Eating on day of induction. What's the usual advice?

[fluffyraggies]

I'm going in at 12 mid-day tomorrow to be induced.

I was thinking i should have breakfast and then a snack before we leave the house, as kicking into labor could take hours - BUT then i started thinking about nausea, full tummy if labor kicks off easily, etc. ...

The hospital haven't said anything about eating/not eating. Googling throws up some advice about having nothing for 8 hours or so before induction. I'm worried about energy levels rather than hunger. I've had natural labors before - no not had this dilemma!

Any wisdom?

I was told to expect them to break my waters as I had been 3 CMs dilated for a few days with unsuccessful sweeps. When I got to hospital I was told that wouldn't be the case (no idea why) but it really got me down, especially when I was told that if the first pessary was unsuccessful I could have another in 24 hours. I wanted to be home by dinner! It didn't take much to make me emotional that day so be prepared for any eventuality tomorrow. My overriding feeling was boredom, embarrassingly enough. I wanted to just have this baby but instead I got a whole lot of sitting on a bed in minor discomfort. Once they kicked in though, things happened very quickly for me, I do suspect because my second birth had only taken three hours, the third was 50 minutes! Also because its not your first birth you may have a higher tolerance of the pain. I wasn't really believed when I said I needed to be moved from the antenatal ward to the pool room NOW because I wasn't screaming, just very calm and concentrated. Make sure you have a birth partner who will stand up for you and who knows where he can run to find a midwife if one is needed! Fwiw, I was home by dinner (well, almost, I was let out at 9.30 after all the paperwork had been done) and I still consider it my best birth, despite having to be kicked off with a bit of a helping hand from the pessary. This time tomorrow you could be holding that tiny baby. No, not jealous, not me....

I was induced with DS as my hind waters had gone at 39 weeks.

I was monitored on Thursday and Friday mornings, admitted on Friday night for induction. Pessary on Friday night and Saturday morning with no effect, so drip on Saturday night. 7 hours for 1st stage, 13 minutes 2nd stage (with episiotomy).

That was from head not engaged.

Fluffy - once the drip is started its really only turned off for fetal distress or if you're hyper stimulated. It wouldn't be stopped to see if you carry on by yourself.

I might be misunderstanding a previous post but have they hinted that if they can break your waters tomorrow then they'll go straight for that option? Its just that NICE guidelines recommend that "cold" ARMs like this aren't done and that all IOL women should have prostaglandin prior to ARM. There is research and evidence to show that this lowers the cascade of intervention. That the prostin may well start you off and that you won't need the drip, then you won't need monitoring, etc.

Good luck.

viva iv had this conversation today with senior consultant at a very well known teaching hospital! the prostoglandin pessaries/gels are applied to move cervix into more favourable position/open it, which sometimes triggers labour, but the aim is to prepare cervix for ARM then give you a couple of hours to see if contractions start.

if the cervix is already in a favourable position theres no benefit to using prostoglandins and obviously its open enough to break waters and if your lucky then contractions will start. this is no less likely than if prostoglandins had been applied to an already favourable cervix.

the bottom line is that you dont know until the day what might happen and you have to go in with an open mind about how and when the baby will come.

nobody wants an over-medicalised birth, medical professionals included, and whilst to us, a doubled risk of stillbirth from say 1 in 2000 to 1 in 1000 is still low, i guess once you have seen an actual stillbirth, the consequences it has, and know that is most likely could have been prevented, as a medic you are going to be seriously risk averse.

ILoveKitty - I can promise you that consultant is wrong.

If you read the evidence regarding prostaglandin IOL vs ARM inc for already favourable cervixes the benefits are there. Greater chance of achieving a vaginal birth in 24 hours, less chance of needing augmentation, less chance of needing/having an epidural and lower risk of pph with using a prostaglandin first. Prostaglandin is far more than just trying to get the cervix to an ARM'ble state. Sadly some Drs are a bit slow to come round to this way of thinking but the research and evidence shows I'm right.

viva i was convinced what you were saying was the case hence my cross examination of her today.

my previous experience of a so-called consultant at a different hospital left me feeling completely appalled by his lack of knowledge of well known studies and procedures. i thought i was in a better place this time around. think i will do some reading before my appointment next week and challenge her with the evidence.

really uncomfortable with the fact that i thought i found someone i could trust and now it feels like i was fobbed iff by the bending of truth to suit hospital procedure.

Oh gosh. Good luck. You definitely need to eat. Mine took three days, and I didn't eat and drink enough (not helped by the drip-fed drugs making me sick). I was poorly afterwards and lack of food and drink didn't help. Had to have a catheter fitted the following day for my marmelade-like urine to be squeezed manually from my bladder. That was lovely.... Not. Too much info?!

Kitty, some Drs do seem to be of the opinion that if a woman is there for induction then the further you can start down the chain the better. Without thinking of the bigger picture.

Some of the consultants where I work are now trying to not bother with the two hour wait after breaking waters to see if the woman starts contracting. In their view she's here to be induced, her waters have been broken so just start the syntocinon straight away. Thankfully midwives are a bolshy lot and we tend to stand our ground and argue the woman's case. Have asked the consultants to show me the evidence for this and it hasn't been forthcoming. Because there isn't any.

hey viva

i did a quick google last night and all the protocols i saw did suggest prostoglandins only if cervix unfavourable.

can you send some of the links?

my consultant has thus far been fantastic and knows i had a dreadful induction last time and is constantly asking me how can we make this better for you and deviating from "standard".

fwiw 3 days of prostoglandin pessaries and gels literally did nothing last time as opposed to every other lucky bastard i know that popped into a quick labour !!!

Copied and pasted from nice guidelines.

On balance, the GDG considered the evidence for the use of vaginal PGE2 in women with an unfavourable cervix to be persuasive, as vaginal PGE2 was more effective than placebo in a number of secondary outcomes. In this group of women, controlled release PGE2 pessary may be more appropriate because the induction time may be prolonged and it is more likely that repeated use of tablet or gel will be required. In women with a favourable cervix, there is robust evidence that vaginal PGE2 is an effective induction agent, and vaginal PGE2 tablet or gel may be more appropriate. In addition, the GDG also considered comfort, convenience and acceptability to be important to women (vaginal PGE2 is less invasive than amniotomy, and oxytocin requires intravenous access and continuous EFM, thus reducing women’s mobility during induction) and the balance of evidence supported the GDG’s view that vaginal PGE2 should be the preferred method of induction of labour irrespective of cervical status.

www.nice.org.uk/nicemedia/live/12012/41255/41255.pdf

Page 46-47.

here nice actually state that ArM should not be used on its own unless there's a specific reason

There was a trial by Mahmood (1995) which showed a significant increase in the need for syntocinon following an ARM induction compared to a prostin induction. Something that the OP said she wanted to avoid.

There's a Cochrane review here which says there isn't really enough evidence on the subject. But that also means there isn't enough evidence to support it.....especially when there's a reasonable alternative. Review talks about increased risks of cord prolapse, infection, decreased rates of maternal satisfaction due to monitoring, etc.

here

thankyou for posting these. I am going to look later and print them off. I trust that my consultant is trying to do the best in circumstances but I am going to highlight the bit about prostins and favourable cervix and ask why that is not the hospital's protocol. to be completely honest though, I have indicated that I am not up for a long induction this time and that if things arent favourable a section is my preferred option....

Op- all the best for your induction today. The registrar waited for me to get and eat some sandwiches before breaking my waters so I'd certainly say eat.

Viva- am I right in reading that those guidelines are from 2008, ie this isn't a new thing? I actually asked the registrar if there was any disadvantage in going straight to ARM and she told me there was no point in doing anything else as my cervix was favourable...

sorry op thread a bit hijacked by all our thoughts!

just wanted to wish you all the best, being your third, itsgoing to be fine and most likely fast. please let us know how you get on xxx

RedKites, yes - that's correct.

Sadly it seems to take some hospitals longer than others to change guidelines and implement new research. I'd say ours is quite quick because we have good proactive research midwives who will rewrite guidelines . I'd say we started following this certainly by 2010 if not 2009. There will of course always be exceptions for medical reasons where the Dr is very justified in deviating from guidelines/research.

IME Drs don't always keep up to date with current research/guidelines unless its something really major. I remember once presenting a paper to a group of consultants who were quite shocked by something I said and asked me where I'd got that from. I said it was from the RCOG guidelines for X and they were all quite stunned. I thought they were challenging me and one of them laughed and said I was probably the only person who'd read the guidelines. I don't think he was joking.

Meant to say good luck for today Fluffy.

viva do you mind me asking what you do in a professional capacity?

id be really surprised if my hospital are not following most up to date research as other consultants there have made recommendations to me that arent yet incorporated in NICE guidelines so quite surprised if there is major disparity in how their consultants operate.

Have PMd you.

Well - i'm back home and still preggers!

Got to hospital all nervous and ready for it, only to be told that my consultant had put the wrong date in (due date is today 21st) and she'd written 23rd!!!!!! Arrrggghhh. Got to ring in the morning to see if they can fit me in. If not, then it'll be Thursday for definite.

sigh

In the meantime the senior MW (lovely lady) did say to me that when i do go in they'll put in a pessary for a couple of hours, as although my cervix is open a little and low and soft, they like to prep. it as much as pos. before breaking waters. Covering all bases there really ...

Sooooo ... here's hoping for a natural start tonight, or on Wednesday!

Oh no, how disappointing when you're all revved up and expecting it to be started today. Hope it starts naturally for you tonight!

Thanks viva. Nothing overnight.

And no room at the inn today, so it's 12 mid day tomorrow ..... again!

fluffy hope you are home having newborn cuddles now and your induction went well.