Induction of labour - some info to be aware of so you are prepared

[mears]

That when you are admitted you will not necessarily be taken to labour ward immediately after prosting gel/tablets if you need it. Sometimes it can take 3 doses to get you into labour which need to be spaced apart. The first 2 need to be at least 6 hours apart and if a third dose is needed it may need to be given a day later to give your body a rest.

The prostin gets the cervix soft and ready for labour. It does not always start labour which sometimes happens. You then need to have your waters broken in labour ward. That might start things off but usually you need a hormone drip to get contractions started, especially if this is your first baby.

If you are being induced for a non-urgent reason then women who have problems in their pregnancies, and those in labour will take priority. That could mean that you are ready to have your waters broken but the labour ward is full and has no room or midwife to look after you.

I have just had 2 very busy night shifts in labour ward and the inductions were delayed for 2 days - partly because they were unfavourable and partly because we were too busy.

We had some very complicated cases which meant that a couple women who wanted induced before their due date because they were 'uncomfortable'' could not be taken.

A full explanation was given with an option of going home and returning the following day. This was declined and the ward staff got constantly hassled.

I think if women understood what was involved more then perhaps they would be more patient when things don't go to plan.

Sorry for the rant but I was extremely annoyed by such a selfish attitude last night.

Mears - sorry you had such a time of it last night but why would anyone be induced for a non-urgent reason or for being uncomfortable given what it can lead to intervention wise.
Why would health professionals agree to it?
I am asking a genuine question, due with first in 5 weeks.

I didn't realise you could be induced just for feeling uncomfortable either - and especially not before their due date.

but don't forget that if your waters have already broken you'll be spared than once it does work ....

I had three doses of that gel at 42 weeks - over two days I think. Went in to hospital for induction on Wednesday moring and didn't go into labout until the following Monday night. Had baby by cs on tues evening

I just posted this so if you do go in to be induced don't expect to have your baby that night (like I did) I felt like I was in a bus station surrounded by people catching their buses and leaving and I was stuck there waiting for my bus to arrive.

Also another thought - am sure this is not the case Mears because in all your other posts you come across as a wonderful midwife but friend from NCT had her baby last week. She was induced (don't know why) and the ward was busy and she was left in labour for hours, told she was not in labour and not a priority and she found the experience very distressing. She was in a lot of pain and no one would listen to her, in fact a paracetemol was offered so maybe those women were in pain?

Sorry have just re-read your post - 'not necessarily in the labour ward' She was left on the ward but not taken to delivery which she said was awful as she could not vocalise or walk about as everybody else was sleeping

I was induced with both my boys. First one had stopped moving so was induced the day before my due date. With my second I was induced 12 days before as my bump was really small and when scanned it appeared he was not feeding off me. With ds1 i had 2 lots of prostin then had my waters broke and was 36 hours before I went into labour, with ds2 i had one lot of prostin then my waters broke and was again 36 hours. With ds2 I was so stressed as I thought my baby was at risk and other emergencies were obviosly put first. I don't understand why anyone would choose to be induced unecesarily(sp). but i agree i don't think women realise how long it can take to induce labour

Thank you for that mears. I too am surprised that medical staff (presumably consultant?) agree to an induction simply because someone is uncomfortable! And I'm sorry you have had to deal with such selfish attitudes too

Incidentally, I wanted to ask you a question about induction - it seems to be the norm these days to induce after 10 days (at least IME in Scotland) - does it still vary from hospital to hospital or is this a countrywide change in policy? If so, has this been prompted for medical reasons or social ones? Just out of interest - thank you

Surely it is downright dangerous to agree to induce a woman for non-medical reasons, both for the woman herself but for other women because it diverts the midwive's time and attention away from other women?

I was taken in to be induced on my due date as routine visit to m/wife showed my bp at 160/115 so was sent straight to hospital to be induced (bang went my lovely water birth in a maternity home!) I was admitted on the Monday as an urgent case and still had to wait until Wednesday until the 1st dose was given as they kept having influxes of people already in established labour. It then took 2 lots of pessarys, 1 dose of gel and a drip to get me going and DD was born on the Saturday. Was very frustrating but knew the staff couldn't do anything about it, however was a little cross that I was left more than the recommended time between each application because they were too busy. Oh well all's well that end's well I guess!

I know someone whoi was induced with twins at 37ish weeks. She had SPD and was extremely uncomforatble.

I think something like the discomfart caused by SPD would probably be classed as a reason to consdier induction but would be non-medical reasons IYSWIM

Miaou, I'd be interested to know this too (I was induced at 41+3). I wonder if it's because they expect it to take a long time. Another difference seems to be whether you have the option to go home or not. I was told that once I'd gone in for my induction I wouldn't be leaving without a baby. My sil in Edinburgh was sent home after the second pessary.

I was lucky though. After the first pessary my waters broke spontaneously and ds was born 5 hours later . I can relate to being on the antenatal ward with everyone else asleep and trying not to make a noise though!

i think it depends on what you mean by uncomfortable?

in my first preg i got spd really badly and the consultant decided to induce me at 38wks as i was in so much pain i couldnt sleep

the inducement didnt work, i had an allergic reaction to the prostin and nearly ended up with am emergeancy c section. i had to stay in and be monitered for three days afterwards and then went home and had to go in once four days overdue to be induced but using syntocin, it was a horrible experience so with my second two preg i refused to be induced, the babies were born at 15 and 17 days late. i had two quick and easy labours, i am sure because i waited for things to happen naturally

they used the prostin gel on me on thursday evening.................monday morning and 1cm dilated they sent me up to cdu and popped my waters then stuck the syntocin drip in my arm...................syntosin was way too high for baby to handle so her heartbeat was dangerously dipping so she had to have blood taken off her head(still securely in my belly at the time iyswim}..................14 hours and she was born, do not let them touch you unless its very necessary they do so

Cant believe someone would want to be induced for being uncomfy- although saying that there was someone being induced because she was too bust when I had ds3 (not that she had issues but she kept telling baby to F off to sleep, or f off are you having mroe milk you greddy little..... quite )

When I was induced with ds1 (emergency, IUGR / Pre-eclmapsia) I was told the Prostin wouldnt work and it would take 4 days, I had my baby in under 2! So can be a really posotive smooth ride.

I think its hard. Midwifes want to do their best for everyone but just dont have time, staffing levels or resourses to do it. I was in last week for lost waters and they were lovely. However, put me on a montior and left me there knowing i had SPD, i tried to move as got into a lot of pain, but ended up buzzing as kept losing trace, but were ever so nice, even said sorry as they hadnt been back as they had emgerency.
I think its hard as a patient as your worried about yourself and baby and very stressed, shame they dont have consultants to shout at instead of poor MW.

L

I think that is fair Mears

Induction is not like some magic wand, and it is right to point out it can take many hours or even days to get labour going....

Am also at women being induced due to being uncomfortable, surely that is par for the course, and to be induced before due date surely is going to take longer....

i think that many women do not understand the whole concept of induction and being favourable, and i think it is worth reading up about induction ,and the pros and cons...

Mears may I hijack? (it is about inductions mind you). I'm going to be induced pre-term within the next few weeks to make sure I'm in the right place at the right time. This is to avoid a likely very fast spontaneous delivery - DS was very fast unplanned home birth, and although I'd have loved a home birth again I have to be in hospital because I had lung clots a few weeks after DS was born. Also I need to come off blood thinners a couple of days before induction. They say they wont break my waters till my cervix is favourable naturally and keep trying to convince me it should be straightforward - should I be worried? Any tips? And am I right in wanting to refuse an induction very early (ie at 37 weeks - DS was born at 41 weeks)?

treacletart - 37 weeks is early but the risk of waiting longer is that you might labour at home which is what the doctors want to avoid. However, you didn't labour till 41 weeks last time so I do not think it is unreasonable to wait till at least 38 - 39 weeks with the proviso you go to hospital at the first sign of any activity. How far away is the hospital BTW?

One of the problems is the induction for someone who has had previous quick labour. They are in hospital, all they need is their waters broken (cervix favourable) at 37 weeks. The labour ward is really busy so frankly she is not a priority. She is in the building should she labour but she is hacked off because she was told she would have her baby today.

For those who are surprised that a consultant will agree to unnecessary early induction you would be surpised. A common reason for induction is 'fed up' anywhere from 38 weeks till 40 weeks. If a woman sits and moans enough at the consultant some of them just say OK.

have to, will come back later.

Cheers Mears. Hospital is about a 15min taxi away (don't run a car) and I'll absolutely be going straight up there at the very first twinge! If I'm booked in I'll be prepared for a wait too!

My consultant asked me yesterday if i still feling able to have natural labour. I have serious SPD and am in wheelchair. Also previous complications with dd1 meant i ended up with EC. I explained i was happy to try butif its going to end in Ec i would rather have a plnned c section. he said we will discuss at next appointment.
I think if i asked to be induced early he properly would, but rather try and stay as natural as possible, SPD pain is no worse than C section pain, in my opinion.

Lisa

Cs pain on top of SPD pain isn't good though. I had a friend who opted for elective CS and regretted it as her SPD symptoms took a long time to resolve and the CS made it worse.

Would always try induction first TBH. Sometimes it goes swimmingly. Good luck with whatever you decide.

Miaou - NICE guidelines suggest induction no earlier than term plus 10 days however it is OK to wait till 42 weeks at least and some of our consultants do.

just rearerad that - I wouldn't have indusction if previous CS. If delivery needed earlier than waiting till spontansous labour then best to have repeat CS

sorry for typos - rushing to go out!

I should add that we were not short staffed last night - we were full to capacity which is a different thing. None of the women waiting for induction were contracting or in pain. They understandably wanted to get on with induction - we couldn't take them. When we got one free bed we took the woman who was hassling the ward staff the most!