Midwives can you answer a burning question about induction?

[DelsParadiseWife]

So, the woman is on a drip and she is finding it unbearable. Why epidural and not just turn down the drip a bit?

Bump?

Gosh, does nobody KNOW?

No idea, I have had an induction but I am not a midwife. I managed on gas and air though asked too late for an epidural

not a MW, so i have no idea if this is correct -

the drip can be turned down, but usually the reason for the drip is that the contractions are not strong enough and/or frequent enough to dilate the cervix

turning it down could prolong labour and with synto, there is increased risk of foetal distress and hyperstimulation of the uterus so making labour even longer would potentially make more issues/intervention

if the drip is turned down and labour is not progressing, then what? turn it back up and it is still unbearable, so the delayed pain relief is given?

of course, i could well be completely be wrong..

Because without good contractions she'll never get anywhere. Turn the syntocinon drip down and the progress of labour can halt/slow, which rather defeats the object!

because if the syntocinon drip is turned down then the contractions may not remain strong and regular enough for progress to occur.

owwww Lulumaam, we are short staffed tonight, fancy coming to work with me? You answered the question better than my student could!

Oh I see Lulumama but seeing as only the woman can know what she is feeling, and that optimal amounts of synto will be different for every woman, - surely there is some room for negotiation?

And also, lots of people say that going onto synto is like going from 0-100 faster than body can catch up with, - why not slow down the 1-100 so the body CAN catch up.

SO what I mean is, - yes turn it down, and if still not progression, turn it back up slowly.

I understand the foetal distress thing and likely c/section, - but isn't that a very likely outcome anyway with induction, and isn't the foetal distress a by product of the high levels of synto/fear and distress of the mother etc?

Their MUST be some level of negotiation, participation of the mother surely?

I'm not saying turn it DOWN, just a little bit so the woman can regain herself!

sure thing maltesers, i think being enthusiastic must count for more than full training right?

Lulu There is at least one midwife I know that I would have preferred you to have takn the place of.

Think 'picking her nose whilst doing an internal examination'!

there is always a level of subjectivith wrt to pain relief

and one woman;s unbearable is another's niggling irritation

i think the issue is once you are on the induction process... it has time scales and expected outcomes... it cannot be micro managed for each woman, more is the pity.

i think that if a woman is not coping with the synto, encouragement to be mobile, upright , use a birth ball anything other than lying on the bed will help...

turning it down could help, but if the labour does not progress, it had to go up, and she will face the same issue with the pain , just later on, when she is more tired

rather than turning it down, it can be kept at the same level of titration (sp?) but at some point, something has to give and the baby has to be delivered

if there is a medical need for induction.. i.e iugr or high bp, prolonging induction/ labour is not good.

blee @ that nose picking..

Okay, Lulu,

An we agree simply that there is plenty of room for improvement with how induction is handled?

I guess you are right that once you commit yourself to the induction process you are indeed in a 'process' that is removed from the instincts of the woman enought to 'possibly' argue she is having birth 'done to her' to a great extent, and as such is under the control of someone else. I would still like to think there was some room for negotiation though.

I am interested in the high BP issue though. Doesn't an overly intense labour increase the risks of this, - or is it just assumed you'd have the epidrual?

Are synto timelines and protocols based on the idea that the woman won't feel anything?

from discussion with MWs, obs, etc i have never ever heard or come across the assumption that a woman won;t feel anything, that is quite quite cynical

the issue is protocol

Lulu I didn't mean to be cynical. I just wondered whether the protocols were largely made with the assumption that an epidural will be offered and accepted.

And yes, tis I!?

I think you make a good point about women being appropriately educated before hand so they aren't beging an overstretch mw for detailed information (particularly if they are a detail kind of mother).

I'm raising this point not to be controversial, but because it isn't something that is generally 'out there' in terms of discussion i.e. if the drip hurts why not turn it down.

I am of course mapping my own experience onto this issue and know without a shred of doubt that if I ever reached pain levels that I did with my first caused by a drip, it would be out of my arm without a thought. I suppose my rational and reflective brain wonders if there is a woman is likely to do this there must be something of a compromise that can be reached.

I'm not talking 'ouch this is unbearable' levels, I'm talking 'I couldn't care if I and my baby die, in fact give me a gun and I will ensure it happens' levels.

Perhsp it isn't normal to reach this level of pain even with an induction though. Certainly if my no.2 had been my no.1 I would have enjoyed talking about the 'unbearable pain like nothing on earth' and not have the capacity to understand the former!

the issue is, even if the protocols are made with the idea of epidural in mind, we know the reality.. is there an aneasthatist available? what happens in the potential 1 or 2 hour wait for one? turning hte drop down can be counter productive, or it could be great.. the reduction in pain might allow the mother to relax enough for dialation to really get going

this also presupposes that opiates, gas & air etc arent being used.. or aren;t enough

i've supported women who've coped with a full indiction - pessary x 2, ARM, synto up full , with gas & air. others have needed opiates from teh first ctx

it is so subjective therefore the only way forward is a basic assumption of how most women will manage and base expectations on that

there is some room for individual tweaking, but for me the rising numbers of IOL for simply being post mature ( happy memories of a client having to explain what expectant management was to a MW ) , leads to more intervention , more c.s and more issues

i thikn starting at why IOL is rising and working backwards is better. the c.s rate is rising and the two things are totally intertwined

also once a woman is induced, her pain relief options are limited, as is her mobility.. both have an impact on labour

not being able to use water, not being able to cope with G&A and /or opiates does have an impact...

I was induced with my first baby and my second baby is due in May this year. My experience of induction and the way the midwives handled it makes me quite frankly petrified of having my second baby.
It started off with an extremely slow increase in the drip so I hardly felt anything. Then the midwife, who didn't seem to know what she was doing, started following instructions on a card to double the dose. At one point she increased the dose so much that my husband who was watching over her shoulder pointed out that he thought the increase was not right, a second midwife came in to check, and sure enough the increase was 4 fold in one increase and no doubt if my husband had not been there to point it out there might have been serious repercussions. Let's just say the second midwife took the first outside and we could hear the shouting. Meanwhile I was on "double peak" contractions lying on the bed and finding it difficult. No one offered me gas and air but the first midwife just came back in with meptid (without me asking) and suggested to me I should have it so I did. I don't think I could have walked around even if I had wanted to and I did want to.
After about 8 hours of being on the drip (4 hours of which were "double peak" contractions I was told I was not dilating much - no one really told me how dilated I was. But by 1.30am another lady was going in for an emergency C section and the consultant came in and had a conversation with me which I endeavoured to concentrate on between the very fast and close double contractions, saying "do you want a C section?" subtext we have all our staff out of bed for the first lady so you can if you like. At this stage no one had exactly told me how dilated I was but the implication (I think) was that I was not very dilated at all notwithstanding the drip).
Meanwhile the first midwife stood over my bed and made some unhelpful comments about labours taking much much longer than the 8 hours I had been on a drip and implying that I had not tried very hard.
In conclusion I had a c section but made the decision with very little information or helpful assistance and I felt disapproved of. So I am just praying that this time my baby might come out naturally and I don't go through that again, labour totally out of my hands and disapproval. Infact I don't actually think I have a low pain threshold at all, I think my pain threshold is quite high and I was quite prepared to see it through. The worst thing tho was, as other people have said above, with a drip, going 0 to 100 in a very short time and then, after several hours of that, being told (or not exactly told but midwives implying in a vague way without answering my question exactly) that I was not dilating, i.e. it wasn't working. Or maybe it was working but in their view I was too wimpy to see it through to the end. Who knows. In my experience, yes, women are not given any information about what is going on once they have been induced.