As you reach that final stretch of your pregnancy, your mind will naturally turn to the series of events that is about to unfold, which will result in the single biggest moment of both your and your babys lives. It is so exciting to imagine that moment he or she is placed in your arms for the first time, where you can feel and see eachother for real.
What you might never expect is that journey to start in a more artificial sense, more white walls and metal beds than candles, incense and aromatherapy. Induction of labour may be recommended by your medical team for a number of different reasons.
Firstly here are some facts:
- Induction of labour is common! It is undertaken in 1 in 5 of all deliveries
- It can involve mechanical or medical methods to start labour off
- At any point after induction begins, natural labour may continue the process and therefore no further intervention required
- In certain situations, induction of labour can be started off and the woman allowed to go home for a while
Reasons for Induction
- Overdue – in the UK it is common practice to arrange induction of labour if natural labour hasn’t begun before around 40 weeks + 10-14 days (the exact number of days varies in different hospitals). This is due to the risks of prolonged pregnancy resulting in higher rates of stillbirth and complications affecting the mother and unborn baby.
- Prolonged rupture of membranes (broken waters)
- The sac of waters around the baby protects it from infection getting in. Once this protection is breached there is a risk of infection causing fever to both mum and baby
- Gestational diabetes, pre-eclampsia, obstetric cholestasis or other complication of pregnancy
- If it is considered more risky to continue pregnancy, induction may be offered.
Methods of Induction
Step 1: Cervical Ripening
There are several options for the first part of induction of labour, all are usually used for 12-24 hours and include:
- Mechanical induction – a balloon is inserted into the cervix and inflated to manually stretch the cervix.
- Vaginal medication – usually delivered by pessary (similar to a tampon) or a gel
The aim of the above methods is for your cervix to soften, shorten and open up enough to reach the next stage.
During this time you should begin to have some contractions which may feel mild and manageable at first. You can help to keep the process going by mobilising as much as you can, and making use of the stairs!
If you are contracting really strongly or your waters break, your practitioner may choose to examine you earlier. Otherwise they will usually wait the full 24 hours.
By the end of the process, ideally your cervix should be 2-3cm dilated with a soft cervix so your waters can be easily reached. If not, then this step may be repeated again after a 24 hour break. Therefore it may take a total of 72 hours to complete Step 1!
Step 2: Artificial Rupture of the Membranes (ARM)
The next step is break the waters with a small hook. By releasing the water that keeps the babys head floating, it allows gravity to cause the babys head to push on the cervix and encourage further contractions.
Step 3: Active labour
Now is the important, and painful bit! With your waters broken, and having had a bit of stimulation to cause your cervix to open you should already be experiencing some contractions which will continue to get stronger and more frequent.
If the contractions aren’t quite frequent or strong enough (3-4 every 10 minutes), then a drip called syntocinon (or pitocin in the US!) will be started. However this requires continuous monitoring of your baby. The drip will continue until your baby is born, which may take around 8-14 hours.
It might be a good time to think about your pain relief options as the drip can make your contractions stronger and longer!
Disadvantages of Induction
Traditionally the risks of induction have been cited as increased risk of caesarean and instrumental delivery. However, a new study questions this traditional view. This study of 6000 women, showed that induction of labour actually reduced the rates of c-section as well as complications of late-term pregnancy.
Although this is early days since the study and many more are needed before we conclusively change practice, there are still important messages we can take away. This is namely that induction may not be as risky as we thought.
Whilst the ideal birth may be a natural delivery with a labour that starts spontaneously, sometimes nature needs a little helping hand.
Should I have an induction if I go too far past my due dates?
One of the questions everyone asks themselves as they reach those hideous final weeks of pregnancy is:
“What will happen to me if I don’t go into labour?”
I am aware that many countries have different advice in this area, but the following applies to the UK and information is taken from @nhsenglandldn .
⏰Will this apply to me?
This advice is relevent if you and baby are both healthy, there are no medical concerns, you have not previously had a C-section and you have one baby on board. If any of the above doesn’t apply, then the advice you will recieve from your team is individual to you!
⏰Why is it dangerous for my pregnancy to be prolonged?
In extremely rare cases, sudden unexplained stillbirth in pregnancy can occur. We know that the risk of this happening increases past 41 weeks from 0.018% to 0.51% over 43 weeks. (risks taken from this Cochrane Review)
⏰When will I be offered induction for prolonged pregnancy?
NICE guidelines advise induction between 41 and 42 weeks – the exact threshold day is decided by each individual hospital.
⏰What are the risks?
There are some suggestions that an induction may increase your risk of C section or instrumental birth. A recent Cochrane Review from 2018 into induction for prolonged pregnancy questioned this, and shows that the risk of C section is not increased, although there may be a marginal increase in instrumental deliveries.
It may also be more painful so you may require an epidural and you will need continuous monitoring once in established labour (4cm+)
⏰What if I don’t want induction?
It is completely your decision whether you want to go down this route. If you choose, you can await spontaneous labour you may be advised to have regular CTG monitoring of your baby after 42 weeks.
Induction can be painful and long, but can help to achieve a vaginal delivery in an otherwise risky situation. Whatever happens, remember that no-one stays pregnant forever!
One way or another your baby will be with you soon, even if induction is a long and drawn-out process, it will be SO worth it in the end!