Can someone explain Induction to me? What happens and how is it different to spontaneous labour?

[DawnAS]

Hi all,

I am only 31 weeks PG but at 28 weeks was diagnosed with Gestational Diabetes. I'm managing to control my blood sugar with diet and insulin injections at the moment and have another growth scan next week. At my 28 week scan, our little Jelly was average size (middle line) for head and legs but towards the top line for stomach.

They are saying that often if you have GD, they induce at 38 weeks to prevent you having to deliver a very large baby. I would rather go full-term and have a C-section if she's too big, but as this is my first baby, I really don't know the difference between an Induction and normal labour (is anything really normal?!).

When I look at other threads, a lot of people say to avoid induction. Why is this? What actually happens?

Any advice gratefully received so that I can make an informed decision if I end up in a situation where they suggest induction...

Thank you.

xxx

Hi, I was induced with my first baby. it's not too bad. Pessary first and then waiting around for something to happen. They can do this several times so can take some hours. If beginning to dilate they will then break your waters. This is nowhere near as bad as it sounds. Didn't hurt at all - water coming out a bit strange though. This accelerates the contractions so they can be quite full on and a bit frightening at first. However, in my case they didn't really get much worse. I think the next stage would be a drip but I didn't have that.
I think people like to avoid induction because it is more likely to lead to complications and assistance being needed. For me induction forced my body to give birth before it was ready hence very short labour, ventouse delivery etc - which I think it quite common. However, I'm sure this isn't the case for everybody and if there is a good medical reason it is probably for the best. The actual process was fine for me but it was very scary having intense contractions straight away and I wish someone had prepared me for that.

Induction is different in that there is usually no subtle build up, it's from nought to full on labour very quickly.

As such the contractions seem much more painful as you haven't had them building up which allows your body to produce endorphins to help with the pain. It can also be quite frightening which in turn steps up your body's adrenal response which can counteract the effect of naturall occuring endorphins.

It can also increase the chances of you needing a far more medicalised birth (more pain relief leading to less effective contractions, leading to more induction drugs, leading to CS)

However, this isn't everyone's experience and induced labours can go quite smoothly.

IME, the beginning of my labour was OK; three doses of prostin gel over the space of 24 hours, waters broke spontaneoulsy at 3cms dilated, laboured well until almost fully dilated.....it was only because I pushed before I was fully dilated (thanks in no small part to a very inattentive midwife) and developed a cervical rim which I was told I could push through) that caused my eventual need for a section. If I had had more guidance from the MW this might not have happened. I was given some oxytocin at one point and the contractions after that were truly hideous.

Thanks Aniseed and LackaDAISYcal for your replies.

So, on my birthplan (or draft as I haven't properly written it yet), I've said that for pain-relief I want a TENS machine and Epidural, nothing else.

So I'm guessing that a TENS machine won't do much as I've heard that you're better using one of these from when the mild contractions start. So will I still be able to have the epidural if the pains are that bad?

xxx

the epidural will certainly take the pain away, but can in itself cause problems. For some they are great though, especially in long labours (which are often the case with induced labours) as they allow you to recover your strength for the pushing part.

Lots of hospitals now offer mobile epidurals where most of the pain has gone, but you can still feel enough to know ehan you are having a contraction and hence when to push.

With my last labour, I ended up needing a forceps delivery and was given an epidural for that....the MW had a hand on my tummy and had to tell me when to push as I couldn't feel a thing.

I think the thing with birth plans is to have an ideal scenario, but be prepared to be flexible in the face of any problems that may arise, especially as we all react dofferently to pain and you have no real idea of how you will cope. Being flexible about your options will help you come to terms with how things go rather tahn saying I want X and being really upset when Y happens

I had an elective section second time, but when I got pregnant again, I really wanted to exercise the demons from my first labour and have a natural delivery so I hired a doula to help me through it. I couldn't suggest a doula strongly enough as she really helped keep both my husband and I calm (he was very traumatised by my first labour) and was able to advocate for us with the MWery staff. My birth wasn't as non interventionist as I'd hoped, but I was happy that things were being done for the right reasons and I was aware that it was ultimately my choices throughout....so I was in labour rather than having labour done to me if that makes sense.

If you keep this bumped, you will get lots of lovely advice I'm sure

I had an induction with my fourth baby and the only bad thing about it was the fact I hadn't cleared out my bowels as you do in a natural labour. The pressure was immense but I was unable to poo () during labour but did so whilst pushing out the baby (again) The fact my bowels were full made labour very uncomfortable for me.

Other than that it was great

If you are being induced your birthplan ideas for pain relief may go out the window I'm afraid. I was induced last year (also because of GD) and very quickly needed painkilling injections (pethidine) as the pain was very intense and I was getting very tired. Gas and air is very good also. Don't get too hung up on what goes in your birth plan about what pain relief you will accept - you views may change when you feel the pain and the medical staff will not be pushing pain relief on you (far from it in my experience!)

Hi Dawn AS

I was induced twice due to diet controlled GD and both times they let me go to full term as the growth scans showed that DD and DS were both normal sized.

I can't say how the induction was compared to a normal birth but I can tell you that while both births were quite different they were not bad I don't think. Both times I had a pessary late afternoon and I started getting contractions at about 4 am the next day. With DS, they broke my waters at about 8am, I had contractions all morning, they put me on a syntocin (?) drip at around lunchtime and he finally arrived at 6pm. DD was in a bit more of a hurry and my waters broke spontaneously at 7.05am and she arrive 5 mins later!

The thing that I found great about induction was that I seemed to get a lot of monitoring and checking throughout labour which, as I am a total scaredy cat, was a good thing for me but I understand some people might not be so keen on that.

As for pain relief, I had gas and air throughout for both (and loved it!!)and diamorphine (I think?) an hour before ds was born. In hindsight, I wished I hadn't because I don't remember much about his birth or his first few hours as I was in a haze so I had put on my birthplan for DD that I wanted to avoid it. Didn't stop me demanding it 5 mins before she was born though...

Hope this helps!

DawnAS Hi I had a spontaneous labour with my first, waters broke first then contractions came very strong and fast straight away, didn't have any build up really. Used a TENS and found it helpful. Was induced second time at 40+14, had one pessary contractions started straight away, they did start mild and were up to full strength after about an hour, used a TENS machine this time too, because I knew labour was starting I could get it on straight away and found it really useful. Used TENS all the way through even when contractions were at their worst. DS born 2hrs 50mins after the pessary weighing 10lb6oz, he was alot easier to give birth to that DD (8lb4oz). I know it is different for everyone but for myself I honestly didn't see a difference between induced and non-induced contractions, whichever way it still really really hurts!
Also would recommend not to get to specific with your birth plan/pain relief preferences, it's one of those things that until you are experiencing it you don't know how your body will cope. It's really a case of going with the flow and deciding what's best for you at the time. I was convinced I wanted a water birth before hand but when I was in labour I couldn't think of anything worse than having to get in a pool and get all wet!!

I had an induction due to pre-eclampsia at 39 weeks. I had Prostin gel on friday night and had very mild tightenings to begin with.

I hadn't progressed enough that evening for them to do anything else, though I was contracting enough that they didn't want to give me any more gel. All of which meant I got to have some pethedine and go to sleep for the night.

the next morning, I had dilated enough to have my waters broken - uncomfotable but not agonising. I laboured then for about 4 hours with just a tens machine. Contractions were getting stronger and by lunchtime, I felt that although they were ok with the TENS, I wasn't having much fun.

Unfortunately, when I was examined, I hadn't got much more dilated, so at that point they wanted to give me the oxytocin drip. As I had read on MN that the drip could make contractions a lot stronger and faster, I asked to have an epidural at the same time, as I didn't think I would cope very well without. Epidural made it comfortable enough to relax for a bit.

By early evening I had dilated far enough to push and because I had the Epidural 'early' it had worn off enough to be able to move about a bit.

I found it difficult to get the hang of pushing though - I didn't really 'get it', even though I could definitely feel the contractions at this point. So in the end there was a little bit of ventouse action.

So all in all, I didn't mind having the induction - DD was rather titchy so if she had stayed in longer it wouldn't have done her much good and my health might have been at more risk. I think the midwives were great at letting me/my body take my time about the whole thing.

Hi DawnAS - just thought I'd mention also that you may not be able to have an epidural until you are Xcm, e.g. past 3cm, or more depending on the hospital.

With an induction, the pain can be full on and start right away, so you could be in for hours of pretty hard core pain without the option of an epidural, whilst you wait to get to the magic number (and then, if they're busy... wait until an anaesthetist is free before getting your epidural.... took me 18 hours before I got one!). So I think it would be wise to consider what coping strategies and alternative pain relief you might use in the interim.

All experiences of induction are different, and there are some who have had pleasant (ish!) labours after them, but equally lots who have felt fairly traumatised after the subsequent intervention that is often needed.

So on your birth plan, I would also consider other forms of pain relief, and also how you would like a c section to be performed if you get to that stage, i.e. have plan a, plan b, plan z etc. Lots of the course of labour is out of your control, especially if you have to be induced, but if you consider all eventualities, then you should hopefully feel more in control and that you have made all the right decisions for you along the way. And if you feel like you have done this when looking back after the birth, then I think you are more likely to view the birth positively, whatever the actual mode of delivery.

Hope that makes sense - wish someone had told me that before I was induced, that's all!

Ladies,

Thank you so much, this has given me a lot of food for thought...

So, on the pain-relief side, part of my problem is that I suffer with something called "Emetophobia" which is a phobia of vomiting. Now I've heard (terrifying) rumours already that vomiting in labour sometimes happens but as my phobia is so severe, I need to speak to my MW about it and ensure that some medication is provided to help.

Because of my phobia, I don't want Gas & Air or Pethidine as I've heard that both can make you feel sick.

I know this must sound really bizarre and so many people have said "Vomiting will be the last worry on your mind at the time...", but really, with a phobia as severe as mine, being sick may well cause me to pass-out.

I haven't vomited now for nearly 10 years and didn't suffer any MS (luckily...), but I think that has just intensified the fear.

So, maybe I will be Ok to stick with trying the TENS machine first...

I have to admit I'm more than a little freaked out by all of this now and am wondering whether, if they suggest an induction, I can request an elective c-section instead. I know that c-sections are major surgery and I'm not taking the decision lightly, but I wonder if that would be best for me under the circumstances.

Of course, all this could end up not being as big an issue as our little girl is currently breech anyway and doesn't seem to have any intention of turning, although there is still some time to go.

Thank you again for all your support!!

xxx

By the way - also forgot to mention that as I am having to have insulin for my GD, I will have to have an insulin drip and have a heart monitor for the baby, so will be unable to move around more than likely... Great!! Not...

But I'm sure our little one will be worth it in the end...

xxx

DawnTS, do a little more research on TENS and vomiting.

I was induced and tried to use a TENS machine and it made me throw up. I went into intense labour very quickly and I think that by the time I tried to use it the pain was too much, and the sensation didn't agree with me at all.

I might just have been unlucky, I might have thrown up anyway but as this is so important to you, I'd advise a bit more research.

FWIW, I later had pethidine and G&A and neither made me nauseous at all. But everyone is different. Not sure if it's possible but what about asking your midwife if you can try G&A before labour? You could also try the TENS machine too to see what effect it has on you.

Dawn - if you have pethidine, then they usually give you a drug to stop you feeling sick at the same time. For what its worth, gas and air didn't make me feel sick - but it can with some people. But vomiting just as a natural start to labour is pretty common (could just be the once though), so it does sound like you need to discuss with your midwife if you can have an anti-vomiting drug at the start... Sounds like you've got a lot of research to do in teh next few weeks, at least it'll keep you busy!

Hmmm..they will be able to give you injections of an anti-sickness drug if anything makes you feel sick - I had to have them before, during and after labour and they were brilliant. Pethidine can comes with an anti-emetic I think.

However, as I understand it, emetophobes don't vomit unless they absolutely have to. In that case I would have thought that gas and air would be very unlikely to make you vomit (it can make you go a bit woozy if you go mad on it but you could easily take only enough to help with the pain without hyperventilating on the tube like some people do ) I know that your fear over rides every other consideration but the intensity of labour will take the edge off it I promise you.

Thanks again ladies.

HensMum, gosh, I didn't know that about the TENS machine, I will read up on it.

I did hear that they could give me anti-sickness drugs so I will be asking for those - I just feel a bit of a woose (sp?) so hope that my MW listens to me properly and doesn't fob me off...

mrsboogie, you're absolutely right - we do only vomit if we have to. I've actually been known to move out of home for up to two weeks before when someone in the house catches a stomach bug. My poor DH was quite sickly when we first met as he gave up smoking after a long time and picked up every bug going, but he used to hold it until he got outside on his way to work so I wouldn't know!! The sacrifices he's made for me are amazing... bless him!!

I start my antenatal classes in May so hopefully that will give me a bit more info aswell.

xxx

I have been induced both time with my dc

the contractions do hurt and are constant

the first time i was induced they offered me and epidural as soon as i was put on the drip but for one reason or another it didn't work . it was a bit of a bummer necause that was my birth plan epidural please!

so ended up having diamorphine which really took the edge off my contractions and gas and air for ' something to do' while I was having a contraction

second time round I had the same process, same drugs same gas and air but I was sick . They did give me an injection in my bum ( which they give with the diamorpine) which is an anti sickness drug ( and it worked)

DawnAS.
I was induced at 42 weeks and ended up with a CS, which is the last thing I wanted to happen. Induction isn't that bad and as I saw it if there was a chance that I could have had my DS via VB then I took it.

I think the thing with induction is that labour comes on very quickly and suddenly, there is no build up, and it's usually at night when your dh/dp is at home - and they may not call him.

CS takes a long time to recover from fully and can also affects how many dc you can have in the future - if you want more than 3 that is.

Induction vs CS - i would give induction a try.

hope it all goes well with the last part of your pregnancy.

Gosh - this is all really scary stuff - BoredWithWork, why wouldn't they call my DH?!! That's terrible. If that's the case I'll keep my mobile with me and just quickly switch it on and text him!! I'm assume they'll let him come in when he gets there!!!

DH and I have decided that after the problems I've had with this PG, this is going to be our only little one. I lost a baby at 5 weeks before this one, had a very high risk for Downs, had a CVS that didn't work followed by an Amnio, which eventually came back all clear. But then got diagnosed with GD that I have to manage by 3 x a day insulin injections and 4 x a day blood monitoring!!

Anything else this little one wants to throw at me, I would still happily take to make sure that she was healthy and well...

Thanks Susiey, I'm definitely going to be asking for the anti-sickness drug up front. It's a bit difficult to give birth I would imagine if you pass-out every time you think you're going to be sick!!

xxx

boredwithwork, can I correct you on the CS and numbers of children thing please. Obviously if you have had lots of CS then there is a greater risk of uterine rupture or maternal complications with subsequent sections, but if the OP has a section this time, there is no reason why she can't go on to have further vaginal births.

I'm speaking as someone who had a vaginal delivery, fairly non interventionist until the the need for forceps as DS got stuck, after two sections.

I had an induction for 'social reasons' at exactly 41 weeks. DH was in Afghanistan and if I wasn't induced he would have missed the birth!

As I only have 1 dd i have nothing to compare it too. 1st lot of gel at 02.30, then second lot at 10.30. The contractions really kicked in then - was on the ante-natal ward but they gave me a single room.

Made it without anything until I went down to the Delivery suite at 15.30 - waters broke naturally on the way down the stairs!

Baby born at 22.16 by ventouse.

All in all induction was fine!

TBH Dawn Spontaneous labour is kinder.

I think you would do well to research the true need for induction. Growth scans arenot very accurate and GD doesn't always mean big baby, and if it does, it doesn't mean too big for a straightforward labour.

I had a spontaneous labour with dd (and it took 25 bloody long hours).

I was induced with ds because he was late and the labour was only 6 hrs.

I would say that they pretty much rated the same on pain, none was worse than the other. I had the pessary and contractions started about5-6 hours later.
I still had to have my membranes ruptured aritificially, but I had to when I had dd too.

Dawn AS, I'm an emetophobe too. This is my fourth pregnancy and I'm hoping for a VBAC. I stayed in my local hospital for 3 days after the caesarean, (8 years ago) and at the time it did not have the notices and handgel everywhere warning about norovirus. Now it has and I am very worried about hospital acquired infection. I very much want to only eat and drink things I brought with me and this is going to be much more possible if I'm in for 6 hours rather than 3 or 4 days, as would be likely for a caesarean.
I've had 2 labours which started normally and 1 induced. I know this is unusual but my induced labour was far less painful. With my natural labours I had quite severe pain in between contractions, whereas on the drip, to my great surprise, I really had the pain-free intervals the books promise. This helped immensely. The contractions themselves were less painful too. I gave birth to the first twin 75 minutes after they hooked me up to the drip. The whole thing would have been over in a few more minutes if twin 2 hadn't been transverse, which led to the emergency caesarean (general anaesthetic).
I had pethidine with my first 2 labours. It didn't seem to help much, but neither did it make me sick.
Gas and air made me dizzy which I didn't like (I have no idea why people inhale it for fun) but it didn't make me sick, either.

I hope everything goes well for you.

Thanks all for your responses!!

139, so glad I'm not the only one - I just hope that my MW takes me seriously. So did they actually give you anti-sickness drugs with your pethidine? I have to admit, I think I will avoid pethidine at all costs, no just because it might make me feel sick, but also because I've heard a lot of people say that it makes them feel a bit out of it and not in control. I may risk the gas and air in the short term until they can give me an epidural. I hope I have an experience like you though!!

Thanks all for all the wonderful support.

xxx