Induction

NICE guidelines state that induction has a large impact on the birth experience, it is more likely to result in an epidural and assisted delivery.

It is a big decision and always entirely up to you if go ahead with it.

Alternatives could simply be waiting or asking for increased antenatal monitoring including scans, depending on the reason induction is suggested.

It is also your right to request an elective caesarean if you would rather go down that route rather than attempt an induction. and indeed if you’d like to start the induction process with the pessary for example but should that not be effective then move to caesarean at that point.

It should be clinically justified, i.e. there should be a reason that it is safer for baby to be born than to remain in the womb and your informed consent must be given that induction is the way that you would like to do that.

1 in 3 labours are induced, 70% for dates alone. It is important to get informed about induction as there is a good chance you will be offered one at some point in your pregnancy.

Methods of Induction

The pessary

Is a synthetic prostaglandin inserted in or close to the cervix to soften or ripen it ready for labour. In some trusts this is offered as an out-patients procedure but in most this is something that you have done in hospital on a ward. Legally they cannot make you stay but this is worth discussion with your midwife in advance. Depending on the method of this, this may be left in for 6 hours or 24 hours and there can be multiple attempts. This part of induction can take a while so make sure you are prepared for a wait and have brought plenty of entertainment with you.

Less commonly used – a balloon might be inserted into your cervix and inflated to dilate your cervix so your membranes can be broken. It’s most often used for women that have previously had a caesarean birth and are now aiming for a vaginal birth (VBAC).

Breaking of waters AKA Artificial Rupture of Membranes (ARM)

Waters can be broken if the cervix is open and you consent to this. This is done using something that looks similar to a crochet hook, (Amni hook) the vaginal exam is the only part of this which may be uncomfortable.

The aim of this step is to have baby’s head make contact with the cervix and help dilation along. Labour can become more uncomfortable after the cushioning of the waters has been removed so have a think about this in your birth plan. Include how you would like to manage your comfort levels. If no surges start, then the drip will be offered.

“The Drip”

Syntocinon is an artificial oxytocin which will cause surges.

Unfortunately, it’s not the same as natural oxytocin in that it doesn’t make you feel happy and full of love as it doesn’t enter your brain, it affects only the uterus. Monitoring of baby regularly or continuously is often suggested when using the drip to keep an eye on how baby is coping with the surges.

Surges from Syntocinon are said to be very intense and have no real breaks in between them as spontaneous surges would. This is very normal and not a reflection of how well you can cope with labour.

Don’t be disheartened if you would like stronger pain relief for this.

The drip and potential continuous monitoring (if wanted) could hinder the ability to move freely, although the wires are usually 1 metre in length and many hospitals have telemetry too. Less range of movement can prevent optimal positioning of the baby and for baby to make the little adjustments to aid birth along.

If you are hooked up to any wires, there are lots of ways be upright and active without laying on a bed. Standing and leaning over the bed, the edge of the bed with the bar up, getting on all fours on the floor (often hospital staff will even assist you to put the bed mattress on the floor for this, talk to them about your wishes! If you do feel the urge to lie down, side lying with a peanut ball can still facilitate space in the pelvis.

Tips for a positive induction

That you have weighed up the risks and benefits and decided this is the right decision for you, as an informed decision and not a coerced one.
Read positive induction stories.  Highly recommend Holly’s
Always think of your environment and supporting your hormones
Remain upright and active where possible. 
Make sure your birth plan covers all possibilities so that you feel calm and prepared.
Ensure your birth partner knows all your wishes and is prepared to manage the space and anyone in it (COVID restrictions allowing I realise)
Communicate with your care providers about what you want beforehand. 
Manage your expectations so that you are ready for a potential long wait and understand each step of the process.