Outpatient induction - do I choose pessary or waters being broken?

[Teacake44]

I’m currently 41+4 weeks pregnant and have an outpatient induction booked for tomorrow if nothing happens before then - although I’m still trying to decide whether to go ahead with it or not.

I had a sweep on Saturday, where the midwife told me my cervix is favourable (soft and central) and I was already 2cm dilated. She expected I wouldn’t make it until Tuesday but we’re nearly there now and nothing substantial has happened… I lost my bloody show after the sweep and have been gradually losing it over the last couple of days. I’ve also been having period type cramps on and off.

The midwife said that I could start the induction with just having my waters broken but the pessary could still be a good idea first as baby is only on the brim of being engaged. But I’m not sure what to start with -

Pessary could be enough and I can have early labour at home. However, it’s still a chemical induction and I know some people can be hypersensitive to it. It however gives baby a bit more time to finish the job more naturally than the drip.

Having waters broken means no chemical intervention and knocks off 24hrs of the induction process but if it doesn’t work, it’s a very fast step up to hormone drip - which I’d reeeeally like to avoid.

If either the pessary or waters being broken works, I’ve been told I can still go to the MLU and have a water birth.

Does anyone have any similar experiences and which induction method did you start with? What would you pick based on my circumstances?

How exciting for you OP, baby is nearly with you!

I think it’s a great sign that you’re already 2cm dilated, I was induced via pessary but from high, closed 0cm cervix and so it didn’t go so well but I think you’re in a good starting position.

In your position I’d give the pessary a go as that’s a bit of a gentler start than having waters broken and you know you can move to that as next step

Also sure you have been but get bouncing on the ball, have sex etc - try everything to get things going naturally too as there is still time

I started with pessary in a very similar situation to you(2cm, show lost) they wouldn’t break my waters until I was 4cm though. I did have a hypersensitive reaction to it, my contractions came back to back, so had to have them slowed down. which then meant I needed the drip anyway. However, after the back to back pessary contractions, I wasn’t going anywhere without an epidural and so the drip was absolutely fine.

Posted too early! I would say the pessary is the best place to start in this situation, as you say the waters broken could fast track everything.

Good luck to you!!

waters! Don’t introduce fake hormones unless you really have to… my waters were broken at 7.40 am and dd arrived at 3.10 that afternoon.

I would (and did) start with the pessary. After 24 hour if nothing is happening you can then try breaking the waters before moving on to the drip if necessary. If you go straight for breaking the waters there is only the drip option after that. For what it's worth when I was induced my cervix was very favourable, I started having contractions 15 hours after the pessary was put in. Waters were broken 12 hours later (I have long labours) and ds was born 30 minutes after the waters were broken. Sil went for breaking the waters over the pessary and ended up on the drip after her contractions failed to start.

I had a pessary after 2 sweeps and at 2cm dilated. After about 8 hours my waters broke on their own. Use a ball to bounce on, walk around as much as you can- those things helped my waters go and labour kicked off quickly after that.

I had pessary with 1st and water with 2nd, I'd go waters every time. However - the minute they broke my waters everything ramped up and he was born 1hr and 6 mins later - I was exactly a week over and think that nudge just set everything off, was quite glad they hadn't gone at home - I'd never have made it to the delivery suite!

I had pessary with first, waters broke on their own and contractions started before the 24 hours were up, dc born 4 hours later.
Second I had pessary and then waters broken after 24 hours. Contractions started almost immediately and dc was born 2 hours later.
It's purely anecdotal but my experience was quick labours with the pessary with both, once contractions had started! Good luck op!

I had the pessary (and it was fine) but I was being induced early so it was a bit different. In your position I'd go with the waters broken, at your stage it might be all you need.

My second was born 15 minutes after they broke my waters - very glad I wasn't at home!!

Why have either? If you and the baby are ok there’s no reason to induce and there are plenty of drawbacks.

I was 2cm dilated for over a week and had several doctors try to break my waters but couldn’t( I think my cervix wasn’t quite in the right place). So had the pessary but that did hardly anything. I then went on the drip and had my waters broken.

I did have to be in hospital with the pessary though, have they told you that you can definitely be at home?
Honestly for me the drip was absolutely fine. I had no pain medication what so ever as gas and air was awful. There was a short period where my contractions were too close together because of the drip but they noticed straight away and lowered the dose. Some people on mumsnet make you think that the drip is the worst thing to happen but there’s no way I could’ve gone pain killer free if I’d not had it and had to endure hours and hours of early labour

I’m a midwife. 100% pessary. Which I believe is backed up by Nice guidelines. Our hospital won’t offer you the option, always pessary first (unless previous section).

your waters being intact can make a massive difference to progress in labour. More constant pressure on cervix to aid dilation and helps baby get in a good position. It’s harder for babies to position themselves once waters have gone so more likely to end up with a malposition

Already being 2cm dilated and having the drip is quite different to being 0cm dilated, effaced etc and that’s why a lot of people say how awful the drip is. 2cm is quite good progress already but going from 0cm-2cm can take hours and hours of being on the drip. That’s why so many women say it’s the worst thing ever

@ShirleyPhallus op is already 2cm dilated

I know, I was responding to the poster who said “Some people on mumsnet make you think that the drip is the worst thing to happen” and commenting on why that is