Inducing labour

Your induction is booked, you rock up to the hospital for your morning appointment, and you’re out by lunch with a baby in your arms, right? Yeah, probably not, says Kelly Eden-Calcott.

It’s perfectly normal for pregnancy to be anywhere from 38 to 42 weeks, but in New Zealand, if you enter your 41st week, your midwife will probably start planning an induction. How convenient! No more guessing and waiting! You now have baby’s birthday in an easy daytime slot between school drop-off and soccer. Hmm, not quite…

Apart from the fact that hospitals often run late to start with, the induction process can take anywhere from four hours to two or three days. You might even be sent home in some cases. But once you start the induction, you’re committed to getting that wee bub out (there’s no backing out!), so pack your bags with a long stay in mind just in case. You’ll want to bring some food, drink, and something to do, because you and your partner might be spending a few hours stuck in waiting rooms or birthing units with nothing much happening and nothing good on TV (if there even is one).

Kick-starting labour

It seems strange, but experts still haven’t figured out exactly what triggers labour. What they have worked out, though, are the hormones involved. So if you need it, your labour can be given a kick-start, or even completely created using synthetic hormones that mimic what your body naturally produces during birth.

If you are overdue, over the age of 40, have health problems such as preeclampsia, diabetes, or serious bleeding in your pregnancy, or if your waters have broken but labour hasn’t started, you will most likely be offered an induction. Around 20% of births in New Zealand are induced. Like any medical intervention, there are risks, and it’s important you know what you’re signing up for. Waiting for labour to start naturally can seem scary, or annoyingly long, but unless you really need intervention, a natural birth is best by far for you and your baby.

What to expect

Once you arrive for your appointment, there are usually three stages to any induction, which may be used separately or in combination.

First the cervix needs to soften, thin out and open. Your midwife or doctor will rub a hormone gel called prostaglandin on the cervix and then you are usually free to walk around the hospital grounds while you wait for it to kick in. Some women feel period- type pain in their back in this stage, and others have painful tightenings. This stage can feel long and tiring, which you are probably used to by now, having waddled around with a huge belly for a few weeks already, but make sure you eat and drink plenty of uids. Remember, you’re about to give birth, so treat yourself like an athlete before a race and hydrate, hydrate, hydrate!

Sometimes a balloon catheter (a small plastic tube with a tiny balloon on the end) will be used to help put pressure on your cervix too. This rst stage can take a few hours or a whole day – everyone responds differently.

When things get started

Once the cervix has opened a small amount, the next stage can start. If your waters haven’t already broken, your midwife will use a tiny hook (like a crochet hook) to make a small hole in the membranes that keep your baby oating around in there. As the uid leaks out, your baby’s head will hopefully come down into your pelvis, ready to be born. This might bring on stronger contractions. Your baby is on the way!

Finally, the doctor will put an IV line into your hand or arm and slowly release syntocinon (the synthetic form of your body’s natural oxytocin) to get your labour going. Once this stage is started, you may or may not be able to move around much. Hooked up to the IV with a monitor on your tummy to keep an eye on your baby can make it tricky to get comfortable. Things are improving all the time, though, and many hospitals now have waterproof, wireless monitors which mean you can walk around and even get in a bath. So get up when you can, let gravity do its thing, and don’t forget those fluids. You still might have a long time to go.

How long will it take?

It can take two to three days for inductions to work, and sometimes they just don’t work at all, which is when your midwife will discuss your options. Failed inductions often mean a Caesarean will be needed.

Inductions are different for everyone, but generally women feel the contractions are more painful than a natural birth. Depending on what induction methods you have had and how much syntocinon was needed can affect your experience of birth.

Rebecca expected a natural home birth with her fifth baby, but when her waters broke and 24 hours later nothing had progressed, she was booked in to be induced the next day. “It was nothing like my last births. It wasn’t like a natural birth at all,” she recalls.

Rebecca’s labour took most of the day to start. She was given the full dose of syntocinon, and then it was full-on.

“My contractions were very different to what I’m used to. More intense than my natural births. Because I’m experienced with birth, I can usually tell how far along I am. I was stunned to hear I was only 4cm dilated when it felt like I was almost 8cm. The contractions were long and close together, so I thought I was much further along.

“I was much more in control in my previous births. I normally think, ‘I can do this!’ You get a break in between contractions and you can cope, but you don’t get that with an induction. I don’t normally need any pain relief, but I needed an epidural in the end.”

Because inductions are medically controlled, there can be less gap in between contractions (two to three minutes) and the normal relaxing, zone-out endorphins a woman’s brain produces in labour don’t get produced with inductions. There’s no easing into labour; it’s all go from the start. Because of this, more women need epidurals than with natural deliveries. Unfortunately, this can lead to a bit of a medical intervention rollercoaster, where forceps/ventouse deliveries are more likely to be needed and there is a higher chance of a Caesarean.

Avoiding induction

There are steps you can take to try to avoid inductions. Walking is a great way to help baby get into a nice low position. Some people nd acupuncture and massage helpful. Stair climbing is also good to get baby into position and hopefully place pressure on your cervix. Make sure you choose safe options and check with your midwife before you start any methods to try to avoid having an induction.

Before getting induced, you can also ask your midwife about having a stretch and sweep. This vaginal examination can stimulate the body to produce its own prostaglandin hormone and even though it’s a bit uncomfortable, it may mean labour starts on its own.

Dim the lights, move when you can, use the calming techniques you have planned, and have a good support person. An induction may not be the natural birth you were hoping for, but can still be a wonderful, special time for you and your new baby.

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