moKee Birth School online:
the induction of labour
6 min read
by Suzi Smith •
Marie Louise joins us on the moKee Birth School Online to discuss the induction of labour.
Firstly, to make you aware, induction of labour varies from hospital to hospital but generally it’s similar methods which are used with varying timescales.
At the moment in the UK around about 20% of women are induced and one of the top reasons is being overdue. There are lots of different types of inductions of labour which I’ll run through with you today.
If this is your first baby, just know that around 80% of first-time mums go overdue, so don’t get fixated on that date. In fact, up to 5% of babies are born on their due date. When we give you your due date, it’s your EDD Estimated Due Date. Please take note of estimated. Please take this date with a pinch of salt. Friends and family bombarding you with texts asking if the baby has arrived is not good for you, so make it clear to everyone that 8 in 10 women go overdue and that it’s to be expected. A good tip is to tell people a later due date to ease the stress and you will probably be overdue anyway!
There can be medical reasons for being induced too; raised blood pressure, diabetes, a smaller baby, a bigger baby. Another reason is if your waters have gone but you haven’t gone into labour within 24 hours. Some hospitals have some variations around this time frame.
If you are being offered an induction of labour, please run through everything with your health care provider- why is it being recommended. Use the BRAIN Tool which I mention in the first session. Run through what the benefits and risks are, any alternatives, what your instinct is telling you and what happens if you do nothing?
If we can’t find your cervix don’t worry, this is very common. If we do find your cervix, the aim is to trigger your body to go into labour. What that does is send messages to your cervix to say, ok let’s do something. You’ll start contracting and can then go into labour. You can have a repeat sweep 48 hours later if it doesn’t work the first time around. Sometimes they don’t work at all- just more than 50% of sweeps work. This is a little bit debatable, because there are so many variables involved though.
Have a look on the risks and benefits of having a sweep on the NHS website. It’s a low risk procedure but it can be quite uncomfortable.
If you go into labour, fantastic! That’s exactly what we want. If you don’t go into labour, sometimes a sweep can cause an irritable uterus. These tightenings don’t put your body into labour unfortunately. We don’t know who will have this or who will go into labour. It’s a conversation to have with your midwife to decide.
If you don’t get into labour at all and you’re still being recommended for an induction of labour. We then need to run through everything. In most hospitals you’ll be given a day and time to come in. Sometimes hospitals will call and change your induction time, but only if you’re low risk.
On the day you’ll come in with all of your bits ready for your baby, because the idea is that you’ll leave the unit with your baby. The whole process takes a long time so takes lots of snacks. A tv card is a must, please ask! Take a book and be ready to wait. Sometimes it can take days….
You’ll be assessed by monitoring the baby with a CTG monitor. You’ll have the baby’s heart beat recorded and then you’ll be offered the prostaglandins - there are two types that you will be offered. One of them is Propess and this is like a little tampon that sits behind your cervix. The other one is called Prostin and is a gel. Both of them aim to soften the cervix and to ripen it. When your body isn’t used to going into labour, generally your cervix is thick and closed. We want your cervix to open up, soften and stretch into your uterus. We want a shorter cervix and slightly open. Some women go into labour just from this.
If we can’t break your waters we’ll generally suggest a hormone drip. We cant break your waters other than in a labour ward. The hormone drip is oxytocin and we pop a canular in your hand, so we need to find a vein. Sometimes it’s in your arm. It’s a tube that administers the fluids. Midwives also monitor your baby throughout this because with any drugs, we need to know that the baby is happy. It goes through quite slowly and the midwife gradually increases it. At any point that you want pain relief, ask your midwife. Make a BOSS BIRTH PLAN- see the first session on the website to see the info about pain relief.
So, the drip will continue to go through until you’re getting about 4 contractions in a ten minute period, coming nice and regularly. We’ll see them on the monitor and you’ll have one midwife continuously to look after you.
So that will run through and will hopefully help you get the right amount of contractions. We should then be able to break your waters if they haven’t already. However, you can be on the hormone drip for some time.
We’ll then get you into labour and the whole point is for you to have a vaginal birth. If the induction of labour doesn’t work then you will need to have a conversation with a senior doctor about other options. We then need to continue and so the next step is generally a c section. At the time, ask all of the questions- run through everything. it’s very rare that there are emergency c sections, so we have time to meet your requests. For example if you want some music paying during your c section, we can have a chat about it. Don’t be afraid of asking what you want.
Who to bring with you for an induction of labour. Things have changed due to Covid 19. Check with your hospital but it’s probably going to be the same as spontaneous labour but we can’t guarantee it. Your partner comes when you’re in established labour- three contractions that are lasting a minute in a ten minute period and your cervix needs to be 4cm dilated. Some hospitals will say that it’s ok for you to go home during some parts of the induction of labour process. Ask if it’s ok to go home. Once you’re in labour you need support so someone needs to be with you. I’ve picked 5 people to ensure that someone will be with me. If my partner has symptoms of Covid 19, they won’t be able to join you. So, ask a few people, just in case.
The last point is immediately after you’ve had your baby. After you’ve had your baby if you’ve had an induction you’ll be in a delivery suite. If you’ve had an epidural or a c section then you will stay in a bit longer and immediately after birth we run through all your observations and baby observations. Get your birth partner to have skin to skin if you don’t feel up to it as it’s so good for babies. A baby’s experience of birth is really unique. They are completely disoriented in this whole new world. It’s cold, light and their body has to do new things. Simply giving skin to skin with baby is comforting; they can smell you, hear you and you can keep them warm. The baby will recognise the sound of your birth partner’s voice if they’ve been around you during pregnancy.
Then we’ll check your baby over. We’ll go from top to toe. It’s my favourite thing to do and every time I think how gorgeous they are. They are so perfect. We are making sure that your baby looks healthy and well. If we detect abnormalities, we’ll call the baby doctor and they will review the baby. This is really rare. Vitamin k is an injection your baby receives. They can have it orally or not at all. It depends on what you’re comfortable with. We’ll also weigh the baby which is really exciting. I always have bets about how much they’ll weight with parents. We’ll document everything and then we’ll offer you some tea and toast. This time is so precious, we call it the golden first hour after birth. Sometimes people ask for visitors quite quickly. If you’re comfortable that’s fine, but just remember how previous this time it is for you to explore your own baby. Always put yourself first. Sometimes it can be awkward but you need to protect that bond and meeting with your baby., You’ll never get these moments back. Block out the rest of the world.
by Suzi Smith •