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.

This is really interesting, during my first pg they were the hospital midwives were constantly hassling me to be induced from the day I got to 37 weeks - just because i had high bp (pre-eclampsia ruled out) - one even said to me, your 37 weeks now just get it out and stop hanging around here taking up space (made me go to hospital every other day 1 hour drive away for bp check as was out of area by that stage). They even made me 2 induction appointments without consulting me. eventually went natural 8 days overdue.

What is Expectant Management? Is it when they monitor the placenta via scan to see if it is healthy to let you go overdue? I'd much rather that than be induced - sounds horrible. Imagine how horrible mine would have been at 37 weeks if they'd got their way when I clearly wasn't ready for another nearly 5 weeks.

Having said that, I know of 2 people who went 2 weeks and 2 weeks and 2 days over and sadly had stillbirths thought to be because the placenta had failed so I would be wary about going more than 10 days or so - is scanning the only way to avoid this if you want to let it happen naturally?

what's the Bishops Score?

Bishop's score is a measure of how successful the induction is likely to be. You get points for the condition of your cervix, position of baby etc. The more points you have, the more successful your induction might be.

Yikes, they didn't even tell me that, perhaps just as well as I would have been even more scared if I'd realised in advance that I might end up with emergency CS (didn't)

Hello mears, I wish I'd had a midwife like you. I begged NOT to be induced, then had 7 inductions which all failed but put me through far worse pain than 'real' labour when it came. I can't believe that women ask for induction because they're uncomfortable!!!! Those false labours were the worst pain of all for me.

Elkidee, no she was my VBAC so that means my first was emCS, nearly 14 years ago! So with such a big age gap I'd really like to have another soon but dp too stressed! Long story

I accept that some women will not have too much trouble with an induction but from the people I know and the stories I hear and the research I've done they seem to be the exception...

And unlike Mears, the mw i spoke to did not give me the downsides to induction at all, and no mention of the greater risk to a scarred uterus! FFS! I had to insist that I was not taking that risk, they are the ones supposedly trained in midwifery too....

The risk of stillbirth is real but small but not enough research is done yet. Expectant Management is where baby, mother, placenta etc are all carefully observed to ensure that baby is still thriving. Factor in the number of scanned EDDs which may be totally out, the difference in gestations between individual women and I don't believe that inducing according to a set graph is ideal. I'd much rather make a decision based on the individual.

But that's my choice and I'm glad that Mears has pointed out to others that they can make their own choice too!

sorry I've rambled again and don't know if I've answered all the points I wanted to...

Slightly off-topic but just to show you how unreliable EDDs are as a guide to when to induce, even when done by scan dates - I went into labour on DS's due date (he was born at 2am the next day). When he came out the mw's both said, wow, how many days over were you? He was really wrinkly and his fingernails were very long - he had a real "overcooked" look about him!

I am shocked at women being induced before due date for being uncorfotable. Policy here in Germany is that they wont do it before 10days over. I am going to ask on monday re induction were i will be 40+1 because my dd is going oaway on the 26th July and I really want her to meet her baby brother before others. She is not coming back home till the 22nd august. I am happy to wait a week and see if things go natuirally but of they dont want to be induced at 41weeks.
last time because dh was deploying I had a sweep on my due date which worked (was a VBAC) so that he seen his son before going back, and had 10 days with us.

One quick question though, as I have had a c-section can you be induced with gels etc, or is it only a sweep... Or as I have had a vbac is it just classed as a vb.

Sorry for long post..

Hope you are feeling better mears.

I am shocked at women being induced before due date for being uncorfotable. Policy here in Germany is that they wont do it before 10days over. I am going to ask on monday re induction were i will be 40+1 because my dd is going oaway on the 26th July and I really want her to meet her baby brother before others. She is not coming back home till the 22nd august. I am happy to wait a week and see if things go natuirally but of they dont want to be induced at 41weeks.
last time because dh was deploying I had a sweep on my due date which worked (was a VBAC) so that he seen his son before going back, and had 10 days with us.

One quick question though, as I have had a c-section can you be induced with gels etc, or is it only a sweep... Or as I have had a vbac is it just classed as a vb.

Sorry for long post..

Hope you are feeling better mears.

u can have a hysterectemy if u fancy it too it's a bit mad here. My SIL complains of women wanting uneccessary opps she's a consultant gyne

twoplusone, I think mears answered that earlier when i asked She said " 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"

HTH
Lisa

Miaou, personal experience leads me to distrust dating scans and anecdotal experience leads to the same re sizing scans, they notoriously innacurate:4

my lmp date was 27th May

Scan said 18th May.

We argue about it (cos I was actually there at conception!) but mw goes with measurements and I allow myself to work to scan date

Baby arrives 2nd June! 42+1 scan date or 40+6 lmp, which is actually VERY normal! Little bit of dry skin on hands and ankles but hair on ears and small of back still, so next time will refuse dating scan and then hopefully not have to refuse or cancel induction 'offers'.

Sorry, I'm being militant again.....

Miaou ? I?m in Scotland too and pregnant with my first so no personal induction experience. I do know that many friends up here have been induced after 10 days ? one very sadly lost her baby because the placenta had already given up ? that thought terrifies me almost as much as the thought of induction.

I think one of the scariest things about being a first timer is that to date, I have always taken medical advice assuming they know best and I am concerned that I won?t have read enough of the right kind of things to know when I can say no safely and when I do need to just go with what I?m being advised to do, any tips? I've already had such a fight on my hands for refusing the Double Test and that was after tons of research by me and DH and a properly formualted argument.

thanks lisa.. thats what I get for not reading all the posts...

I just wanted to add that The Most Frustrating thing about hospitals in my experience is that you're not communicated to regularly enough. I guess most women would assume that being inducted is a green light to go into labour, unless explained otherwise - and I know you said a full explanation was given, but I guess by that time they'd already thought it was The Big Day and were reluctant to go away and gee themselves up again a few days later.

My experience is just based on 'appointments' to date at my hospital, where I have a time, turn up at that time along with my DH, register at front desk and am told to sit and wait to be called, only to find usually they're running at least an hour behind - and no one feels the need to tell the women waiting!. Both myself and my DH arrange for time off work/meetings around antenatal care and feel that neither the receptionist nor midwives take this into consideration. To tell your boss you've got an 11am appt and then show up at 2pm because of having to wait around is v embarrassing!

Anyway, just thought I'd add that though it is a kind of digression.

Meant to say too, that I think it's really excellent to see a regular midwife here. It gives me confidence in the profession to know that you're interested in finding out how your 'punters' experience pregnancy and that you're keeping up-to-date with public opinion - I always read your posts with interest

You are absolutely right Annie75, communication is the key. Unfortunately antenatal clinics can be unpredictable. They can start late because the doctor has been held up at the hospital, or because women have needed a longer appointment than has been allocated. The system really needs an overhaul.

I think I was so mad the other night because we actually had complicated things going on in the labour ward which made things worse.

I understand how frustrating it is for women when they have been admitted for induction, but to take it out on the poor midwives in the ward who can do nothing but sympathise it out of order.

Unfortunately that type of frank discussion does not take place. I personally would have liked to have advised the woman to go home and write a letter of complaint.

I was too busy caring for a woman who had lost her baby

Thank you for your kind posts BTW - I do find mumsnet helpful in understanding women's concerns. I do like to help when I can.

Women also need to be educated that induction for non-medical reasons before 42 weeks will probably lead to a spiral of horrible interventions. painful scalp monitoring on your lovely baby's head anyone?

Mears. It must be awful for the staff when that happens.

oh mears, how devastating - must be very hard for you to deal with.

MrsMcJnr - try not to get yourself too worried and upset about things - that's where MN is worth its weight in gold! Any questions, just ask - can guarantee there will be someone who has been in your position and can at least tell you their experience . And I find that sometimes simply talking things over on MN can help you come to a decision.

Re the double test thing - it's purely a matter of choice IMO. I was asked repeatedly if I wanted them but just kept saying "no, it will not affect our decision to keep the baby". Sorry you were pressured so much - sometimes I wonder if there are "targets" to meet, ie a certain percentage uptake of double/triple tests for women over a certain age - not very patient-centred if so.

I had a long chat during my last pregnancy with a lovely consultant discussing the pros and cons of waiting past 42 weeks to be induced. The main thing that swung me not to go past 42 weeks was that the monitoring only offers you reassurance that the baby/placenta is fine then, placental failure can happen very quickly etc. I've had 4 inductions they were not pleasant but at 16 days over with your 2nd having had contractions and still having a bishops score of 1 I have no idea just how long I would go without getting into spontaneous labour.

I think knowing several women who've had still births also made me focus on having a healthy a baby at the end of it rather than "the perfect" birth IYSWIM.

I always tell people to pack some food and good reading material if being induced and also if it all starts dragging out after they've started the induction don't be a wimp if you want an epidural ask for it as it can be a long long haul.

sorry about your poor patient who lost her baby, Mears. I have much stronger memories of the midwife who was with me in that situation, than the ones who delivered my liveborn children. I'm glad your patient had someone as kind as you with her.

sorry about your poor patient who lost her baby, Mears. I have much stronger memories of the midwife who was with me in that situation, than the ones who delivered my liveborn children. I'm glad your patient had someone as kind as you with her.

mrsdarcy.. i didn;t know you had lost a baby at birth.. i am really so very sorry

mears..from what i have seen of you here, if , god forbid , the worst should happen, i would want a MW like you there, to support me.. i think you are the epitome of what a good MW should be

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