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.

I was induced 1 week early for "social" reasons.

My Dh was in Iraq and was only allowed home for 5 days, and they had to be set days before he left. Therefore the consultant agreed that a social induction would be best bet for us.

I was taken in on the thursday night, gel inserted. Nothing and i mean NOTHING happened until they broke my waters at 10am on Friday, still nothing happened and started me on the drip at 2pm. It was 5.30pm before contractions started, and I didnt give birth until 2.45am.

Looking back, although it was nice DH was there, I wish I had waited, because Jessica was a tiny 6lbs 6oz and covered head to toe in vernix - she just wasnt ready to be born.

Sorry you had a mad night Mears, I dont envy your job at all. x

I do think though that reasons sucha s JARM's and SPD paina re mosre than just discnfort, they're genuine reasons.

Thanks Mears. Im a little confused now

Would i be better to have C section given previous history, and risk C section pain with SPD? Or go induction and hope dont need another section?
LOL it doesnt take a lot with my baby brain.
Oh and one more question, sorry would you be worried about a babies heart rate being around 165 most of the time and raising to 207 at different times even when not moving? Cheers

Lisa

treacletart - I was induced at 37 weeks as my liver was not functioning properly and my baby was in danger of being poisoned if the pregnancy continued. The birth went OK and LO did not need SCBU. There was quite a lot of difference between my 37 weeker and my antenatal class who had 40/41/42 weekers, but this cleared up in time. In my experience, it is OK to be induced at this stage and if I have another, I will go for induction at the same stage as my complications are very likely to be back!

mears - just to say it is a very difficult situation all round - my consultant had wanted to induce me at 36+6 (I was already in hospital with a few problems, mainly my liver not functioning and being in danger of suddenly poisoning my baby) but the delivery suite were too busy for me to be induced. I didn't give any staff a hard time about it as it was obviously not their fault, but I was just sat in my hospital bed crying because I was afraid my baby was going to get poisoned and die during the delay. It was my first and I was alone because my mum wasn't allowed in because it was baby's fathers only for visiting and DH couldn't get off work. All ended well so I don't think about it much, but if it happened the same way again, I would be terrified and begging for the induction to commence.

this is a HUGE bug bear of mine!

How many women know that they can refuse to be induced or cancel an induction booked by the HCPs for them?

Or that it's contra-indicated for VBAC?

Or that it is likely to lead to intervention or CS?

How many women actually get given ALL the pros and cons about induction when it is very 'kindly' offered?

And how many women are offered induction due to merely going past an arbitrary date and how many have a genuine medical reason which needs baby out now?

My tagline on another board is 'just say "no" to induction' and I really recommend women do their own research before making a decision to be induced.

Thank you, Mears, for bringing this topic up, I hope that it gives more women the chance to have a serious think about their Birth Choices.

Stay strong!

no lack of selfish rude people in the world. but maybe some of them genuinely think there is a magic wand and it is being witheld because you are 'busy'.

i had a failed induction. midwives did not explain anything at all to me, assumed i was either stupid or knew everything but i was actually too scared to ask any questions. ffs i was too frightened to even have a wee during 8 hours of drip! mears of course you'd never do anything like that, but do i think sometimes professionals who deal with the same thing day in day out forget that some people just have no idea at all.

I was induced at about a week overdue because my BP was climbing steadily: but DS being a September baby meant it was rush hour on the labour ward and, from being told to get myself straight in there by my GP on the Thursday morning, didn't get a room or bed till late Thursday afternoon, nothing apart from tests all day; they sent my birth partners home at 11pm and then a consultant finally showed up at midnight to say he thought maybe they should induce right away. At which point I asserted myself a bit and said that I would much rather have a good night's sleep thank you very much and I promised not to die in the night (please note that I knew damn well I was not starting pre-eclampsia as had had no protein in wee and no other symptoms, just high BP which I am prone to anyway). So got induced next morning, first dose didn't work, second one did and lovely healthy DS born 9pm Friday night.

My main bit of advice re inductions is: it can make breastfeeding more difficult so be prepared for this and make sure you have extra help and support if you want to BF.

Yes, I was given no information at all about induction. Just told on my due date, after an attempted sweep had failed because the junior doctor doing it couldn't find my cervix, that I had been booked in for one 10 days hence. It was the first time in my pregnancy that I'd seen a doctor other than my gp when I made an appointment after finding out I was pregnant. Communication skills were definitely lacking - she was so nervous that I felt inhibited from asking anything.

Reading up on it myself, I knew it was something I wanted to avoid but somehow I just went along with it. It all worked out fine for me but I suspect that had quite a bit to do with my body being pretty much ready to go on its own.

I would have found it difficult to say no though, especially because the fact there had been no explanation and no discussion meant that I'd had no "in" to ask about the possibility of delaying.

The rate of induction at my hospital is 27%. It does specialise in high-risk pregnancies (cs and instrumental delivery rates are also higher than the national average) which makes up for a portion I should imagine, but there must be a hell of a lot of women being induced just for going over dates. Does that increase pressure on the labour ward or actually allow them to plan more by not starting the induction process when there are no beds I wonder?

People have all sorts of unecessary treatment on the nhs drs and nurses should have the autonomy to refuse it and send them home.

Why do they induce if over dates? Does being in there longer make it more risky to mum? Sorry to sound dumb but dd was early C section so didnt get time to read up on if she was later
L

There is an increased risk of stillbirth after 42 weeks but the findings of the research is quite controversial iirc and doesn't take into account things like scanning to check how healthy the placenta is (mine was still in very good nick apparently. My midwife showed it to me with great interest and pride ), monitoring to check that things are still going ok etc.

i know people who ate their placenta! i couldn't bear to look at it.

All i know is mine was terrible and started to fail around 27-29 weeks, fingers crossed this time is better
hmmm yummy with some salt!!! LOL, no idea how anyone would cook it let alone eat it!
L

Like liver apparently. This is just what I hear, I want to emphasise that. I wanted tea and toast after labour, not liver n onions.

it gives me the shivers thinking about it

Interesting, I was booked in for induction at 40 + 9. All 3 of my mum's children were late, and she managed to resist induction, but that was between 38 and 27 years ago.

One of the reasons that was given to me was concern re my age, but as despite my advanced age (37 years 10 months) I had no medical complications, blood pressure was fine etc etc, I wonder if this really makes induction more necessary. I'd be interested to know Mears' thoughts, or those of other midwives or other maternity professionals on this. Things went ok and I didn't mind the need for a ventouse, but I hated the level of monitoring and being fastened to a monitor etc during labour. I managed to sit up rather than being on my back some of the time but it wasn't what I'd hoped for.

As I failed at breastfeeding, I'd be interested to know the connection between induction and problems there. I didn't get the right support at the start, but also when as a result he lost weight etc and we were taken back in, neither planned treatment or course of events really supported breastfeeding, though they put lots of resources into supporting it.

The significance of this for me is I hope I might get to have a second baby, but if I do I'll be at least 39/40! I think it's more than likely that I'll face a second induction and I really want to at least do better on the feeding.

uh, induced twise after cs, not absolute contra-indication here. Suppose could have had another cs but preferred vbac+induction (well would have liked to avoid induction altogether, vut consultant not happy to go beyond 40 weeks)

lisad123 - if this pregnancy is progressing normally and you don't have plaventa problems like last time then there is no reason why you should not be able to try a VBAC.

When labouring with a previous CS it is much better to go into labour on your own. You can however be induced but the risk of scar rupture is higher, especially if prostin is needed to ripen the cervix.

Only you can decide what you want to do. My friend (who is a midwife) was on crutches and she found it much more difficult to move that she imagined after her CS. Her SPD took months to get better unfortunately.

If you were not able to carry on waiting for labour due to your SPD, it might be better to have elective CS, but you might find that your cervix is very favourable for labour and induction would not be hard.
You really need to make a decision based on all the facts and discussed fully with your consultant.

I totally agree that often women don't know what is going to happen because the professionals don't explain fully. The incident last night was with someone who had had numerous babies before and was annoyed that induction had been delayed because we were busy. Everyone waiting had been told the reason why.

In this case it was down right selfishness IMO.

elkiedee - I share your frustrations about induction for maternal age. I do not think there is any justification for it myself and neither do a number of my consultants where I work.

Babies who are induced may not actually be 'cooked enough' and ready to come hence possible feeding problems.
Next time stick to your guns and refuse induction unless there is a problem with your pregnancy. Good luck.

Thanks for advise Mears, i would never have known half of that. I guess i just have to wait and hope same complications dont happen again.
I would love to be a midwife but dont think i could, i'll stick to my job
I hope your next shift is better for you and i'll rememeber to aviod induction as much as possible and if i do not make plans for the following day LOl

L

Sorry to divert, but several posts back Suzie mentioned women in labour experiencing full on, extremely painful contrations being offered paracetemol. Mears I'd be really interested in your views on this. I've posted on the subject before and there is a thread here which just scratches the surface if you'd rather not reply on this thread. Thanks x

Personally, I cancelled an induction booked for 42wks scan edd and negotiated for Expectant Management based on my lmp date (40+5). Baby arrived the next day, I was 38.

I desperately want to be ttc for another child and would insist on Expectant Management if I was to go beyond 41/42 weeks depending on my health. (I am 40 now and that clock is LOUD) IF there was to be good valid medical reason to get baby out NOW I'd have a very difficult decision to make whether to take chances on induction or choose elCS. If Bishop's Score was less than 9 i think i'd go straight to CS... but who knows until placed in the situation...

mears- I love you. After a crappy night due to selfish women, you post on a board full of pregnant women, not to moan and say "don't be selfish" but to give helpful information in a genuine effort to help others.

I know you haven't been around a lot lately, and you are missed. Every woman deserves a midwife like you.

I was induced at 36.5 weeks as my baby had to be born then (ob. cholestasis with climbing bile acids) I was told success percentages for induction which completely ignored the fact I was pre-term, and with my first baby, and was therefore totally unprepared for the almost inevitable failed induction and emergency c-section. Why can doctors not trust women with correct facts about their various options?

Klaw, was that your first child at 38? Hope you get to have another.

I don't know if there is evidence of this...but the midwife said to me that induction can be quite successful for women who are ill - I was really quite ill and baby needed to come out early (had low Bishop's score), however induction still worked quickly for me even at 37 weeks with 1st baby.