prostaglandins are used. Think positive, hope and pray that you go in to spontaneous labour, a much safer option for you and the baby. Good luck

agreed maxbear...misoprostol was never intended for induction, i believe...

Twiga..my c.s was for failure to progress after a failed induciton

i had a sweep at 39 weeks, a show, then DD was born on her due date. succesful, intervention free VBAC and she was OP! there is hope!

Lulu.....sorry to butt in, but can Natty have some advice over here . she thinks she's lost her plug!

You can refuse any intervention - they can't force an induction on you at 41 weeks.
I too am hoping for a VBAC. If nothing is happening by 42 weeks, I would rather opt for a c-section than be induced.

It's a load of rubbish that you're "not allowed to go over this due to previous CS".

There are many of us VBACers that have waited for spontaneous labour to start past 42wks. The risks of induction actually outweigh the risks of stilbirth beyond 42wks, in fact there would be 60 additional ruptures from induction in order to avoid 6 stillbirths.

Which is why I would ask for expectant management, and continue to wait for labour to start spontaneously. Knowing that I would be getting checked out daily, fluid levels checked, baby checked etc is far preferable to the distinct liklihood of a tough labour and certain worrying about my scar.

There is also the issue of how edd is worked out. My baby arrived at 42+1 scan edd (how would a machine know?!) or 40+6 lmp edd (that's more like it!) whcih meant that I had major arguments to avoid induction, and in fact I cancelled the one booked for 42wks scan.

So I'm telling you that from my experience, you CAN call the shots!!

I also can't decide if I would elCS or take a risk with induction for a future baby, it's a toughie, but it IS your choice, not the HCPs. They can make recommendations and are supposed to make them with regard to your own individual circumstances, not as blanket hopsital policy. Then YOU decide!

I've had 2 inductions without pessaries. Mine started with the drip and then waters were broken. I think if your cervix has already started to open you don't need the pessaries, they can go ahead and just break your waters.

For me induction was hideous, and last 2 pregnancies were c-sections as doctors agreed i could never be induced again!

IMo c-sec is easier but we are all different so personal choice.xx

Thanks for the advice/stories. Finding trying to decided what to do sooo much harder than I thought - want a VBAC but need to decided just how far/what I would want to do to facilitate this. Gingerbear have to say, I feel much like you, would rather have a section once 41/42 wks over than face induction again. However, know I would kick myself wandering wether or not the induction may have clinched it - aargh, just don't know!

If you get as far as 42 weeks or whenever you decide to book a cs date you could always ask to be examined and induced if very favorable, then go for cs if unfavorable and therefore unlikely to work. Also a sweep is not always bad, you could always ask for one but only go ahead if you are confident that the midwife will stop immediately if you are unhappy to continue. It would be so worth it if it worked. Good luck

I was offered the choice of a prostoglandin pessary or an oral tablet for my induction. The consultant told me that most of the women at that hospital (Homerton) opt for the tablet as it's obviously less invasive but that the tablet was not actually licensed for use in the UK for inductions and that it can potentially bring on contractions even quicker therefore causing the baby distress. I opted for the gel in the end.

Forgot to say that I too would struggle with the decision whether to go for a VBAC or not as I would really not like to risk another induction....maxbear's suggestion sounds good to me - I think I would ask for that next time(?!) if the hospital would agree. I also was unable to have a sweep last time as cervix was still unfavourable and the induction itself was pretty hard going...and eventually ended in ECS.

With my VBAC, I was 15 days late, had foley catheter first and then syntocinon drip. Read loads about scar rupture, assessed the risks and thought they were really minimal. Agreed to intermittent monitoring, kept mobile, baby born in 1.5 hrs...it was a brilliant birth. I found that the consultant could be negotiated with over the due date (they originally had me scheduled in for 4 days past my due date) but I said I would come in for monitoring whenever they wanted.

Hex, can you tell me a bit more about the Foley catheter? Did you have that done in the UK or are you somewhere else - not heard of it before. Had a wee look on the internet and it reads like a good alternative to pessaries. DH is a surgeon (doesn't do obs and gynea though, so new to him too) so I've got him trawling for credible papers etc so I can maybe present this as an option when see the consultant in a couple of weeks time. Thanks!

I had it done in australia but the consultant said he'd used it in Scotland so i don't think it's unheard of here. With dd1, the pessaries didn't work to dilate my cervix art all and in the end I chose a CS. With dd2, I wanted to give birth vaginally, knew that the failure of pessaries might make them more likely to whisk me to theatre for another CS so didn't want to go down that route of risking what they would see as a failed induction. I did lots of reading about the foley catheter and its success rate in opening up the cervix. It's not comfortable to insert (sorry TMI) or to keep in but essentially they pass a catheter up into your cervix, fill it with solution so that it balloons and presses down on the cervix causing it to dilate. Sometimes, this might be enough for them then to sweep yr membranes, or even for you to go into labour spontaneously. With me, I needed further induction (syntocinon drip) - which was absolutely fine. Baby born vaginally 1.5 hrs after labour started. There was a fair bit of blood altho i suspect this was from the catheter - my cervix was tightly closed and not effaced at all. I was over the moon it worked. Oh yes, after being in for 2 hrs, the catheter came out (because it had wideneed the cervix). Yes, it felt a bit strange, but hey...I got what I wanted in the end...you need to be armed with information..I was lucky I had a dedicated midwife and she chose an empathetic consultant for me to see.

My cervix was high up and oddly positoned...so this is why it was uncomfortable to insert although it was the first time the registrar on duty had ever done it so I'm sure skill comes into it. I even hate smear tests because i find them uncomfortable. It doesn't take long to insert (3 minutes or so)

Thanks for sharing your experience Hex - am suprised at the 2 hour bit, that's quicker than I thought - had visions of it being a 12-24 hr slow type thing. I'm in Scotland so it's useful to know it's at least heard of here. My main reason for avoiding pessaries is the reaction I had to them, left me very sore internally so this really sounds like a good alternative. Great to read a positive outcome from this.

Muminfife - apparently the induction at 41 wks thing is hospital policy. The reg I spoke to was also very firm about their "strict timetable" if they do induce. To be honest I wander if it's not more to do with the fact it's a busy overstretched maternity unit. Don't get me wrong there are some very kind and good mws here but they are short staffed.

CONCLUSION: Routine labor induction at 41 weeks likely increases labor complications and operative delivery without significantly improving neonatal outcomes. Taken from this

and VBAC: On whose terms?

Twiga, you are an individual and do not conform to hospital policy! They tried to get me an induction but fortunately I had the support of an online VBAC forum and managed to gather strength to say no, time and again! My tagline on that forum now is "Just say 'no' to induction"!!!!

They MUST treat you as an individual and have yours and baby's best interests at heart, not their blasted protocols and policies!

Induction must be reserved for true valid medical reasons. Ask for expectant management in order to look out for the true valid medical reason before making an informed decision.