Induction in the UK???

[Twinny25]

Ftm here! I’ve been booked in for an induction and had a few questions if anyone has experienced one before

1. can you choose which induction method you want (gel instead of pessary?)

2. can you come home or do you have to wait under observation once they’ve started the induction?

3. can you ask for an epidural before the procedure?e

I can only say what happened to me and it was 16 years ago.
I didn't get any choice about method
I couldn't leave despite it taking almost 3 days
I got my epidural when labour finally started BUT I had to be pretty stroppy about it
I would say though that it was my 2nd baby and despite it being a bit shit waiting for DS to get going once he did it was pretty quick and much better than my 1st supposedly natural birth.

@Twinny25 I think a lot of things are very dependent on the specific hospital OP so you’d be better getting in touch with them to get proper answers 😊
For mine specifically:

• I wasn’t allowed to choose method. It was pessary until dilated enough to break waters and start the drip.
• I wasn’t allowed to leave after pessary was put in. Took 49 hours from first pessary to delivery. This was during Covid though so not sure how much that had to do with things.
• My hospital don’t allow epidurals until you are in the delivery suite so I couldn’t have one during the pessary stage but could have asked for one after I’d been moved and had my waters broken.

You’ll hear a lot of horror stories about induction but there are also lots of successful ones 😊 Mine was long but I didn’t need any further interventions. Baby was born at 3am and I was home by 3pm. Only baby so I can’t compare the intensity of contractions.

I was induced last year-

Question 1) It depends on the hospital. I was given the choice of the gels or the rods, one friend was induced at a different hospital and had no choice it was balloon catheter, so it depends.

Question 2) Again, depends on method & reason for induction. If I had started with the rods then I’d have been allowed to go home for 12 hours, but with the gels I wasn’t, I had to stay in & be monitored every 3 hours I think it was roughly.

Question 3) No. You cannot have an epidural until you are in active labour, and you shouldn’t want one either. Epidurals increase the chances of you needing c section or instrumental delivery because it’s not good for you to be stuck on your back for labour- things progress much quicker and helps baby get into position when you are up & about.

In my experience:

1. Potentially yes depending on what methods your trust offers, however there might be clinical reasons why one method would be preferred over another, but these should be discussed with you.

2. Some trusts will offer outpatient inductions, but generally not with most prostaglandin methods (eg the gel or pessary) as there’s a small risk of something called hyperstimulation where you get lots of back to back contractions and that can cause the baby to struggle. Sometimes you can go home with rods or a balloon in place, and sometime with a propess, but that also depends on why you’re being induced, how much monitoring you’re going to need, and how far away you live from the hospital/whether or not you have your own transport.

3. You can discuss this with the team looking after you, generally you wouldn’t have an epidural unless you’re on delivery suite with one to one care due to the higher level of monitoring you’d need, so normally the earliest you’d have one is at the breaking waters and starting on the drip stage. The process of getting to the point where you’re dilated enough to have your waters broken can take days, and you wouldn’t normally have an epidural for that long, it would put you at risk of things like pressure sores and skin break down and all sorts of things tbh.

Good luck OP! Hope it all goes well.

I was induced

no idea by what method

went for a walk after with DH and after an hour ish felt contractions

so walked back to the maternity ward, got my epidural and DD was born quickly, painlessly and needed a vonteuse ?!? Suction cup thing on her head to pull her out

I was induced 2 years ago. They gave me the pessary with the aim to get me to 3-4cms dilated so they could break my waters. I did have the drip even with them breaking my waters, to be honest I just done what they told me to do. I’ve got no desire for bodily autonomy and just wanted the baby to be born.
I asked for the epidural about 1 hour into the drip as the contractions were quite intense, I don’t think I could have gone the whole hog without it.

My induction was 21 years ago! Was given a pessary which they didn’t really expect to work but it was 36+6 weeks. I was induced at 6, was 1cm at noon, was taken to delivery at 4pm for gas&air and she was born at 6:30. I didn’t want an epidural so never asked. I wasn’t close to home (lived on a Scottish island at the time and had been airlifted off due to my illness), so couldn’t leave!!

In the end it was a good experience though I had a 3rd degree tear - waters only went on second last contraction and she was born very fast though only 7lb13oz (compared to previous 2 being well over 9lb).
im not really sure that inductions have changed that much in 21 years!

I had the drip and was almost instantly in the most appalling pain, I thought my uterus would rupture. I had to suffer it for hours before they finally gave me an epidural. I was too scared to have any more children.
If I was you I'd refuse an induction until you get an epidural.

Do you actually WANT an induction? Or did they schedule this for you?

I’ve had 4 inductions between 2000-2021 (5 births) these are my experiences:

1. no. This was based on what was likely to work/what the hospital offered. So with my first they inserted the pessary, about 6hrs later my waters broke, for reasons lost to time now I had the drip and an epidural (because of the drip). Because I was already 3-4cm dilated with dc3,4 and 5 my waters were broken to induce labour and I believe they used balloons at this point instead. With 3 and 5 that was enough to start labour but for dc4 nothing happened so I needed drip. I refused drip until an epidural was in place.
2. no. This was not an option.
3. my experience was they were fine for me to wait for an epidural I waited from about 4pm until 11pm for an anaesthetist to become available, though arguably I wasn’t a priority as I wasn’t in labour or pain, but I absolutely wasn’t having the drip without one, and it was the right decision in my case because they very quickly ramped my contractions up too much!

With DC3 and 5 they were very straightforward, waters broken and both babies born exactly 2hrs later. No time for epidurals.

With most I was home same day.

from an obs anaesthetist's PoV...re. epidurals, the timing is a quite individual thing and depends to some extent on the mode of induction and how things are going. You do have to be on the labour ward to have an epidural because of the need for 1:1 care and fetal monitoring.

Most commonly women start off on the antenatal ward and the induction +/- contractions get started there before coming to the labour ward and then at some point during labour request their epidural.

If the plan is to go straight for an ARM and oxytocin then some women do request their epidural before getting going (more commonly between the ARM and starting the drip than before having anything done though). There is some evidence though that women are more happy with their epidurals if they've had them sited after having some painful contractions (probably because you've got a better idea of what you're comparing). Having a very early epidural can be associated with an increased chance of a section, but having one later on once you're in 'proper' labour isn't thought to. There is an association between having an epidural and having an assisted delivery (suction cup or forceps), however the nature of that association isn't always a causative one. There is a failure rate with epidurals and if you have one sited before contractions are painful (eg. before starting the drip), you still won't really know if it's going to work until things get a bit further along.

If there's a reason that an epidural might be more difficult then it's often best to get it in earlier to allow for extra time needed to get it in and working well. There may also come a point in advanced labour at which the risks of an epidural outweigh the benefits (if you're really about to have the baby) so it is worth bearing that in mind... anaesthetists are still usually happy to have a conversation about it though and help weigh up pros and cons. It's also worth looking at the labourpains.org website if you've not seen it already - it's run by the Obstetric Anaesthetist Association and has a load of patient information re the different modes of pain relief (and anaesthesia if needed). HTH.

From my experience, they tell you what method they want to use. My trust stopped using pessary induction between me having DC1 and DC2 as it has a track record of being ineffective.

Once they start the induction you don't leave until you have your baby and they will only give you an epidural once you've been moved to the delivery suite

I was induced with my dd. I didn’t have a choice which method, they just told me it would be gel. If after 3 gels I didn’t start, then I was told it would be a c section delivery. You had to stay in hospital once the first gel was inserted, but you weren’t restricted to the ward, you could have a wander around the hospital. After the second gel I was eventually about 2cm dilated. This was about 24 hours after the first gel. The midwife then moved us to the labour ward and broke my waters. I told her that I would be wanting an epidural. I then repeated this request every ten minutes, was ignored and then the anaesthetist turned up at the door just as I pushed my dd out on just gas and air. The excuse was that they were short staffed and busy and because my dd was fast (just under two hours) I’d missed out.

Hope your experience is better than mine OP.

I had an outpatient induction (3 years ago) so I went home after pessary, told to come back in 24hours or earlier if labour started. Went back in after 6 hours as pessary alone was pretty effective for me (I was 2 weeks overdue).
I was booked in as an outpatient induction though so I knew this would happen. Didn’t need epidural. Don’t remember being given an option for pessary/gel but also don’t remember asking.

The induction methods were described to me as a scale, so many hospital ms work up the scale. My hospital had balloon, then pessary, then drip
When I went for my induction they tried the balloon first. I was induced after going in for reduced movement so I wasn't allowed home after the balloon

I had an induction 5 years ago. I didn’t have a choice of method - it was pessary. It does depend on circumstances though, a friend who was induced at the same hospital had the balloon because she’d had a previous C section.

I was sent home after the pessary was inserted, at mid day, and told to come back after 24 hours if nothing was happening. My contractions started 6 hours after the insertion, at 18.00, and I went back in when I started to struggle (at 4am, 16 hours after the insertion).

I had very very painful contractions and no break in the pain, as the baby was back to back. I was moved to the labour ward at around 13.00, 25 hours after the insertion. I was barely 1cm but they managed to break my waters and give me the epidural I had been asking for. There wasn’t an option to have it until I was on the labour ward.

The epidural was wonderful for me. I relaxed, and went from 1 cm to 10 cm in 4 hours. I was in so much pain beforehand, I wasn’t able to move around anyway - I just lay in a heap. The joys of back to back babies!

Bear in mind that more recent studies do not show a causal link between epidurals and instrumental or C section births. It is correlation, not causation, not helped by the fact that more complicated births (which are likely to end up instrumental or with an EMCS) are more painful and longer and so more likely to involve and epidural.

I was induced nearly 18 years ago so my experience may be out of date .

i was given the pessary but went into labour in a couple of hours and my Ds was born 2 hours 20 minutes later - so don’t recommend going home .

I've had two inductions.

1. Can you choose which induction method you want? (gel instead of pessary?)
IME no. I had gels both times. With my first (5 years ago) it was because gels were the only option. With my second (3 years ago) it was because baby was stationed high, so a balloon was ill advised. They will use what is clinically best for you.

2. Can you come home or do you have to wait under observation once they’ve started the induction?
IME no again. But I was being induced for pre-eclampsia, so needed to remain an inpatient for monitoring. However, my sister had the 24h pessary and was allowed home. She was being induced due to being post dates, so it probably depends on why you're being induced and what with.

3. Can you ask for an epidural before the procedure?
The early stages of induction (i.e. cervix ripening) isn't done on delivery suite and there is no 1:1 midwife care, so there is no epidural availability. Once you make it on to delivery suite (contracting or not) it becomes an option. I was offered it before the drip was started with my second, but I declined. I wanted to at least get labour established first, and I'd delivered my first with the drip without an epidural. I did need some diamorphine though. I did eventually have an epidural with my second as labour was slow due to him being back to back. At the subsequent C-section it turned out he'd also tipped his head back and was undeliverable vaginally.