Updated: August 2019
This post has been inspired by conversations I’ve had with women about their experiences of induction. Induction of labour is increasingly common, yet women often seem to be very mis-informed about what it involves, or what was done to them during induction and why. For example, one woman was told by her obstetrician that induction would involve him using a pessary to ‘gently nudge her into labour.’ Women need to be given adequate information in order to make birth choices; and practitioners need to give adequate information in order to meet legal requirements. I have written about the risks of induction in a previous post so will not repeat myself here. Instead, this post aims to provide some basic information about the process of induction – what is done and why. I would really appreciate input from readers about their experiences of induction – what was done, how it felt etc. I am hoping this post will be a resource for women who are considering induction, or are unsure about what happened during their induction.
In my old 1997 version of the ‘Midwives’ Dictionary’ induction is ‘causing [labour] to occur’ ie. someone causes a labour to occur rather than allowing the baby/body to initiate labour. The dictionary goes on to say ‘this may be carried out when the life or health of the mother or fetus is in danger if the pregnancy continues.’ Of course this statement is open to interpretation and most inductions are carried out because of a variation to pregnancy (eg. postdates) rather than a complication (eg. pre-eclampsia). Regardless of the reason for induction, the process is fairly standard.
Making the decision
The decision to undergo an induction of labour is the woman’s – you can read more about roles and responsibilities in the mother-midwife (or other care provider) relationship in this post.
The National Institute of Health Care Excellence (UK) provide guidance for health professionals about what information they should share with women when offering induction:
- The reasons for induction being offered
- Where, when and how induction could be carried out
- The arrangements for support and pain relief (recognising that women are likely to find induced labour more painful than spontaneous labour)
- The alternative options if the woman chooses not to have induction of labour
- The risks and bene fits of induction of labour in specific circumstances and the risks and bene fits of the proposed induction methods
- That induction may not be successful and what the woman’s options would be.
There are a few things you need to be clear about before choosing to be induced:
- That the risks involved continuing the pregnancy are greater than the risks involved in induction (risk is a very personal concept – see a quick word about risk).
- You are committed to getting this baby out. Once you start you cannot back out, and a c-section is recommended for a ‘failed induction’.
- You are not having a physiological birth. You have intervened and this intervention creates risks that require further monitoring and intervention. There is no ‘natural’ induced birth – vaginal birth maybe, empowering perhaps, but not physiological.
The Induction Process
There are 3 steps to the induction process. You may skip some of the steps along the way, but you should be prepared to buy into the whole package when you embark on induction.
In a physiological birth the baby and placenta signal to the mother’s body that baby is mature and ready to be born – this starts the complex cascade of physical changes that results in the labour process.
Note: If your waters have broken naturally the term ‘augmentation‘ rather than induction is used to describe getting labour started. This is because it is assumed that your body has started the labour process itself. You can read more about this situation here.
Step 1: Preparing the Cervix
During pregnancy the cervix is closed, firm and tucked into the back of your vagina. This means that you can have contractions without the cervix opening. In order for the cervix to respond to contractions it needs to make a number of complex physiological changes. Relaxin and oestrogen initiate these structural changes, and prostaglandin, leucocytes, macrophages, hyaluronic acid and glycoaminoglycans are all involved in softening the cervix ready for labour. You don’t need to remember all of this scientific stuff – all you need to know is that it is a complex process, and prostaglandins are only one piece of the puzzle. However, prostaglandins alone are the focus of the induction process. All of the interventions aimed at preparing the cervix for labour (ripening) either stimulate the body to produce prostaglandins, or introduce synthetic prostaglandins. Prostaglandins are part of the body’s inflammatory response.
Some practitioners offer a membrane sweep during pregnancy to avoid a ‘post-dates’ pregnancy. The procedure involves a vaginal examination where the practitioner places a finger into the opening of the cervix and ‘sweeps’ it around the inside of the lower part of the uterus. The aim is to separate the membranes of the amniotic sac from the lower uterus – this releases prostaglandins. A Cochrane Review into membrane sweeping concluded that: “Routine use of sweeping of membranes from 38 weeks of pregnancy onwards does not seem to produce clinically important benefits. When used as a means for induction of labour, the reduction in the use of more formal methods of induction needs to be balanced against women’s discomfort and other adverse effects.”
When you are being induced your cervix will be assessed by vaginal examination. If your cervix has already changed and is soft and open enough to get an amnihook in you can skip straight to step 2. If your cervix is still firm and closed, attempts will be made to change it so that step 2 is possible. This is usually done by putting artificial prostaglandins (prostin E2 or cervidil) on the cervix in the form of a gel, pessary or sticky tape. Artificial prostaglandins can cause hyperstimulation of the uterus resulting in fetal distress, therefore your baby’s heart rate will be monitored by a CTG after the prostaglandin is administered. You may also experience ‘prostin pains’ which are sharp strong pains sometimes accompanied by contractions. If there are concerns about giving you prostaglandin (eg. previous c-section) your obstetrician may suggest ways of trying to get your own cervix to release natural prostaglandin by ‘irritating it’ (this is the theory behind membrane sweeps). This is done by inserting a balloon catheter into the cervix and filling it with water ie. you basically have a water balloon sitting in your cervix.
Successfully completing step 1 may take a few attempts with re-insertion of prostaglandins. This can take hours or days because you must wait hours before re-assessment and re-insertion. You may respond to the prostaglandin by going into labour therefore skipping the following steps. However, you are still having an induced labour and will usually be treated as ‘high risk’.
Step 2: Breaking the Waters
I realise that this step is not always part of US inductions but I have never experienced this approach, so will stick to what I know… Once your cervix has softened and is open enough to get an amnihook in, your waters will be broken. This allows induced contractions to be more effective; the baby’s head to press harder on the cervix; and may trigger contractions avoiding step 3. I was also taught that it reduces the risk of an amniotic embolism (amniotic fluid getting into the blood system) which is a rare risk associated with induction. There are risks associated with artificially breaking the waters. Once your waters have been broken you can wait a few hours to see if labour starts, or go straight to step 3.
Step 3: Making Contractions
You now have a cervix ready to respond to contractions and no amniotic water in the way – next you need contractions. In a natural physiological labour oxytocin is released from the brain and enters the blood stream – it has two main functions:
- It works on the uterus to regulate contractions
- It works in the brain to contribute to the altered state of consciousness associated with labour and promotes bonding feelings and behaviour
In an induced labour, artificial oxytocin (pitocin/syntocinon) is given via a cannula directly into the blood stream. It is unable to cross the blood brain barrier therefore only works on the uterus to regulate contractions. I have written about the risks associated with artificial oxytocin here along with references. Basically, it can be pretty nasty stuff which is why your baby will be monitored closely using a CTG. Women usually describe artificially stimulated contractions as being different and more painful than natural contractions. Having supported women during inductions I am also convinced there is more pain associated with induced contractions. During an induced labour contraction pattern and intensity increases quickly compared to most natural labours. Women are not able to slowly build up their natural endorphins and oxytocin to reduce their perception of pain. In addition the circumstances and environment that often surrounds induction (intervention, equipment, etc.) can result in anxiety, increasing the perception of pain.
Once your baby is born you will need to continue using artificial oxytocin to birth the placenta. A physiological placental birth is not safe because you are not producing your own natural oxytocin at the level required to contract the uterus strongly and prevent bleeding. Basically medicine has taken over and must finish the job.
In Summary
Inducing labour involves making your body/baby do something it is not yet ready to do. Before agreeing to be induced, be prepared for the entire package ie. all the steps. You may be lucky enough to skip one step, but once you start the induction process you are committed to doing whatever it takes to get the baby out… because by agreeing to induce you are saying that you or your baby are in danger if the pregnancy continues. An induced labour is not a physiological labour and you and your baby will be treated as ‘high risk’ – because you are.
You can read more about induction in my book Why Induction Matters
Hi! In my fifth pregnancy, my blood pressure went up to 145/95 at 11 weeks. It was thought that I would miscarry my baby, but I didn’t. My bp stayed there until 6 months, when it started to rise. At 8 months, when it rose to 190/120, the decision was made to induce. The prostaglandin was inserted at 6:00 Sunday evening. At 6:00 Monday morning, pitocin was started. They continued to increase the amount of pitocin, but labor did not start, and my cervix was closed. They stopped the induction for the night, and started again the next day, with the same result. At that point, they sent me home until the following Sunday, when they repeated the prostaglandin at night, and the pitocin at 5:30 am. At that point, I was at 2 cm, but not in labor. The doctor wanted labor to start before he broke my waters, but at noon, with no contractions, he broke them anyway. I immediately went into very hard, painful labor (and I labor well!). At 5:10, my precious one was born healthy. It was the most painful labor I’ve ever had. During the labor, my bp went up to 245/135!
Thanks for sharing your experience Bonnie. 245/135 is a pretty scary blood pressure :0
No wonder her blood pressure was up with all the stress of forcing her uterus to do what it was not ready to do. Would someone explain to me how all of that extra chemical was supposed to reduce her blood pressure. Was there any attempt to reduce blood pressure with rest medication and counselling during the pregnancy – were you kep in hospital during the antenatal period for observation – those are very high readings>
or may be with 5th child provide home help. I am surprised the baby did not want to get out of there.. What machine was used was it measured with another machine and a different person. Who was measuring the blood pressure? . There is enough prostaglandin in semen to start labour and surely a more pleasant way to bring baby into the world. I am puzzled as to why this level did not harm the baby – something not quite right here.
To birth educator: In answer to your excellent questions: Yes, every attempt was made to reduce my bp with counselling, rest, and meds. Also, child care was organized as my bp continued to rise. I was in hospital on and off, but not as much as usually would be recommended since my husband is an RN, and between him, my mom and a home health nurse, my bp was taken regularly throughout the day. I did have to go in several times a week for various tests. Yes, more than one blood pressure machine and more than one person took my bp. As to why this blood pressure level did not harm baby, I was told first that I would miscarry, then that baby would either die or would have IUGR. They couldn’t figure it out either. I know it was God. There is no other answer.
As to your comment on prostaglandin in semen being adequate to start labor, that sometimes works. Definitely not always, particularly a month early. I am a homebirth midwife now, and I wish it did work all the time!
Bonnie
Well with my sense of humour included ( wry and cynical) it may be depend on whose doing It and if the machine involved was well primed?! I assume your baby was OK? Saturday night on night duty with a full moon and especially lightning and thunder and a relaxed couple would arrive with monotonous regularity and huge numbers (4 years on night duty on Friday and Saturday nights was my experience in a private section of a public hospital). If they were not advanced in labour our message was to send them home with the euphemistic language glass of wine and “nudge nudge wink wink” – in the days before we were able to even say sex?! One couple of doubtful intelligence actually just nudged each other -true story.
To birtheducator: Thanks, my “baby” is 17 now, and gorgeous and talented. She wasn’t entirely unaffected, though. The pediatrician said that she acted as though she were quite premature (reflexes, reaction to light, etc.). Yes, I agree that with a full-term baby, the “nudge-nudge-wink-wink” method often works, but my baby was a full month early, and my body wasn’t about to let her out! Your story about the “nudgers” is hilarious! People! I had two points with my story: one was that sometimes induction is actually medically necessary, and the other is that in my case, pitocin induction didn’t work! I had three days of pitocin induction, which only got me to 2 cm and 50 % effaced. It was breaking my waters that then brought the baby.
Thank you for sharing. I have a client going in for induction of her first child and it is good to hear that a vaginal birth is possible after such an intervention.
Thanks for this Carolyn. I think you’ve written a clear, unambiguous and easily understood explaination of induction – hopefully my own explaination to women & their partners is equally balanced and informative.
You have highligted a very important point: that it is essential for women (and the caregivers who have decided that an induction is warranted) to fully appreciate that the ultimate aim of induction is to birth the baby…that is, if the cervix doesn’t soften or dilate then a caesarian is on the cards. I have seen the induction process abandoned after 2 days of prostin when the woman remains unARMable as noone wants to take the radical decision to perform surgery. We must then ask “was the indication to start induction actually strong enough if it can be abandoned in favour of waiting a few more days? “.
It is also very important that we give women time to fully accept their changing level of risk and the adjustment to care that must take place if we are to be safe guardians of her birth. I think many times, it is a huge challenge for women (and some midwives) who are deeply committed and invested in fully physiological birth to accept that CTG, active 3rd stage and progress/time monitoring (etc) have a legitimate place in circumstances such as an induced birth. That is not to say the birth need be a medicalised circus – we can still create a sacred, calm environment resulting in a positive & transformative experience but we must all respect that the level of risk has changed and our care must be modified accordingly. Getting the balance right is the real challenge we all face.
Finally, I challenge the notion that induction contractions are worse than physiological labour – many women experience intense & overwhelming physiological contractions. I think it is probably the events associated with induction that alter her perception of the contractions and in that way impact on pain perception and coping: continuous surveillance and assessment vs sleeping through or minimising sensations (until the woman herself calls for a midwife/hospital to assess her); concern and stress associated with having a higher level of risk that has led to the induction; the speed of onset and acceleration that can often (but not always) be quicker than a physiological birth – to name just a few.
thanks again for your blog – another wonderful written essay tat gets me thinking
Maxine xx
sorry Rachel, got confused with my bloggers! still think it’s great 🙂
Maxine, I agree with your reply for the most part – this is a fantastic piece Rachel – but I will beg to differ on your challenging of the notion that the induction contractions are not rougher than normal spontaneous labour ones. They are. Only a woman who has experienced both could make this determination with any degree of objectivity, don’t you think? The oxytocin induced contractions do not start softly and build up like the natural ones, and let me tell you they rip through you like a chainsaw in an instant after that drip is commenced. I did not use an epidural during that birth so I feel I can genuinely comment that it was like being assaulted for many hours until the birth of my baby was achieved. For a PPROM at 35 weeks it was warranted, I get that. Compare this with my three other naturally beginning labours that only became unbearable type contractions of the same intensity at the point just preceeding transition, so much less time to cope with that out of control feeling. Anyhow, just wanted to put my thoughts across to balance this point out. BTW, am now a final year Mid student and loathe putting women through the inductions that they beg for!
As a long time practitioner and user of hands eyes and ears when examining women in labour and coming from an era prior to chemicals use I can tell the difference between the strength of labour pains and the perceptions of pain by women and assess correctly. Firstly normal labour starts gently and gradually soft and the musclular tissue is penetratable by gentle pressure. When the graduated contractions of 2nd stage start they feel like a hard brick and last long and strong. When an infusion of artificial synthetic hormone is poured in through a drip those iniitial contractions begin and feel like a brick and do not lessen in strength and are horrible to feel to the touch. There is no gradation. I can only imagine what it feels like – but I recall 2nd stage labour very clearly from my own experience. Epidural is essential in most induced labours – these labours are not fair to the fetus either – because each strong long contraction give pain because oxygen physiologically is absent – just as a heart attack give pain through lack of oxygen. Most babies in the uterus if not being fed properly want to get out. Apart from that there is a great deal of harm caused by the chemicals unknown it seems to most writers – epidural by itself lower blood pressure and requires extra fluid in the system to keep the blood pressure up. All very scary interventions. Of course the artificial breaking of membranes is another story of introducing infection and increasing the pain of labour. The whole story and debacles caused, send my blood pressure up.!!!
From experiencing 3 vaginal births, two of which were induced by gel and later the breaking of waters and one with natural onset, I would have to say that the labour which started naturally and had no interference or monitoring in a very mother directed environment had contractions that hit me all of a sudden with great aggression and no gentle slow pressure build up. Contractions double peaking and one on the top the other and never actually dying down completely. My induced labours were far more calmly progressive and manageable. However, I didn’t need a drip to aid contractions. I really think that the mind plays a huge part in the perception of pain and that women ‘perceive’ that their pain was worse with induction because that is what they read and are told and all the stress that women may feel because they are not having a ‘natural labour’. Maybe the labour was always going to be really painful regardless of how it was started! Once hard active labour started with all 3 of mine the intensity of pain all felt the same between induced and natural onset of labour.
I agree – the perception of pain is influenced by lots of factors. From what you describe you had physiological contractions ie. your own natural oxytocin created them. The ‘drip’ is the synthetic oxytocin and it is this medication that creates contractions women often describe as different and more painful. You had the gel which is prostaglandin hormone to ripen your cervix. You were obviously close to labour anyway and this first step triggered your body to produce natural oxytocin. I am guessing that the labour you describe as starting naturally was not your first baby? Women often find subsequent labours can start more suddenly without the long slow build up of first labours… then again we are all different and so are our labour experiences 🙂
I can only speak for myself, but I was completely ignorant of any difference in contractions or pain between ‘natural’ labour and syntocinon/pitocin induced labour when I had the latter. I was looking forward to labour! Had been for the whole 8.5 months. I really wanted to experience it and was not afraid at all. So for me this ‘perception of pain’ played no part. I had no idea of the differences, ignorant as I was. Now… second time around, having experienced the syntocinon… I am not looking forward to that again and will be bargaining with my Dr on monday to try everything BUT that. I’d love a spontaneous labour, if only to explain my first hand differences in experiences to my daughters in 20-30 years time. But if it doesn’t happen in the next 6 days I will be induced again. I’m ok with this, ultimately. But will surely be avoiding that nasty syntocinon if at all possible!
Thanks Maxine
I agree re. pain is largely about perception. I think increased perception of pain during induction has a lot to do with not getting into the altered state of consciousness via natural oxytocin + endorphin, and with the events associated with induction.
ps. I am quite happy to be mistaken for Carolyn 🙂
Awwwww “blushes” I’m secretly thrilled Maxine thought the post was mine because I love your blog Rachel! <3
Are you making the assessment that induced contractions are the same based on any personal experience or are you just assuming? I don’t think many women who have experienced induced contractions would agree……. An interesting theory that the natural oxytocin isn’t present and therefore women have less natural hormones to help them cope, but I still don’t agree that it is about perception of pain. I think that is why in many hospitals that induction is an indication for an epi
From a physiological perspective a uterine contraction is a uterine contraction and oxytocin whether synthetic or natural acts in the same way ie. oxytocin receptors in the uterine muscle respond to the oxytocin then create a contraction that starts in the fundus and waves down the uterus. Uterine contractions are usually more painful for women despite the fact that the physiology is the same. This is probably due to a number of factors. With a natural labour contractions usually slowly build up allowing the woman to build up endorphins. With induced labours the syntocinon is cranked up every half hour until regular strong contractions happen – often only taking a hour or two. Induced contractions can be too strong and getting the balance between contractions that work and contractions that are too strong is difficult – so often women are experiencing contraction strengths that they would not naturally create. So, it is the context of the contraction pain that makes it more painful because the physiology is the same. Epidurals are often ordered along with an induction because it is known that women experience more pain. Personally I think any woman who gets through an induction without an epidural deserves a medal – I wouldn’t do it.
I agree with what you are saying Rachel, a contraction is a contraction. I also agree that they are pumped up to make them very strong very quickly and therefore many women don’t cope with that in such a short space of time. I don’t necessarily agree with Maxine’s assumption that it is about perception of pain. I do agree that some things help us cope better and worse that are about the mind, but I think the overwhelming anecdotal evidence from women who have had inductions who have found them unbearable in comparison to their un-augmented labours can’t be ignored
I need a medal then…..x….
Ditto! 18hrs…
“Personally I think any woman who gets through an induction without an epidural deserves a medal – I wouldn’t do it.”
Boy, how I agree with that!
I went from a failed induction turned cesarean with my first baby, to a home water birth with my 3rd baby, and in my personal experience (which means nothing scientific, but helps the story) pitocin contractions are hell on wheels compared to non-induced contractions. In my professional experience as a doula, I can also say the same. Even my clients WITH epidurals cannot often handle the pain caused by a pitocin-induced contraction. They are horrendous. Of course, I think what really contributes to the Pit-pain is everything else that surrounds the procedure. If she’s got Pit, she’s more than likely strapped down with CEFM, and we all know that strapping a laboring woman down creates a lot of anxiety and more physical pain than allowing her body to be upright and mobile. Of course, the brain is also not releasing those awesome beta-endorphins that accompany natural oxytocin production either. I’ve known few moms who can handle Pit contractions without the epidural, and they honestly blow my mind. Huge kudos to them.
I have to agree with this 100%! I have been induced with all three of my children….1st one out of ignorance and doctor’s schedule, and the 2nd and third because of failure to progress with concerns due to gestational diabetes…after being 4+ cm dilated and 70+% for 2-3 months with each….my body never progressed even with pitocin until after my water was broken. With the 1st 2 I was “strapped down” and it made me crazy…far more than the third where I was “allowed” to get up on my hands and knees (more like I didn’t care what they said and did it anyway…) where the baby instantly dropped and I went into HARD labor….pitocin levels were way too high for all 3 leading to back to back to back contractions the entire time I was in active labor…luckily each one only took 20-40 min to push out! I did not have an epiderural, it was not an option I was willing to consider, but man did the nurses try to convince me! Poor ladies got their heads chewed off several times in the midst of labor for that one…
I did it. I opted to have a natural birth without the epidural. However, as my labor did not progress, my baby became distressed, so they recommend pitocin. As soon as they started the IV, my contractions went from painful to extremely unbearable pain, I really thought I was going to die. I never accepted the epidural. Later, my OB mentioned how rare it was to go that route (pitocin – epi). Im really glad I did not have it as it allowed me to be free from the confines of a bed and labor all over the room, bath, stool, ect.
well, I just think that each birth for each woman is different and sometimes even a physiological birth can be intense and challenging: too fast, too slow, too “whatever”- and perception of pain is heavily influenced by the circumstances surrounding the birth. I don’t mean to minimise a woman’s experience of induction by my comments – just that the uterus contracts strongly and intensly for every labour (spontaneous and induced) , and perhaps the perception that the pain is worse in an induction is more to do with the associated factors as I listed in my original post. it’s based on many years of reflexive practice – observation and reflection on women’s birth stories/debriefing/sharing with me
That may well be the case Maxine, but pain is whatever the woman says it is. And we know that pain is so much more than a physical experience. So even if the lived pain experience is worse because of the associated factors you mentioned, and not purely physical/physiological ones, this is still the woman’s experience of pain, and is no more or less valid than the pain experience of normal contractions.
exactly – what she says it is is what it is.
Very interesting Maxine – I’ve has similar experiences with my hypno Mums. Expectations and emotional state change perception of pain and I’ve had lots of Mums go through induction without needing an epidural and they found it manageable. I’m a 3rd year student Midwife and I find that women are told to expect induction will be unbearable and will need an epidural by staff and by other Mothers. Mums in our care are in a highly suggestible state. Why not ‘suggest’ to mums that inductions can be quite manageable for some women and they do great without an epi?
suggesti
thanks Tracy, you seem to understand what I’m saying – I do hypno preparation with women too and perhaps thatis what guides and influences my attitude to a woman’s expectation/perception/experience of her birth
Good thinking! I agree!
Gotta say that most women (myself included) would beg to differ about induction and physiological contractions feeling the same. No way on earth! For whatever reason, be it the altered and fearful circumstances which dry up the endorphins, or the dosed, relentless application of strong hormones, most women who go down the prostins/syntocinon route end up needing an epidural. I do think that, as hospital midwives, we owe it to the mother to explain as gently and positively as possible, alllowing her to have time to absorb the (full) information. We should also allow her to say “no” – something which is often not an option when accompanied by horror stories about what might happen if we waited. The most common reason for induction is “post-dates” which is often based on faulty or lazy calculation of gestation in the first place.
Thank you so much for this post. It is a great fact-filled summary of the process of IOL in hospital, and one I’ll be able to recommend to women in general, and my follow thru’s, if they are considering induction. I’m a 2nd year BMid student and I’ve just finished a 4 week block of clinical placement. I saddened me that so few normal, uninterfered-with births occurred – didn’t surprise me, but saddened me nonetheless. I’ve had 2 kids to date – the first born at 43+1, the second born at 43 weeks. I did have monitoring with the first, but not the second. The cultural pressure was there to be induced, but I wasn’t interested in the alternative, so I waited. What else was I going to do? I’m so very glad I did. And so very grateful for my wonderful, trusting midwife who was willing to wait with me.
So many women are surprised when I say how long I’ve been pregnant for. The usual incredulous response? “They let you go that long/far over?!” My response? “Who is they? It’s my body, my decision, my baby and we were fine so I chose not to fix what wasn’t broken.” The usual reply? “Wow, you’re brave/patient!”. “No. I’m stubborn/trusting/it’s sheer bloodymindedness!”
(And for the record, I can tell you about 4 points in my first labour/birth or even before where I would have been ‘recommended’ for a C/S – an unnecesserean as it would have been.The fortitude and support I had which allowed me to birth my first normally has changed the course of my life forever, for the better. I don’t know the path not taken, but I suspect I’ve seen it a number of times in others, and I’m glad I chose not to walk that path. I am forever grateful to my midwife/midwives who took the path less travelled with me and facilitated an empowering birth which has made me feel I can do ANYTHING!)
“which has made me feel I can do ANYTHING!” Love it!
I love the ‘road less travelled’ comment too! Any ideas how to make it a superhighway?
One at a time Carolyn…at least that’s what I tell myself (over and over again, especially on placement!). My mantra this year has been ‘starfish’ (see link… http://www.facebook.com/note.php?note_id=184161658288110 – I am unable to determine the original author of this story, nor it’s truth in fact, but the analogy remains valuable nonetheless).
It’s a bit like direct selling I guess – one person buys a product, shows it to their friends, their friends show it to their friends………… I hope, at least.
You awesome, experienced, wise, privately-practicing midwives who write easy-to-read and access, evidence based and referenced blog articles that we can post links to for other students, or on facebook – you are the ones allowing us inexperienced ones to share the reasons and logic behind taking the different road. You have seen what we haven’t, and sharing your knowledge allows us to make a difference in our own and others’ lives.
Thankyou.
hopfully me too!
Hi there, this is a very timely reminder for me. I live in Qld and am currently 30+4 weeks with number four. All of my children have come into this world via induction. With both our boys I ended up with an epidural and my daughter came so fast there was no time for much apart from gas. I am almost certain that my first induction should never have happened. My body was not ready but without realising it, my midwife (he was born in NZ) was very much into intervention. She had too many clients and I sincerely wish I had seen that at the time. Needless to say, his birth was the most traumatic (vacuum extraction) as he was coming out the wrong way up and an epidural that made my legs so dead they had to be in stirrups. All of this made for a hideous experience which I am working really hard to move through. This time I am determined to let my body and baby do what it needs to do. There will be no medical intervention (unless there is a ‘medical’ reason for the baby or myself). Our bodies are made to give birth and I owe it to myself to trust my body for my baby and I, and our wellbeing. I always thought birth plans were something for those who had big aspirations but I will be writing a very basic one for this time. I give thanks to my husband who is an amazing support person and more than prepared to support any decision made. Thank you for a great piece of information for all those considering induction. Even though I have had three, all three have been different. I am so pleased to have found your page and look forward to reading your blogs.
Thanks for sharing Sacha. Check out 10 month mamas on facebook for some support. I am a mum who has birthed at 43+1, and again at 43 weeks. I know the pressure to induce, and what it took for me to wait…and wait…and wait! It can be done, but it requires mental readiness, preparation, support from significant others, and an understanding of the alternative (which you are already very aware of!). Good luck this time around.
Thanks Anna. I will check out that page. I had a midwife visit today at the hospital where we wrote a very short birth plan. I told the lovely young midwife that I would like to avoid an induction this time as all three of my previous births were induced. She was very supportive of my wishes however did state that they would not let me go past 40 +10 days as research had shown the placenta starts to fail after this time and the baby doesn’t get the oxygen and nutrients it needs. I thought at the time hmmm … this sounds like standard jargon to me. I obviously isn’t too harmful if there are mummies who have delivered significantly later than 40 + 10. So, as it stands they are supportive to a point but I wonder as time draws closer, how they will approach my stance on induction. Will keep you posted :o)
Ask her to show you the research… There is NO research that supports the theory that a placenta shuts down at a specific point in pregnancy. This is only a theory and one that Sara Wickham does a great talk on ie. how stupid it is. The placenta doesn’t have a best before date. I have seen juicy healthy 43 week placentas and scrappy calcified 37 week placentas. Term is 37 to 42 weeks – even by text book standards 42 weeks is normal. This mis-information makes me fume (can you tell).
“they would not let me go past 40+10 days”… what are they going to do physically enforce an induction or c-section and get charged with assault and battery?
It is not their job to ‘let you’ do anything or tell you do do anything. They provide information, you make a choice, they support your choice – easy.
Looking back, it was a miracle that I wasn’t pushed into a C-section at the last minute like so many induced births are. I was very overweight. The doctor’s visit that I initially went in for ended in the hospital a week before my due date because the “baby wasn’t moving enough.” I later found out that the reason for that was because I was in the initial stages of labor. I was hooked up to a blood pressure monitor all night, which painfully took my blood pressure every 30 minutes- effectively removing my ability to sleep the night before giving birth. Exhausted, the next morning they started me on Pitocen which began to speed up the little bit of labor I had left, since my body had almost completely stopped contracting on its own. The doctor then broke my water as the nurse kept upping the amount of Pitocen going into my system. The shock and pain of all of these things happening at once, though I didn’t want one, had me asking for an epidural. This was the first time I was able to sleep in 36 hours. This rest allowed my body the time and resources it needed to hurriedly get ready enough, though everything was still so rushed. Nurses came in every two hours to check my cervix. I prayed the whole time that my body would just cooperate and I wouldn’t have to get a C-section.
I’ll finish this part of the story just by saying that I did give birth to a healthy little girl. I was so exhausted and disconnected from what had happened that it didn’t even seem real. I couldn’t bond with my baby. I couldn’t nurse. This only spiraled into a postpartum depression that got worse. I fought depression and pumped for four months trying to learn how to nurse before we finally figured it out. There is nothing I have faced worse than my baby screaming because she was hungry, and I was there ready to feed her, but we couldn’t figure out how. In my mind, at least, that lack of bonding and problems with nursing all seemed to come as a steamroller effect beginning with induction.
Great post as always Rachel. You always seem to come up with exactly the right information at the right time for women. Given the latest figures on the rate of induction in this country it is so good to have this resource to help women and their partners know what is involved with what seems like such a simple decision. I’ll be sending this information far and wide!
Hi Denise! I guess the hardest part is making the decision to induce or not and weighing the risks…something that isn’t easy when you’re carrying another little you around in your belly. Thanks for this detailed post and I have a copy of your dictionary right beside me 🙂
Adina, your story is heartwrenching. Sadly, you are not alone with your feelings and your reactions after such an experience and you are right, induction is the beginning of that roller coaster for many women (too many and increasing as induction rates skyrocket). There are many aspects to the way that the induction process influences the bonding and breastfeeding complex – hormonal level changes, intracellular and intercellular fluid level changes and other complex changes in all physiological and neurological interactions from the minuscule to the huge ‘system communications’ for both mother and babe. I do hope you have been able to heal from that time of disconnect and that your relationship with your daughter is improving in leaps and bounds.
“Basically, it can be pretty nasty stuff which is why your baby will be monitored closely using a CTG.” You’ve got that right; pitocin isn’t even approved for the FDS for labour induction or augmentation!
http://www.birthroutes.com/home/2010/5/30/pitocin-not-approved-by-the-fda-for-elective-or-non-medical.html
My membranes released spontaneously at 39+5 without contractions. As I had tested GBS+, this put me in the high risk “you-need-to-be-induced-RIGHT-NOW” category. I resisted being induced (i.e. with syntocinon) for several hours until they finally bullied me into taking prostaglandins, which was presented to me as a “reasonable compromise” option. Naturally the waterbirth I had planned was off the cards now, except that 24 hours after my SROM and about 6 hours into established labour the obstetric nurse on duty “let” me get in the bath. (She didn’t believe my birth process was established yet.) I experienced as close to a “normal” birth process as you can get with an induction (i.e. no AROM, no synto until third stage, but plenty of interventions on the side like VEs, CTGs, and other standard hospital fare), and it was the worst experience of my life. One of the things that upsets me so much 4 years later is the way they made it sound like induction was so urgent, and that I was taking such a dangerous risk by refusing it, and yet once they had determined that I was one of those pesky patients who wanted a “natural” birth and would resist all suggestions for intervention, they left me more-or-less alone until I was pushing a day later. What happened to the urgency? It wasn’t urgent at all, they just wanted to feel like they had control. If only, if ONLY I had not agreed to the gel! (Or better yet, if only I’d stayed home in the first place…)
OK folks – I’ve added a bit to the posts about pain because I obviously didn’t make it very clear first time around.
Thanks everyone for your input – especially the birth stories. I know that women find other women’s experiences extremely useful 🙂
I guess this post raises many issues in additon to the original (improving awareness of the process of induction). One thing that often strikes me is the lack of questioning about a particular investigation & what might happen if the result is other than normal or what we want…when we check the nucal fold on USS, measure a woman’s blood pressure, do a GCT or GBS swab, USS to check the placement of the placenta (to name just a few of the multiitude of antenatal investigations) it is to assess for the presence of pathology that might need further monitoring or treatment. I don’t think enough explaination about these tests and the subsequent intervention that might be offered/suggested/insisted upon takes place prior to the investigation.
At the end of pregnancy, it is not uncommon to have the fluid around the baby measured (AFI) – if the level is adequate, it gives reassurance that an induction is not indicated and waiting a couple more days for spontaneous onset is an appropriate choice; if the level is low it means the placenta is probably declining in function and induction is appropriate. Despite this, oftentimes the AFI is done and the results disregarded. I think to be a good midwife (obstetrician) we must always start by practicing “expert inactivity” but also acknowledge when the process has deviated from normal. This means acknowledging the value of (judiciously applied) intervention and medical technology and help support and guide the women for whom we care in the grieving that invitably takes place when the birth is no longer the one they had planned & fantasised about
I was so young (well 25) and clueless when I had my first. He was due on the 11th December and they told me that I would have to be induced on the 15th. No one ever said why, but I think now that it was to do with Christmas approaching and staffing levels. Ended as an emcs as my son didn’t like either the syntocinon or the epidural.
A client of mine was taken into hospital on a Sunday evening to be induced because she had OC. She was told that her baby would die without induction. They gave her gel on Monday morning, again in the early evening. Forgot about her all day Tuesday because they were too busy. Wednesday she fought them to go home for a few hours, which they reluctantly agreed to after telling her her baby was a great risk. She reminded them about Tuesday. Wednesday evening more gel. Thursday morning more gel, Thursday evening syntocinon. The baby was finally born on Friday morning. She said to me “They scared me into it by telling me that my baby would die and spent five days ignoring me, except for when they put the gel in.”
Thank you for such a great article about induction. It is now in my resource pack to give to clients that want to know what induction is all about.
Mars xx
I had PROM at 36 weeks, and after 48 hours was told to go into hospital “to be checked”. When I got there a junior doctor said that she was going to do a VE “to check whether my waters really had broken”, but I declined, saying that if they hadn’t, all well and good (they – er – had), and if they had, well we would be introducing bacteria which was a really bad idea. She said that it didn’t matter as they would be inducing me later that day! I’d gone in to be “checked”!.
I said that I wasn’t prepared to be induced, and she told me that it was dangerous. I asked why, and she didn’t really know, but just said that induction was just what they did.
I was then referred to a more senior doctor because she really didn’t know what to say to me. Cue a lot of pressure to go for the induction, because the baby could be at risk of infection.
I then started ask – what was the risk of infection? What was the potential problems that might happen if infection set in, and what were the chances of infection? She argued with me that I was putting my baby at risk (blah blah, we all know this stuff) and then passed me to the senior obstetrician in the area.
When he came to see me, he was brilliant. He actually explained the risk – that infection could be very serious or even life threatening to my baby – but that the risk of an infection setting in was small, and he acknowledged that the risk of induction and the risk of complications from thiings like CS were also significant, and much more likely to happen.
I then asked what turned out to be the critical question, which was when a mum’s waters broke really early in pregnancy, they couldn’t induce so what did they do? The answer was to keep a careful eye on the baby with monitoring, and to carefully watch mum for infection by regular (2 hourly) temperature checking and blood tests. If anything seemed to be going wrong then we were to keep an open mind about options. It was also recommended that I had IV antibiotics in labour to sweep up any infection which may be starting, and while I wasn’t happy about this, I felt that it made sense.
In the end I went into SL 5 days after PROM at just 37 weeks. I had a straightforward labour, TENS machine for the first half then pool for the second, and my little one was born peacefully and serenely underwater with no damage to me at all. He was a bit squashed and stiff from being without fluids for so long, but some cranial osteopathy helped that over the next few weeks.
He’s just turned 1, and tragically a few weeks ago there was a big news story locally about a baby who had died post delivery following a mum delivering several says after PROM. From what I can gather from the news (where obviously you can’t actually know what happened), the mother was somewhat left to her own devices and not properly monitored. Even so, we were aware that we were taking a risk – and some might say that you should never risk your baby’s life – as they drive their little one home from the hospital. Nothing is risk-free and for us, the risk of induction was a much higher risk than the risk of infection, which is a hard decision to make when the risk of infection can be so serious.
My husband and I essentially forced the hospital into giving us what we felt was a pretty basic standard of care, and by doing so we created a lot more work for them. Sadly, I feel that it is only because of this that induction following PROM is the way people are strongly impelled to go, because to ensure that the very best is done for the baby without induction, careful monitoring seems to be essential, as well as trust in the parents that they will actually tell the doctors if signs such as a raised temperature are starting. Let’s face it, doctors don’t tend to trust women 🙁
I wanted to write my story to show that induction isn’t always forced on parents, and asking “why” means that you CAN, sometimes, actually be involved in your own care. It was not a walk in the park. It was one of the most stressful weeks of our life. But it worked for us.
this is a great post – thanks for sharing – and really highlights the importance of asking “what if” when exploring all options and weighing up risk (and what constiutes a risk for YOU, not necessarily the staff). Well done for having the sense to ask ask “what happens when water break really early in pregnancy” because it is something I have thought of too – that some women sit around for weeks with ROM waiting for the baby to grow but others are whisked in within hours of induction “because it’s a risk to wait”. It takes real courage and fortitude to stay the course of your convictions, and also it sometimes takes luck to encounter thoughtful staff that consider your input in the decision making process.
I think if there is honesty from the Doctor in his answer ( a bit of heart), then the outcome is wonderful…
When I asked ‘why’, I got a lie…and believed it…..So it depends again, on who is answering and if you are well informed yourself. If you are not, it is easy to fall into the trap of ‘Doctors know best’ as long as my baby is safe…..Thanks for sharing your story.x
I don’t know where to start with my “story” it could be quite long. This is a fantastic blog and I thank you for outlining the information in an easy to read/understand way. I would love some input from you about my induction. I started latent labour naturally at 40 6. I didn’t know at the time but my dd was back to back. I continued to contract until 40 12, contraction were never further apart than 30 mins but very often were every 2.5 mins sometimes for 6 hours. I managed the pain (I have HMS and SPD) for the six days with bath after bath and a tens and paracetamol. On 40 12 I had SROM in the bath and was advised I needed to be checked over. At the hospital they discovered meconium in my waters so sent me to the labour ward (from a birth centre). They discovered that not both parts of my waters had broken so AROM on the other part, I was two cm dilated. They attached a syntocinon drip, I never once contracts regularly and five hours later the contractions were out of control (i had an epidural at this point) and going 6 in 10 mins then 1 in 10 if they turn the drip down. The circus of internals, drs checking the trace ect ended 16 hrs after it stared by EMCS. I had dilated to 8 cm in that time but my babies heart beat had dropped and she was in distress:(I had so wanted a natural birth. I know now that one intervention usually leads to another and so on but I can’t decide at what point my first intervention happened? How could I have stopped it all spiralling out of my control? I did visit the hospital twice in the six days before the induction and was turned away because I wasn’t in established labour so I was examined on each occaition. They also used the CTG at one of the visits because they didn’t believe I was contracting as frequently I said and not progressing well for the duration I’d been in latent labour. So was my first um necessary intervention the first visit to hospital, the first internal, the paracetamol I took at home? The subsequent hospital visits, the other internals? The trace? Where does it start? I think as I’m writing this that it might be the first internal/visit. If I didn’t know at that point I was only 1cm and cervix not favourable then mentally I might have progressed naturally? Can anyone give me any information or thoughts on my experience? Sorry it’s so long.
Shelley. You did nothing wrong. You didn’t fail. You did exactly what you needed to do in a trying situation. Others with more experience may be able to shed some light on your birth, but you need to know you did what you needed to do at the time. It’s hard, and it can’t be changed, and hindsight might be useful, but it doesn’t change the outcome for this birth. I wish you peace and healing from, and acceptance of, a difficult situation, and that you can take the pressure off yourself.
Thank you Anna, I know a lot more now and I plan to home birth my next. Hindsight is useful and I will learn from it and move forward. I guess I just want to know if it was all inevitable form the start or if I made it happen, but i’ll never really know.
Thanks Anna – exactly my thoughts.
I am sorry that your birth experience was like this. It really is impossible to say what might have happened differently – hindsight is a wonderful thing. You did the best you could with the knowledge you had at the time.
In the US, I was told that I *could* leave the hospital after a failed induction, but only if my water had not been broken and I did not have an epidural. Also, I would not be given another scheduled date for induction – so if my pregnancy continued past the point where I was comfortable, I would not be given another date/appointment. The key is that the water not be broken, and my understanding is that it is in most induced labors (only after labor is induced by some combination of prostaglandins/synthetic oxytocin), because the chemicals are not usually enough to get labor going on its own.
Some hospitals will abandon an induction but that just reinforces the fact that induction was not necessary ie. that the pregnancy continuing does not put the mother or baby at risk. When I first started midwifery we used to administer prostaglandin then after a few hours send the mother home overnight to come back for her next dose in the morning. However, there have been a few deaths associated with mothers going home after prostaglandins. So, the hospital changed its policy and everyone had to stay in until the baby was born.
My story’s similar to Shelley’s — the day after my due date I had partial PROM (a very tiny amount in retrospect), followed by latent labour, pressure to be induced due to infection risk (which I resisted), finally agreed 48 hours later for the rest of the waters (which had “thick meconium”) to be broken, then after nothing else happened a few hours later, agreed to oxytocin drip. Cue several hours of the most pain I’ve ever experienced in my life before I could get an epidural, then told not to push at 10cm even though the urge was strong, then directed pushing right after epidural top-up, baby never really moved, and the whole thing ended in EMCS after I refused to let them at me with the ventouse.
By that point I needed a known outcome and EMCS seemed like the best choice (how bad does it have to be that EMCS starts to look attractive!) Thankfully the baby was never in distress but I certainly was. Have recovered from the EMCS but as the whole experience was so far from my desired homebirth, I’ve been left wondering if I could have done anything different, or was my baby destined to be born by CS?
Not gone into hospital after waters had broken? (I did because I had a low-lying but safe placenta and was told I had to go in if I had any bleeding or waters breaking). Waited for rest of waters to break naturally? (They were afraid of cord prolapse, so that’s how it was sold to me to have ARM). Not agreed to be induced? (By then I was told I had no other option and I was out of energy fighting against it).
What are the choices really when you’re faced with these situations? I’m planning to get a copy of my notes and have a birth debrief but I honestly would like to know what other options I could have had.
You did the best you could with the mis-information you were given. I suggest you take someone with you to your debrief to write things down – as often you forget what you are told. I also suggest you talk about this with someone outside the hospital ie. an impartial person. I makes me angry that women are left with all these questions after their births 🙁
Just curious then — if there is a small PROM (forewaters I believe it’s called?) and no labour forthcoming, no other complications or health risks, what do you advise women to do? Monitoring for infection… for how long is it safe? When does induction become a useful thing to do — or should it be avoided at all costs (which is kind of how your original post comes across?)
I don’t give advice only information 😉
Read this post http://midwifethinking.com/2010/09/10/pre-labour-rupture-of-membranes-impatience-and-risk/ it might provide you with more information about this situation. Induction can be a useful thing and can save lives. Some women will choose to be induced even without a medical indication, and as long as they are fully informed – it is their choice – no judgement from me. Safety and risk is an very personal and individual concept.
By the way – it is called ‘augmentation’ when your waters have already broken. Not sure why as it is basically the same thing.
While I quite agree with all the principles of your article (even though four of my six labours were induced), I have to take issue with the term “physiological birth” much the same way I take issue with the term “natural birth”.
Physiological is defined as, of or pertaining to biological functions, or consistent with the normal functioning of an organism.
Whilst my labours may have been induced or augmented, the process of the baby getting out was most certainly a normal, joyful and extremely biological process in which I was fully engaged and which resulted in babies being born vaginally, happily and healthily. However the labour was begun, the births were all normal and uneventful. It’s ridiculous to define that as somehow non-physiological. My personal anecdata aside, it’s alienating to women who have undergone medicalised births to somehow imply that their births are “less than” by appropriating language that actually, really does still apply to them.
I am sorry if the word ‘physiological’ is taken as a judgement. That is not how it was meant – there is no ‘less than’ or ‘better than’. But, I will continue to use the word because I like to call a spade a spade and be honest with women. Although an induced labour can be uneventful, normal, joyful, even empowering – it is not physiological. Natural oxytocin is released differently and is able to work on the brain (vital during a physiological birth). Artificial oxytocin only works on the uterus as it cannot get through the blood brain barrier. Induction is not ‘consistent with the normal functioning of an organism’. If you want to know more about the physiology of labour hormones check out the work of Sarah Buckley (you can download her ebook here) or Michel Odent (you can find his research depository here). Moberg has also written a book about oxytocin and it’s behavioural effects in mammals (and humans) –
the oxytocin factor.
I think it is unfair to pretend to women that the physiology is the same. Some women want to know why they ‘felt’ different during and after an induced birth vs a physiological birth. In some cases they also deserve answers about why breastfeeding may have been difficult, or they found it difficult to bond with their baby (ie. they did not get the behaviour effects of natural oxytocin). There is lots of research going on at the moment looking at the role of oxytocin in bonding, breastfeeding, postnatal depression, autism etc. I hope I am not alienating women by being honest but I can’t pretend the physiology of an induced labour is the same as a physiological one and deny the science.
Are, here is the bit I was searching for, that natural oxytocin works on the brain whilst syntocinon can’t cross blood/brain barrier. This made so much sense to me when I read about oxytocin, as to why IOL’s are so much more painful. I wish Obstetricians would read about oxytocin rather than deriding midwives’ knowledge of hormonal actions on labour & birth.
PS I am a hospital midwife who is in a funk and found your blog whilst seeking articles for my master’s assignment. keep up the good work!
Oops, meant ‘Ah’ not ‘are’ LOL
Thanks for yet another great article and on a subject that so many women face – isn’t it scary how many women are induced simply because they reach a certain date in their pregnancy (never mind whether or not mum and baby are healthy and happy)? I often worry about the idea of women having an ‘informed choice’ about induction as there is such limited information out there concerning all the steps involved (the excellent AIMS booklet on induction excepted). I will certainly be recommending people to read your article.
I was induced all 3 times, for medical reasons. I did it without an epidural. The first time, I had very high BP/eclampsia, my second was stillborn, and the third was a combo of gestational diabetes/eclampsia/BP again. I did have a morphine drip with the second one, but that was mostly for the mental issues of dealing with having a stillbirth. I actually had very easy labors until the last 25 minutes or so. I am assuming I was lucky, and that is not how induced labors usually go? I just want women to realize that there ARE legit reasons for being induced, and that does not make us bad parents for choosing it when needed. If I had not been induced that first time, I would be dead, and so would my child. What purpose would that have served? That being said, I think that being induced because you are “tired’ of being pregnant is ridiculous, but it does happen.
Amy – induction of labour saves lives and is a necessary intervention for some women like yourself. I think you were lucky – but interestingly I have noticed that when there is a medical indication induction often works better. I’m not sure if it is because your body ‘knows’ it needs to get the baby out. Anecdotally midwives talk about knowing it was ‘real pre-eclampsia’ if the induction was quick.
I know I was lucky.And I am thankful. I have heard how painful an induction can be, and I very much wanted to avoid an epidural/pain killers. And i did! 🙂
So sorry that you lost a baby, not very lucky at all. High BP does tend to make labours progress more quickly and you were very wise to agree to a induction in light of your obstetric history. There certainly are valid reasons for having an induction.
AS I have said and learned from experts years and years and years ago. Babies of mothers with pre-eclampsia have a cervix ready to come into labour – the baby has an ejection reflex that appears to get things moving as well. Pre-eclampsia itself is silent with signs only of a small baby for the length of gestation – stated many times by the old consultants who did not make much money out of their philanthropic donation of time. Often the first sign after “small baby for dates’ may be early labour or even term labour. When a member of staff came in to emergency with symptoms of headache indigestion and double vision, – as well as contractions – I wheeled her to the birth suite and within seconds she was convulsing that is having an eclamptic fit (old language kidney fit – because of damage to the kidneys from this condition).. Her bush doctot a GP, had not taken the indigestion seriously – she had been given a bottle of Mylanta and Panadol for the headache. All the cardinal signs were there. 1. Raised Blood Pressure 2. genearlised oedema and 3. proteinuria. I do not want to ever repeat that experience – she survived and the baby became a ballerina. That is Only 1 story.. The question is would all of that happen if she had seen a midwife and a home birth? I ask that about every hospital birth gone wrong.
Just realised I am supposed to ‘REPLY” to the person writing” – must not sit here too long lots of bills to pay online and a talk on bush tucker to prepare.
IThank you for starting this conversation this is one of my stress producing subjects apart from Unnecessarians being the other..
I haven’t read all of the above but at the outset I invented the name Obstetric Cascade just after I had given a lecture to Mercy Hospital Students on the cascade of the pregnant and normal process of clotting formation and effects of haemorrhage in the early 1980’s . Many of my colleagues and the women and some men were already on the path to highlighting the harms of 15% induction rates. Submissions to the Victorian Goverment’s Interim Birth Inquiry came on about that time. In 1989 Maternity Coalition Victoria was formed some of whom were on the board of that Inquiry.
My advice for normal physiological induction is to wait for a full moon accompanied by an electrical storm (may work on its own) and/or use nature’s method of sexual intercourse taking a long time over foreplay. Apart from the mechanical action the semen contains a good dose of prostaglandins (mega doses of synthetic hormones are in the gel and the oxytocic infusions) hopefully orgasm for the woman (often stimulates uterine contractions – false labour for some during the preceding last 3 months). Sexual Intercourse for pregnant women is not harmful, (despite one of my mothers-in-law telling my husband that it was?! ) in fact it should be good for you before during and after pregnancy. The semen contains minerals and the action is essential for keeping all plumbing in good working order. It helps each other to gently heal wounds and is an expression of mutual love – I often wonder when I see some women screw up their face at the suggestion – but I have planted the thought and suggested it is OK>
I wonder about inductions when the baby is compromised – I was taught by the gentle men of obstetrics that pre-eclampsia was not a reason to induce as pre-ecamplsia itself was a precursor or instigator of early labor. That is the baby decided to get out early often presenting with premature labour and often unrecognised by unskilled or inexperienced health carers.
It was more important to recognise pre-eclampsia by monitoring pregnancy. Family history and previous history (except if the partner has changed) sometimes is an predictor. Although once recognised rarely re occurs because of awareness and better care.
The first and earliest sign is small baby for gestation by manual assessment plus the cardinal signs of rise in blood pressure diastolic by 10 mm hg and Sytsolic by 20 mmhg or more.
Generalised oedema meaning the lower back and shins as well as tight rings. Protein in the urine on testing. Late symptoms of frontal headache, indigestion and double vision is usually a late symptom and this becomes an emergency treated medically first with oxygen to the mother and durgs to avoid convulsions .All other conditions ought to have been excluded such as chronic kidney disease or infection.
The woman once recognised should be rested with vigilant monitoring before any intervention and have the baby in optimum condition before birth. But of course now no one has time to rest and wait there may have been improved changes in management with better outcomes. I question the inductions with long strong hard contractions from Syn tocinon infusions or frequent small contractions over a long period due to the gel with its dangerous Misoprostel and Cytotec, which results in pain due to nature not supplying oxygen to the uterine muscle. All of this in the mother’s system with an already compromised baby. That is a baby which is being already deprived of continuous nourishment and oxygen in the uterus. Others have said this on Face book and I have watched in horror as women unquestionably submit to this SOMETIMES necessary but often only done in the interests of speed and saving time.
One woman stated “Just how fast do I have to go?”
I was monitored very closely. I was on bed rest for a month(starting at 34 weeks) sue to protein, swelling, and high blood pressure. Strict bedrest. Only getting up to use the restroom. I was doing NST’s twice a week. By week 38 , my BP was way to high, and nothing was working. That is why I was induced. I was exaclty 38 weeks when Megan was born.
Thank you so much for writing such a great article! In Poland induction rate is almost 60 % :(( Can I translate it and share it online (Facebook and my forum) in Polish giving a link to your blog? I haven’t came across such a great and simply written text about induction yet in my language. I’m a hypnobirthing GentleBirth teacher in Poland.Thank you for all you hard work on this blog. I love it!
Of course you can. I’m flattered that you want to 🙂
both our boys (now teens) were induced and I have no problem with that. why should I? They were very large babies – the first 9 pounds six ounces and the second 9 pounds 13. I delivered both vagnially, one with pain meds one without.
I do think had these pregnancies continued so too would have the likelihood of a c-section.
I breastfed them both.
Congratulations on breastfeeding as sometimes these inductions lead to operative delivery. Due to a now 9 — 12 hour time limit on waiting for inductions to work Caesarian birth rate have soared in private hospitals up to 50% in Victoria.. Caesarian births are linked strongly to low breastfeeding rates with many not going past 3 months. This leads to cows milk (meant for calves) formulae Allergens from formulae are well documented as is the introduction of straight cows milk under 12 months. The early introduction of wheat based foods such as “Farex” ( before 6 months usually at 8 weeks) for most of the last century has led to the current explosion in “irritable bowel syndrome” translating to Gluten intolerance etc. The baby’s organs have not matured enough to produce Insulin at 3 months (AKre)
There is evidence produced by Beischer N, and Ratten, G in the 1980/s that babies generally do not gain weight at term or near term and they mention a reduction in liquor – which in my educated mind suggests the baby is getting ready to use its own fetal ejection reflex (See Odent M.) – synthetic based (prostaglandin./ oxytocic produced from horses urine at my last investigation) . Induction of course overrides many of these reflexes. . The findings of Beischer and Ratten revealed that they were actually recommending that babies do not need to be induced for “failure to gain weight at term”. In those days we though these guys were interventionists – but in contrast the current situation is diabolical. It is important to realise that
“one butterfly does not make a summer”.
Now I know the reasons for induction must have been to prevent further weight gain of your babies. I have heard of that as a reason. There are several given. Two of the most persuasive are “Your baby might die” or more subtle “If you want a healthy baby” . These are not reasons. One reason give to a client was because of a “rash” which had been complained about by the mother during pregnancy and which was ignored, but was made a reason when persuading the woman to have a synthetically induced labour?!.
Studies demonstrated that despite starvation diets women went on to produce large size babies in concentration camps in the early part of the Second World War. Other studies show that fat is laid down during pregnancy mainly on thighs and upper arms. Breastfeeding for 12 months and ideally 2 – 3 years will take up that fat – as most of us know getting rid of fat from upper arms and thighs is very difficult otherwise.
Dieting in pregnancy is therefore counter productive if you wish to maintain a milk supply. There are ample studies which state that that weight size had more to do with pre-pregnancy health and diet. The fact that you produced a big baby in the previous pregnancy should have alerted carers to the fact that your pelvis and musculature was able to birth a large baby. My neighbour’s 4th, 5th, and 6th children were over 12 lb. No stitches – all grew to 6 feet and over. Father and mother both tall and healthy as are the children and their children.
Others would be inclined to label large babies as pre-diabetic and your babies mistakenly labelled and treated as such – separating your babies from you to the special care nursery resulting in worried and stressed parents. Go view the babies of artists of the previous centuries. Artists such as Rubens painted in reality the newborn babies were huge, babies were breastfed and cherubic.
This is such a fantastic blog! A great article with many important explanations. One point I find needs emphasising to women booked for induction, is the fact that induction is generally a looong process & that it may well take 24hrs to even commence labour. I often see women arrive for induction with a whole entourage of family & friends excitedly anticipating the imminant arrival of baby. When we gently try to usher the party out so Mum can try to get some sleep before her body starts responding in earnest, people are often taken aback that they won’t be meeting bubs that night. Who is explaining (or rather, not explaining) the process to women before they agree?? Sadly, it’s Midwives as well as Obstetricians & it drives me batty!! Of-course all the portrayal in the media of rushing to the hospital at the first sign of anything remotely representative of labour before the baby falls out or both mother & baby die doesn’t help! In a perfect world health professionals would share their knowledge, provide complete & unbiased information & support the choices of birthing mothers ~ and women would take more responsibility for their health by asking questions & weighing options to come to decisions that are right for them instead of thinking they’d better just do as they’re told.
Good article. Another thought, women often ask for inductions as they are ‘sick of being pregnant’, and they don’t want to hear the truth of risks, the ‘cascade of intervention’ and increased chance of a caesarean. Women need to be more aware, and actually take on some responsibility of self education, and ask questions, before asking for an induction. We spend a lot of time informing women of why it is not feasible to induce their labour at 36-41 weeks when they are well healthy women. I swear that I spend more time researching what car to buy or paint colours to pick than some women spend learning about pregnancy, birth and parenthood.
You are right – some women don’t want to know and want ‘experts’ to make decisions. However, practitioners have a legal obligation to give them the information in order to gain consent – whether they want to hear it or not. Unfortunately many women don’t do the research until after a bad experience.
excellent info. but don’t forget, the oxytocin usually causes the contractions to be very intense and very close together. this pain is almost always the precursor to an epidural. trying to weather through this type of pain and contractions (often) less than a minute apart.. Very difficult. Sometimes leads to maternal exhaustion, which may result in emergency C-section.
WHEN it comes to medicine like this, the blog holds true, once your induced.. your labor is out of your hands. UNLESS MEDICALLY NECESSARY, DO NOT DO THIS. And please remember some OB’s perfer scheduled inductions vs. natural labor. They can control when you give birth vs.being called in the middle of the night to deliver. Or maybe theres more income potiential for an MD when induction is taking place? Of that, im not sure, BUT THE MAIN POINT IS “ITS YOUR BODY, and YOU need to take charge. DO YOUR RESearch! from a mommy of 4.
I was more than 2wks “overdue” with my first and went in for an induction. I was almost 2cm dilated so I went straight to the pitocin at 9am. I was not allowed out of bed unless to pee. Around noon I was 4cm and my water was broken. I was fine up until then. Contractions became unbearable at that point. by 2pm I got an epidural and I was still 4cm. At 10pm I was still 4cm and she was deceling to 90bpm during contractions. The OB said I needed an emergency cesarean because she wasnt tolerating the pitocin and it was at the highest she could put it. (pit to distress anyone?!) I said “No, if its the pitocin causing her issues turn the pitocin off” She said fine and told me that I had an hour to dialate or she would cut me. Not such an emergency was it? By 11pm I was fully dialated, on my own, no pitocin. 90min of pushing and she was born vaginally.
I am pretty sure had I waited another day or two my body would have gone on its own. My second child was a spontaneous natural homebirth at almost 43wks. My babies just like to cook. 48hours of labor(slightly acynclitic and nuchal hand) The contractions for his labor were totally different than my daughters and I would take his long labor over her induction labor any day of the week.
Just had a natural 2nd birth on Friday morning. Had practiced hypnobirthing this time so I know what you mean by the power of suggestion. It was all manageable and I found it exactly how I imagined it could be during my relaxation and visualisations. 1st birth 6 years ago I was made attend the hospital after 48hours for antibiotics as my waters had broken. I was told I was either 4or6 cm dilated. As I was told the drip would take hours and I had to be monitored on the bed the whole time I panicked as I didn’t really know how this would affect the labour progressing. What I did know is that as I had been on crutches for 3weeks with severe hip problem, lying on the bed in one position would be agony before I even considered contractions. I asked for an epidural which was granted. The whole thing then went on for another 15 hours in the same position in the bed – not good for my back! The consultant came in to do an assisted delivery after I refused the offer of a C-section. Once my hips where in the stirrups my hips were much more comfortable and baby 1 was delivered in about 5 minutes after the 4 day wait (every one was relieved). I know the staff just followed their guidelines but it took 3.5 years for my back pain to go away and another 1.5 for me and my husband to consider trying again. So regardless if the pain was ‘real’ or ‘imagined’ it has long term psycological effects on women which there is no ‘real’ way of addressing. I feel fortunate I found my hypnobirthing instructor who helped release my fears so I could move on. I know others who won’t have more children due to their negative birth experience.
“Although an induced labour can be uneventful, normal, joyful, even empowering – it is not physiological. Natural oxytocin is released differently and is able to work on the brain (vital during a physiological birth). ”
I’m also questioning the use of the word “physiological” labor not applying to an induction. My labor was “induced” via step 1 only- insertion of 1/4 tab of prostaglandin on a “ripened” cervix only…I was never given any pitocin. So it would seem that all my contractions actually were producd by natural oxytocin- right? This seems to be more of a “jump start” to a physiological birth. I also continued to be treated as low risk and was attended by my midwife.
I agree – your labour was physiological. Your body was obviously ready to labour and the prostin kick started the process. Your contractions were produced by natural physiological oxytocin. Having said that – as a midwife I would keep a closer eye on any labour that had been ‘kick started’ by medical or ‘natural’ means… If the body was waiting there may have been a reason (eg. baby needed to get into a better position).
I agree the fetal ejection reflex should be trusted but a pair of and eyes and ears also need to be heard and sometimes the mother instinctively feels there is a problem and the ”
music in h er message” is about everything but what she is worried about. OR your instinct is alerted by some hint that may be this baby was conceived earlier or later. I try to always examine and comprehensively assess by asking questions slowly and at first – hands off until necessary. Recently one woman at term (primipara) was so bruised from excessive palpation that I could not palpate but guessed that she could not feel a head – so the head and heart beat were up high and it was breech at term… Knowledge acquired is always essential. For example someone further back mentioned a strong labour and strong painful initial contractions with the third baby. The muscles of the uterus increase in size and are shorter and thicker. The uterine muscle fibres are therefore more labour ready by the second, third and subsequent babies. Depending of course on the strength of outer abdominal muscles and the stature of the uterus. The multiparous uterus and therefore the baby is usually not ready to enter the pelvis until labour starts. The ligaments which hold the uterus are less taut and the uterus remains inert and higher up out of the pelvis. Those muscles are so clever and ready that the initial contractions do not cause pain that is why some lucky third babies are born on the hospital steps.
By the way on the Royal Womens Hospital website Fact page on inductions they do not refer to Cytotec for inductions they refer to Prostaglandins I looked this up separately
WEBLINK FOLLOWS
What is Cytotec®?
Cytotec® (Misoprostol) is a synthetic analogue of Prostaglandin E1 (PGE1). Like endogenous PGE1, Cytotec® exerts a protective effect on the gastrointestinal mucosa by increasing mucus and bicarbonate ion secretion and by increasing mucosal blood flow. In addition, Cytotec® inhibits acid secretion.
Naturally occurring PGE1 is ineffective after oral administration because it is unstable in an acid environment; it is also quickly degraded when administered parenterally, giving it no practical clinical utility. However, the structural modifications to naturally occurring PGE1 that led to the development of Cytotec® resulted in an orally active drug with a duration of action that makes it clinically useful.
5. Is Cytotec®‘s action a local response or is it dependent on absorption into the systemic circulation?
Cytotec® (Misoprostol) acts locally on the parietal cell to decrease acid secretion. It also exhibits local mucosal protection by supplying an exogenous source of Prostaglandin’s.
The principal active metabolite (Misoprostol acid) is rapidly metabolised and absorbed following oral administration.Prostaglandin Cytotec. The women are given the gel according to their Fact page.http://www.thewomens.org.au/InductionoflabourFactSheet
The RWH recently had instructions that stated they could then go home after an hour following the gel insertion and fetal monitoring but I have checked and this has been removed – HMMMM.
Cytotec (misoprostol – prostaglandin1) in Australia and the UK is primarily used for termination of pregnancy or in the management of severe PPH. There are safety concerns regarding the use of this drug for induction. In the US the maternal death rate has risen since the use of this drug for induction. It is more likely to cause over contraction and fatal distress and there is a theoretical link to the increase of maternal fluid embolism. Usually Prostin E2 or Cervadil are used in Australia to ripen the cervix.
I’m guessing sending a woman home after you have put a potentially dangerous medication into her is probably not best practice. A woman and baby who is being induced is at high risk of complications. I wonder if the RWH had a bad outcome relating to sending a woman home… that is usually why hospital change policy – in response to a poor outcome.
Yes this is why Marsden Wagner talks about this use of Cytotec as”offline”. That is, one drug is used initially for one purpose, but by accident (I was told a woman having cancer treatment with Misoprostol had a miscarriage) light bulb thought ‘aha’ if it works for this may be it can be used “off line” to induce labour. Sigh……….
Midwife thinking I am surprised (with tongue in cheek) that you would think that was the reason to change policy?!!
4 Magical Questions → this quote from Gloria Lemay currently repasted on her blog I thought was fairly telling. Informed consent quote
Posted on May 26, 2009 by gloria
“If one went to the extreme of giving the patient the full details of mortality and morbidity related to cesarean section, most of them would get up and go out and have their baby under a tree…”
-Neel, J. Medicolegal pressure, MDs’ lack of patience cited in cesarean ‘epidemic.’ Ob.Gyn. News Vol 22 No 10
Great post – and I wholeheartedly agree. I’m a mother of two and have never been induced.
With my first I went 8 days over and I had a very rough, mean obstetrician (in the public health system) who I feel steam rolled me into signing the induction paper work – not to mention the incredibly painful VE he did when he informed me that I was undilated and baby wasn’t engaged at all.
Two days before the induction I was so scared of being induced I took castor oil – thankfully it worked perfectly and I had a four hour labour and a perfect little girl. Luckily, with my second I was in the midwife stream and felt much more comfortable about the fact I could go as long as I liked as long as my pregnancy continued to be uneventful (she turned up at 39+6).
I really wish that more medical practitioners saw 42 weeks as full term and didn’t try and force perfectly healthy women into an induction because it’s the “thing we do at that stage”. Knowing what I do now, if a doctor asked me to sign an induction form, I’d simply refuse unless I was worried about my baby’s health.
This was very helpful information thank you very much for your help in this article..
I’m going to be induced on Monday I’m very excited but at the same time nervous about it my first son came when my water broke and now I’m going to be induced very scared. :-\
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This was an interesting post. I can give you some experience on the births that I’ve had. These may help those who are wondering what it is like to be induced vs. going on your own.
Birth#1: I was induced with #1 after my NST showed that the baby’s heart rate dropping and showing signs of distress. I was only a fingertip dilated and I think I was 50-75% effaced. I was at a prestigious hospital in Chicago and the doctor (who was part of my group, but I had never met) wanted to be safe to decrease my chances of ending up with a c-section. Looking back after hearing about failed inductions, I am very thankful for her approach. We started with a foley catheter which worked to dilate me to 4cm. It worked with the pitocin to help get me to that level. Up to this point, I had not had anything to help with the pain. I wanted to get to 4-5cm before I would even consider the epidural. I finally got the epidural, which seemed like heaven at the time with the contractions i was experiencing. I think I was in labor for about 18 hours with my first. It took about 45 minutes of pushing (since i had never done it before and I couldn’t really feel how to push). They did turn off the epidural when I started pushing. By the end, I could feel her coming out.
Birth#2: I was induced at 40 weeks 2 days. On this baby, I wish I would have been more informed. My doctor wanted to induce because I was “late” and she said the chances of me going into labor on my own was very slim. So, I said okay. I was put on pitocin right away since I was already about 2cm dilated. I contracted with the pitocin until about 4-5cm when I got the epidural. It took 3 times for them to get it placed right. This was horrible in between the contractions. I couldn’t feel anything when the epi hit. It was horrible. I felt pressure, but didn’t think anything of it since with #1 i felt pressure from about 7-10cm. Well, the doctor that scheduled my induction was in a c-section, so the other doctor decided to stop by and check me. He quickly put gloves on and a gown and caught her since she was crowning. It was a horrible, unreal sensation to have a baby and not realize that I was so close. I was also frustrated because I was only in labor for about an hour from when I got the epi. I could have handled that. My first was another 5+ hours after the epi. I decided that the next time I wouldn’t get the epi.
Birth #3: I was induced at 41+1 day. I was measuring huge and the doctor was worried about how big the baby was getting, plus he doesn’t feel comfortable with waiting much longer then this because the risk of something going wrong (fluid levels, placenta, etc). I was about 2-3cm with this baby as well when I went in. I asked him to start by breaking my water and seeing if that would get labor started. I had a few contractions over the course of 1 1/2 hours, but nothing steady that was doing much. So, they started the pitocin. Again, I decided that this time there would be no epi. At one point I questioned that and asked my husband to get them to give me something. What I didn’t realize was that I was in transition. When they checked me, I was complete and she was on her way. I am so thankful that this time I did not get the epi. First of all, it was empowering to have survived the induction without pain medicine; second, I felt so much better afterward; and third, my baby got stuck. She ended up with a broken collar bone. Since I was able to feel everything, I knew how I needed to push when she was stuck and they were pushing on me to get her out.
Birth #4: I was induced at 39+1 weeks with this one. I had the same doctor as #2 and #3. He was so concerned after #3’s birth, that he wanted to not wait like we did last time. He said that she was the biggest baby my body could handle. I was 3cm when I was induced with pitocin. I was able to labor with her without any pain meds and she came quickly.
Birth #5: It was an answer to prayer when I had #5. I had tried everything before with all my pregnancies (sex, spicy food, walking, etc) and nothing worked. I had given up this time and had tried the sex and walking, but at my 40 week appointment, I was still about 2-3cm. My doctor decided that he would let me wait until 41 weeks and then we would induce. It was my birthday and so I went and got a massage and pedicure. I told the ladies to push on every point that may help induce labor. I told them I was past my due date and would be artificially induced, so please help me. I then picked up mexican food that night as well. I woke up around 4am not feeling well. I had some contractions and when I timed them they were about 4-5 minutes apart. I told my husband to try to do some nipple stimulation to see if we could keep them going. We did this for about a 1/2 hour and then he went to sleep. The contractions kept coming and were regular. At around 5:30, I decided to get up and take a shower. I was still in denial that this could be real. The contractions weren’t that bad, but they were constant. I called my doctor and told him that I thought I was in labor. By now, my contractions were about 2-3 minutes apart. I then called my neighbor to come watch the girls. They got here around 6:45am. We left for the hospital around 7. I had some really painful contractions in the car on the way to the hospital. I parked with my husband and walked to the hospital. I had to stop when the contractions hit because they were so intense. When we got to the triage, they wanted to check me and see if I was really in labor. My husband told them that I was really close. They checked me and I was 9cm!!! They then rushed me to the delivery room and my doctor barely made it. I had her around 7:30am after only 3 1/2 hours of labor!!
Birth #6: At 40 weeks I went through my NST and everything looked fine so my doctor again told me that we could wait until 41 weeks. I was desperate to not be induced this time. After going on my own for #5, I can tell you that the contractions were so much nicer then when on pitocin. I tried everything again (sex, spicy food, walking every day, nipple stimulation, evening primrose oil-I had never done this one before, etc). Nothing was working. I decided on Friday evening to just try everything that evening. I went and got a reflexology massage, ate Mexican food, had sex, did nipple stimulation for an hour (I had some contractions, but they stopped as soon as I stopped this), and I did castor oil for the first time. The castor oil was horrible and I’m glad I never did it before. However, I woke up at 1am not feeling well. I thought it was residual effects of the castor oil. Once I woke up, I realized that I was having labor pains that were pretty intense. They were so intense that when I came to bed, it woke up my husband and he told me that we were going to the hospital right then. He didn’t want to deliver at home. 🙂 I called my neighbor and she came over to watch the girls. We headed to the hospital to the ER since the normal area wasn’t open yet. I had to wait in line to be seen. I was worried that I was going to have the baby right there. I was waiting in a wheel chair for L&D to come get me when my water broke. I had never had this happen before on my own. They freaked and took me to a room to check me before letting L&D come get me. I was only 5cm. I was surprised because the contractions were really intense at this point. By the time I got up stairs, I was 6cm. Transition took awhile and it felt horrible (from about 2-3:15). At one point I wondered why I had told them no to the epi. Around 3:15, I told my husband to get them because she was coming. The doctor wasn’t planning on checking me again until 3:30. I had her after one push at 3:28. So another successful natural delivery in about 2 1/2 hours. I have to say that this time, the contractions were a lot worse then with #5. I would say that they almost beat the pitocin contractions in their intensity. I had one that peaked for over a minute, seemed like it was coming down and peaked again for another minute. I thought I was going to die! 🙂
Overall, I would say that my inductions were successful. #2 probably shouldn’t have been done when it was, but I learned from my mistakes. I was much more informed later on with my deliveries. I think that it is possible to go “natural”/no epi when being induced, but it is intense and you need to be mentally prepared for it. With that being said, going into labor on your own is a lot better. I enjoyed laboring at home with #5 as long as possible. If I had known that #6 would take longer, I would have stayed home longer. Those were my experiences, I hope that it helps or gives some insight.
I’ve been induced twice the first time was a brilliant experience as I just had the 24hr pessary and labour was very much like natural labour. My 2nd experience however was awful as I was induced due to IUGR and there being issues with the bloodflow aswell as lack of fetal movements and decelerations. Obviously due to the complications I had to be induced on the delivery suite where I could be monitored closely. I had 2 lots of propess one straight after the other without a break and then was taken to have my waters broken. Personally I don’t think they should have broken the waters due to how often my baby was having decelerations however they ignored my concerns, no sooner were my waters broken did my baby start having bigger decelerations right down to 64bpm with every contraction, after the first 3 times they decided to give me a drip of fluids and was left to it with midwife having to change my positions regularly to see if that helped however none of it made one bit of difference with his heartrate as each time a contraction hit his heartrate plummeted. After 3hrs the obstetrician decided to take a sample of blood from my babies head to decide how to proceed and because that was fine he said to leave me to labour longer despite by now heartrate dipping to 53bpm and taking longer, I wasn’t allowed the syntocin drip (thank my lucky stars for that one). I think after upto an hour the dr came back in to take another sample of blood from my sons head which this time I tried to refuse as contractions were intense (he was back to back) and I was starting to worry more I did try asking for a section however I was clearly ignored and despite me saying no to having the second lot of blood from my sons head I was forced onto my side and into stirrups so they could take the blood and the midwife and someone else held me down whilst my partner tried telling me it was ok. I hated every second of that and tried to knock myself out on the gas and air which was the only painrelief I had. I think when the dr left the room I must have started pushing as within 10mins my son was born although at time of blood sampling I was still only 6cm dilated. Whilst I’m glad my son arrived safely and despite being a tiny 4lb 6oz he was healthy and needed no assistance.
I just can’t believe that two induction for two very similar reasons can be so different.
I just wanted to say thank you for the article and all of the comments. I am pregnant with my first and hoping for a natural, unmedicated birth with midwives in a hospital. I am trying to learn as much as I can and arm myself with knowledge so that if I am confronted with “your baby is at risk” I can ask for more details and feel confident that I am not being pushed into something I don’t want. I find your website very helpful! Thank you!!
Hi, very interesting and informative but I have a question regarding failed inductions.
I had my daughter in May 2011. My blood pressure has slowly risen over the course of the pregnancy and I was suffering with severe SPD which left me pretty much bed ridden. From 33 weeks onwards I had ‘tightenings’ every 5 minutes which increased in frequency and intensity if I moved around. At 37 weeks I was scanned due to lack of movement and was told that the baby was estimated at 9lb 11oz. Of course I freaked out. My consultant agreed to induce on my EDD. When I went into hospital VE showed my cervix to be forward, central and open a finger tip. Prostin was inserted and I was left to my own devices for almost 14 hours. I had awful pains, plus continued tightenings, but on VE has made no progress. 2nd Prostin was inserted and I was left 8 hours. No progress. I eventually had a 3rd Prostin inserted and was left another 14 hours. When I had my final VE the midwife told me that she ‘could not find my cervix’. I cried. I was told my only option was to haves CS. At 40+2 my daughter was born weighing 9lb4oz.
It has taken me a long time to come to terms with everything that happened. I feel like I did not ‘give birth’ and that I failed. I have so many questions about why things happened this way. Why didn’t I go into labour? If I had waited would I have gone into spontaneous labour? Would I have coped with labour given that I was in so much pain already? Would I have been able to give birth vaginally given her size?
My questions now are regarding future deliveries. I really want to try for a VBAC next time however Having had a failed induction already, what are the chances that I would a) go into labour naturally next time before 40+10? B) would induction work if I tried again? C) would I be offered anothe induction?
Sorry for the long winded post!
Hi Heather
You story is a common one. So much needs to occur in the body and baby to be ready to labour – ie. respond to prostaglandin and syntocinon. If an induction is attempted before all these physiological changes occur it often fails. Essentially the body is not ready to labour yet. You did not fail. You were not ready to give birth. In some ways you could consider your body worked well by protecting you and your baby from a labour it was not ready for. In answer to your questions:
Why didn’t I go into labour? Because your body/baby were not ready
If I had waited would I have gone into spontaneous labour? Absolutely. I have not met a woman yet how did not go into labour herself when left to do so. However, you may have gone into labour at 41 weeks or 42 week… whenever your individual body/baby were ready
Would I have coped with labour given that I was in so much pain already? Every woman copes with pain in labour… there is no other option. No one has died from pain in labour. Wether you cope or not the labour continues. With SPD you may find lying on your side more comfortable – especially for the actual birth. Water immersion is great for SPD.
Would I have been able to give birth vaginally given her size? Probably. Women can birth very big babies. Usually all that is needed is patience and avoiding positions that make the pelvis smaller (ie. lying down or sitting on your bottom). Under 10lb is not big. The pelvis is built to open.
Having had a failed induction already, what are the chances that I would a) go into labour naturally next time before 40+10? No idea. It will depend on what your natural gestation time is.
B) would induction work if I tried again? Possibly if your body was ready this time.
C) would I be offered anothe induction? Depends on the care provider you engage. Induction increases the chance of complications occurring – particularly with a previous c-section. If you are in the US it may be difficult to find an OBs to agree to a VBAC. Here is more information about VBAC http://midwifethinking.com/2011/02/23/vbac-making-a-mountain-out-of-a-molehill/
Keep researching and approach your next pregnancy with the information and self-trust you need. You are the expert in your body/baby. 🙂
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Hey There,
I am new to this site – it is fab, thank you
I am a student midwife & currently looking to do my literature review relating to “are midwives using or losing their hand on skills as a result of technology” – ie. are midwives using their hands on skills, or are they losing them because of scans, ctg’s etc.
I wonder if anybody on here could possibly point me in the right direction to some research relating to my potential topic?
Thanks so much in advance
Might be best to narrow it down to particular areas ie. ultrasound rather than palp to determine presentation at 36wks (standard practice in a local hospital); dopplers and ctgs = midwives not developing skills in the us of poniards; etc, etc. This list goes on. Midwifery has been redefined as medical and technical – there is lots of stuff on this if you search for the medicalisation of childbirth/midwifery.
Thanks so much for your reply
I’ve done an assignment on medicalisation of childbirth but I suppose I was looking for particular articles relating to midwives losing their hands on skills as a result of advances in technology
I’m sure I will find an abundance of research when I have figured out exactly it is that I want to focus on. I need to limit it I suppose
Thank you so much
Im currently on my 4th day of induction. 4th propess in and nothings happening. Do i have any other options?
Hi Laura
I hope you have had your baby by now. I don’t know why you are being induced. The reason, and how close you are to labour (i.e. full term) will influence how easy it is to get you into labour. It sounds like your body is not close to birthing ie. there are a lot of physiological changes that need to happen first = taking a lot to get you there. If a decision has been made that it is unsafe for your baby to remain in your uterus hence an induction – then the only options are a c-section or continue pregnancy + risk. Anyway – let us know what happens.
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I was induced in my twin pregnancy (after a natural active birth) and I wish I had read this first. It wasn’t until they had broken my waters (I skipped step 1) and was connected to the hormone drip that they told me I couldn’t get up or change position or even eat. Cue 16 hours of absolute hell and a birth more agonising than I could possibly describe. If I had known I’d be deprived of an active labour, I’d have opted for a c section. I wouldnt advise anyone to go through the sheer hell of induction!
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Hi,
With my first pregnancy I was induced at 38 weeks because of low fetal movement, I then had to have a ventouse delivery ( with just gas and air) baby and I were fine after birth no complications.
Anyway my partner and I are trying for another child does having previous induction make me high risk for the next pregnancy?
Thanks
S.
No 🙂
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What a fab article. I can see that even though it was posted a couple of years ago it still resonates with many mothers. I hope you don’t mind me adding to the long list of questions at this late stage.
In my first pregnancy I was diagnosed with OC, they wanted to induce me 2 weeks early, luckily I managed to convince them to let me think about it for the weekend and then come back the following monday for induction. However, I thankfully went into labour naturally that weekend! (Huge amounts of pineapple juice? 😉
I am now pregnant with my second, and at 29 weeks I feel the symptoms of OC coming back. I am seriously considering not reporting it to my midwife, as I am terrified of induction. The problem is, I bled when I went into labour first time, plus there was mec in my waters, but I don’t know if that was a symptom of the fast labour I had or a distressed baby due to the OC. Everything else was fine.
Realised I didn’t actually ask my question! Shall I report the OC this time, or not, if I can cope with the itching?
I cannot advise you to withhold information from your midwife. OC is a pathological condition with associated risks for baby and you. However, the management of this condition ie. induction etc. remains your choice. You should be able to make your own decision about what you want to do regardless of whether your midwife has the full picture or not. Ideally you would have a relationship of mutual trust and respect with your midwife and she will support you in your informed decision making. The standard recommendation for OC is induction at 38 weeks but you have to agree for this to be done with consent.
Thank you for your advice! I really appreciate it.
thankyou, i did learn alot here.
I was induced with my first child at 41 wks 0 days. From the time they inserted my IV until the time she was born was only 10 hours, without an epidural or any other interventions besides the pit. I feel like I got lucky that she was actually “cooked” all the way. When she came out she was wrinkly and the pediatrician said she was overdue. BUT, looking back I can honestly say that things could have turned out way worse. The only reasons I agreed to the induction were that I was ill informed of the risks, I was excited to meet my baby, and I was ready to be done with being uncomfortable. Now that I am pregnant with twins the doctor is getting his panties in a bunch because he is worried about letting me go too long since twins are considered full term at 38 weeks. And even though my labor and delivery with my daughter were not a bad experience, I would still rather not do the induction again.
Hoping one of the midwives that have contributed to your wonderful article can help me with advice! Or better, you the author.
I’m 37 weeks pregnant with baby number five. The first three were all delivered naturally and started spontaneously with waters breaking – all on their EDD too!
For baby number four I had severe pelvic pain and was 38 yrs old – and i’m slightly overweight (at that stage i had a BMI of 34), so was told i needed to be induced at 38 weeks and 5 days. I was not informed as to how this would look or feel. Fortunately for me, once the gel and my waters were artificially broken, my body remembered what to do – and i required no more intervention and he was born 2 hours after waters broke. The pain was intense – even though labour was only a few hours shorter than the previous ones. I didn’t know that hospital policy would prevent me from having a water birth (which i’ve had for all the others), so i found it far more difficult to cope with ‘gravity’ i suppose you’d call it.
This time, baby is measuring large for dates – both by scans and by midwife measurements. And I have developed fibroids (which are only 2cm big) and have pubic dysfunction again. Now, i’m nearly 41. All this has led to my midwife and obstetrician to say that i need to be induced at 38 weeks and 5 days… I’ve asked why, and they say because my baby has an increased risk of being still born due to my age and the fact that this is my fifth baby.
What I need to know is – does this really mean I should follow their advice or stick to my guns and wait for nature to take it’s course?
Just breifly the reasoning behind the exact time in weeks and and days is that they do not want you to come into labour before hand and get them up out of bed at night or have to let you have a normal labour. Pure and simple – 41 is not a sentence of too old .Lucille Ball had her two children in her forties – but knowing Amrica they were proaably caesars nthing wrong with the children. You mentioned only 2 cms about the fibroids have a look at that size and mesure it in reality terms. I have seen these excuses to ensure a likelihood of caesarian birth many times The only advice I have is dont turn up for the appoinment or postpone it – which country are you in I have heard of police being sent in Australia to the door – for not turning up – the only suggestion I have is that had a long lost relative turn up and she is only staying for a few days –anything – but you are being pressured. You ligaments and pelvic muscle area have stretched by now and are so practised they are very efficient. There is no resistance to a larger baby the head has bones which mould that is they overlap and the head is not nearly as big as you think. t. Squatting gets your pleivs to stretch by 30 % and a deep bath gives you buyancy for relieving pain – and so on but you know all of that.- My neighbour had two babies 12 lb 10 oz after 4 previous of 10lb – but they were long and tall – you need to make sure that your haemoglobin is up and eat plenty fo dark green vegies for folic acid and iron. GB well above 10 gdl would be good more even better. Rest and relax. Juliet I wish you well I have not read others so hope they are looking out for you as you are for yourself – trust your body.
I’m in New Zealand. What’s a GB? Both ferritin levels and haemoglobin levels are low too (and i get diarrhoea from iron tablets)
Beverley is correct, uterine fibroids are fairly common and luckily don’t generally get noticed = not a problem. As for your age… I have attended women having homebirths in their 40s and have not noticed any difference in their ability to birth, or their babies. Although statistically there is a slightly higher risk – this needs to be considered on an individual basis. You are an expert birther and I’m pretty sure your body has not forgotten how to make a baby, and birth a baby between your last baby and this one. I would also be concerned about inducing you because you have previously laboured 4 times i.e. you being a ‘multip’ (were the others c-sections?). The risks of uterine rupture for a multip is much higher and you are more likely to respond to syntocinon (pitocin) too strongly = fetal distress. On the other hand – you may not need syntocinon and may respond quickly to an induction. You need to decide what is important for you and make an informed decision. This is your decision.
all my previous babies were vaginal deliveries, thankfully!
Sorry Juliet I am an old typiste of 60 years expreience I am 75 but still involved in midwiifery – I educate and support when I can.
I meant Hb Haemoglobin
New Zealand used to have a very good reputation for quality birth and midiwves. They have free service> Midwives who did not have to pay more than 2000 NZ dollars for insurance indeminity premium. I had heard that had gone backwards so not sure where whre you live and what idstance you are from help. Home birth was suported well. Although I heard whispers that the Obstetricians who joined up with the Asutralian groups and are known as RANZCOG. That meant they wanted to get in with business of control and making big lots of cash the Austrlian way. The (rates here are 50% caesarian birth in private hospital and 37% in public hospitals. A very high induction rate – chemical in a dubious quality gel and artifically rupturing membranes.
An intact amniotic sac is much safer keeps baby safe from infection Pain less for mother’s labour. Keeps the baby from having uneven pressure on the cord – so please find out more about induction and attempts to pressure you to have that baby induced. what about the College O Midwives in New Zealand used to be in Shristcurch Karen Gillialand is a good woman. Young than me I am 75. Induction requires them to rupture the membranes if you do not speed up – I wish you well and you have done the right thing askiing questions – well done. Midiwfe thinking is very good value and she is right it is your decision TRUST YOURSELF
AND YOUR INSTINCT.
Not so BAD AS in New Zealnd, because years ago they had an agreement that midwives could conduct births and the Maori women were instrumental as they ahd a treaty. Stand alone clinics run by midiwves only. Obstetricans as well as anaesthetists in AUStralia are known as the highest TAXPAYER SUPPORTED EARNERS through Medicare. That is because they practise abdominal surgery for birth otherwise known as Caesarian. On the other hand there are good doctors in the country . You need to be a ware that midwives here are very sensitive to the push = funny word that – Pushing without the urge is not encouraged by up to date midwives as it means you hold your breath during a contraction AND THIS DEPRIVES YOUR BABY OF NORMAL AMOUNTS OF OXYGEN AND NUTRITION. I suggest TO t mothers that they open their mouth and breath out and pretend to make a noise like you are pushing , make a circle with your mouth like an ‘O’ . TRY THIS NOW IT RELAXES YOUR PERINEUM TRY THAT . mY DAUGHTER GOT THROUGH BY ACTING AS IF SHE WAS PUSHING AND THEN WHEN THE REAL URGE TO PUSH CAME SHE COULD PUSH AND WAS NOT EXHAUSTED.
XXX Bev
I had two inductions.
The soften the cervix with the gel for my first child, and took 2 days. My water broke naturally but needed forceps in the end and a blood transfusion because baby wasent ready.
The second child they broke my waters and gave me the drip that brought on labour!
It was extremely quick and painful because I went from completely normal to delivery within the hour.
It was very fast and rushed and needed surgery after because I forced my body to do something it wasent ready for.
The next time I will hopefully be Abel to go naturally with no intervention and let my body do it’s own thing at its own pace 🙂
My first labour with my son occurred spontaneously and with my second labour with my daughter I was induced.
1st – I was 40 +12
2nd- 40 +15
I was very keen to have minimal interventions. Refusing a sweep with my first, accepting 2 sweeps with 2nd as a way to convince professionals to let me go past 40+ 10 with no induction.
Induction was a very unpleasant experience. I was given a pessary at 6pm and gave birth at 10pm same day. The contractions were violent and I perceived them as being unrelenting. There was no pause in the rhythm of contractions. Quite unlike my first labour. I thought I would rip in half with the continuing force of contractions. It was a sensation that left me feeling out if control of the labour. Unlike my first.
Thank you for sharing. It is important that women’s experiences of induction are ‘heard’.
Hi I have recently ( 4 days ago ) left hospital by self discharge after a failed and very painful induction. I was given a pessary at the start of the induction which initiated what I was told was falsed contractions but after a while these stopped and the pessary was removed after 24hrs . I then was given a very painful sweep where I was told the consultant was trying to pull down my still very hard cervix and babies head was still very high ( and my cervix still tightly shut) . After this was still unsuccessful I was given 24 hrs rest in hospital . The following day they attempted again to break my waters but I was barely 2cms dilated , babies head still high and cervix still hard and they were unable still to break my waters. So another pessary was inserted behind my cervix and in the next 24hrs , nothing happened . Once removed I then was given another attempt at my waters broken , this time it was unbearably painful and I was screaming in pain , but the consultant still was unable to break my waters my cervix was unchanged and finally gave up after several attempts with the amino hook . I was left very bruised and battered and blood everywhere !
I self discharged myself that evening as I was told the next step was to attempt breaking my waters again in the morning but this time on the labour ward with my legs in stirrups . But I could not bare the excruciating pain and fear to go through that again.
Now 3-4 days after leaving hospital , I have been able to walk for the first time yesterday . I walked about 10 mins up the road to a slimmingworld group I go to ( and have done all the way through pregnancy ) but feel so exhausted , drained and hurting I had to get a taxi home . Last night I was again exhausted , drained in severe pain and shaky and threw up twice . This morning I’m not feeling much better and now worried I could have an infection.
Another shock I had when I went and weighed yesterday was the fact I had lost 11lb in weight from my hospital stay – the food was either tiny portions , unfit to eat or removed or missed as I was being monitored on heart monitor at the time and food would go cold and it was against their policy to heat up the food.
I am now waiting for labour to happen naturally but concerned when it does about returning to hospital . This is my 5th baby I have had 4 previous natural deliveries and was being induced this time because I had severe SPD and was permantly in pain on crutches with a suspected large baby . ( not easy with 4 other kids to look after ) . I am now also concerned I have an infection and if I will even have enough energy to do labour as my irons have been pretty low the hole way through my pregnancy.
That sounds like an awful experience! Can you see a health care practitioner and check that you do not have an infection? You will have enough energy for labour but may struggle with recovery if you are anaemic.
I phoned up the hospital again , with advice from my Midwife to see an obstetrician to check for an infection. But they was not interested in seeing me , and said there was no more they could do and as I had no signs of a temperature they said there would be no infection. They asked me to get better pain relief of my doctor , and left it there .
That is worrying. Can you see your GP? Sounds like your midwife is supportive.
It’s ok I got some codydromol off my doctor for my pain and some lactolose to help with the discomfort of constipation and have been feeling much better since . I have another midwife appointment tomorrow . Hopefully my baby will get things moving soon xx
Hello Rachel, I was wondering your (or any other midwives’) opinion – a relative of mine is nearly 36 weeks pregnant. She is measuring big (approx 38 weeks), growth scans have her on the 98th percentile. She did the glucose challenge at 28 wks and was negative for GD. She has just been into hospital to discuss her options, she was told that her baby is twice as big as it should be at this point (which is rubbish – they estimated he is 3kg! I don’t think a 36wk baby is supposed to measure 1.5kg) and they want to induce her next week. This just seems so early to me. I want to help her but don’t know what to say. The midwife also told her she thinks she has GD, but didn’t think she should bother re-testing for it as it won’t make any difference at this stage. If you have any words of advice I would much appreciate it.
Thanks
Bri
Hi Bri – not sure where to start…
– She does not have GD – the reason for inducing for GD is not for size of baby but for increased risk of stillbirth.
– Ultrasound is very poor at estimating fetal size, particularly as pregnancy progresses.
– 3kg at 38 weeks is not big at all… most babies would be around 3kg or more at this gestation.
– There are risks of inducing, and even greater risks of inducing before term.
– There is probably little you can do. Your relative has engaged the care of these ‘experts’ and will most likely be coerced into following their agenda. All you can do is gently offer an alternative perspective but support her choices whatever they are.
It can be frustrating – good luck 🙂
Thanks Rachel, yes I guess there isn’t much I can do! It’s frustrating – in the model of care she is in she has is not getting continuity, and is hearing something different from each different doctor she sees with no one to help her understand what is being said or advocate for her. Hopefully whoever she next sees at the hospital will favour a wait and see approach. I did encourage her to go and do another test for GD so that she knows one way or the other about that, as she is really stressed that she has somehow caused this ‘problem’. Fingers crossed she goes into labour before anything else is done. Thank you!
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I live in the US and was induced with my daughter. I was 17 at the time, so fairly ignorant about all the intricacies to the birthing process in hospitals. All I knew was that I wanted as natural a birth as possible. I did not want to be induced, and fought it, but ultimately was basically told by my OB that I didn’t have a choice. I found the breaking of the water to be quite traumatizing, the instrument used looks like a knitting needle. It didn’t hurt from what I remember (not much because of all the drugs they pumped me with later), but I do remember crying because the thing looked so… creepy. I then had to have a scalp electrode inserted through my vagina and onto my daughter’s head. This was also unnecessarily invasive and ‘creepy’ to me. I had the fetal monitors on my belly as well so I was confined to my bed, which I had not wanted either. A few hours later my cervix was dilating well and I was completely effaced but my daughters heart rate was continually dropping(it went up and down after the pitocin). I suspect this was due to the pitocin usage. Long story short, this ended in an emergency cesarean. My daughter also had a nuchal cord.
I realise this is probably a bit late given previous comments are from 2011, I stumbled across this blog recently as a friend is having a difficult labour and this came up when I goggled meconium. I felt a bit sad about this article I was induced after getting preeclampsia I fully considered the induction and what it meant ie risks. However there was no other option with my condition. I feel my birth experience was natural despite the induction and I worked incredibly hard to make it so, it can be done a more natural way but I guess I had come to peace with the consequences and that’s a big ask. I had accupuncture the morning of the induction, refused to be strapped to the monitor after the initial monitoring, demanded and used the water bath and other means of active labour and didn’t not have active management of placenta yes I realise now how risky it all was but it was risks I was willing to take. We had fully prepared with birth worx and hypno birthing and although I didn’t quite get the home birth I wanted I still feel I achieved a natural birth. I’m not recommending induction (I will be trying everything I can think of to avoid preE) however I think we shouldn’t close of the possibility that in some cases it can still be a kind of natural. It’s often the protocol in hospitals that prevent it (luckily my midwife was ok with supporting my decisions). Baby was fine she was born apgar score 9 and I had no excessive bleeding or complications I was just a bit strung out from being harassed by hospital staff who were freaking out that I wouldn’t be strapped to the bed for monitoring/examinations. I am however looking forward to reading more of your blog it’s very interesting!
Thanks for sharing your experience. Pre-eclampsia is a dangerous condition and an induction is an appropriate intervention. You can have a positive induction experience – many women do. One of the ways to do this is take control of the bits you can – as you did. You do need to consider that there are risks involved with the intervention of induction and with pre-eclampsia when making choices about monitoring and birthing the placenta: http://midwifethinking.com/2012/05/05/an-actively-managed-placental-birth-might-be-the-best-option-for-most-women/ 🙂
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am curious about your thoughts on herbal and/or homeopathic means of “kickstarting” labor (ie: red raspberry or nipple stimulation to promote uterine contractions, sex/semen protaglandins for cervical ripening) . would you consider these to be interventions as well or would these be considered part of a “physiological birth” in your eyes?
large, overdue, posterior babies run in my maternal line: my daughter was born by induction at 42 weeks, mom had all three of her children after 41 weeks- two with induction-, and grandma had my mom at 43 weeks w/o induction; all babies were over 8lbs and all but two were born vaginally. interestingly, gma, mom, and me all had overdue, posterior baby girls as our first. mom and gma ended in emergency c-secs, i had a vaginal birth (due to the patience and wisdom of my AMAZING midwife who let me labor down, kept me off a clock, and took me off of pit when baby started to decel).
i’m due with my second this monday (Feb 10), and needless to say, am not expecting him or her for a while yet. 🙂
ps; SO SO SO ENCOURAGING ANS REFRESHING to read your thoughts on birth of posterior babies! i was getting a bit “spinning babies”- obsessed and today my midwife talk me down from the ledge a little bit, reminding me that my pelvis birthed an almost 9lb posterior baby and that i had nothing to “fear” about my current baby’s position or my body’s ability to deliver. 🙂
It sounds like you don’t have ‘overdue’ babies in your family but that the women in your family gestate longer than the ‘average’ woman 🙂
My thoughts on ‘alternative’ forms of induction are that they are still induction ie. you are intervening with physiology to make the body do something it is not ready to do yet. The question is ‘why do you feel the need to make your body fit externally determined prescribed timeframes’ – the answer is often about care provider/system needs and pressure or discomfort/impatience. As a homebirth midwife I don’t advocate any induction method if the woman is birthing at home. The reason is that you are increasing the chance of complications by intervening. In hospital there is close monitoring of an induced labour because of the associated complications. At home there is not. If a baby really needs to be induced (ie. it is safer for the baby to be outside than in), then this is a medical issue – not something to be doing at home. Having said that women do what they want and I have cared for women who have used tried ‘natural’ methods of induction.
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Hi if you are looking for more induction stories I have had two (out of two births).
Induction 1 at 37weeks because my baby had an exomphalos (liver) and between needing to plan staff being on hand to operate etc and concerns about babies with these problems going to term it was planned well ahead of time. I was not chuffed but it was better than most other hospitals (in the UK) that routinely did cesareans for the same problem. Beforehand I did sweeps, sex, pineapple, curry, walking etc etc but was not at all ready. Luckily in the hospital they still had a GP delivery room at the time (8 years ago) so my husband could stay with me overnight when they put a pessary in, it burned and did nothing and I suspect it wasn’t placed very far inside because a different midwife put another one in the next morning and it wasn’t at all painful and then I started effacing and dilating soon after. I had some contractions but nothing much happened so they broke may waters around noonish….then I walked around a bit more to see if anything would happen, after a few hours I was put on a monitor and pitocin started…but allowed to sit on a birthing ball in a calm room with music and a TENS machine and gas and air. Here is the important part. We asked how the pitocin was increased and the midwife said they raised it (based on time) until the contraction took up X number squares on the graph paper. My husband then watched this paper like a hawk and insisted she stop increasing the dose once the number was reached. She was not happy and argued about it but she did it (this was a midwife who told me she did mostly home births)…I was in an awesome rhythm and coping with the contractions etc (which were intense) by listening to my child’s heartbeat on the monitor, I could hear it start to increase before I felt the contraction start, then I’d hit the button on the TENS, inhale the gas and air and focus on getting through the contraction, this was while sitting on the ball leaning back on my husband and it was really fantastic…then the midwife insisted I pee, instead of bringing a commode she unhooked me from everything and made me walk to a toilet, after that I never got my rhythm back and it was extremely painful. I asked for an epidural and was told ‘they call it labour for a reason’ and she said as she was going off shift I could wait for the new midwife to examine me and arrange for the epidural… when the new midwife came she said the previous one had told her i’d be about 5cm.. she examined me and said ‘let me see if I can get my finger round the baby’s head’…I said I guess it’s not 5cm? She said no, too late for an epidural, you can push… which I began to do and the second midwife was amazing and supportive and it ended up (despite everything and the massive crowd in the delivery room) being a good experience (though a ventouse was needed as I just couldn’t do the final push, they held her steady with the ventouse then I pushed her out)…just a note about the wonders of perineal massage, I didn’t tear!
induction 2 I went to 42 weeks and was really ready for the baby to be born, tried all the walking, sex, pineapple, curry etc etc,….walked to the hospital for the induction and the wonderful midwife listened to my story about induction 1 and was very sympathetic… she broke my waters and I went for a walk (doing the sideways up the steps thing she suggested) and went into massive contractions very quickly and went to push before they could get the bath ready for me (we were going to do a relaxing bath)…this one was gas and air as it was too hot and the TENS electrodes didn’t stick to my back…there was no monitoring involved, 4 hours later my 4.6 kg baby was born, no doctors on hand, a wonderful environment, in a hospital but on our terms and 2 hours after that we were home…so a very positive birth experience over all…(and again, no tear! Yay perineal massage!!)
Hi Kate. It is important for women to have access to other women’s experiences. Thanks for sharing yours 🙂
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Hi., I’m.due.to.be.induced tomorrow. And although I.have had a induction with my first. It’s all.still new I’m pretty. Scared as people say you second is quicker so.I’m worried I’tl be too quick to.have a little pain relief as with my first I felt all my contractions but not.the actual part of his head. And.body.come out. So. Very nervous do.you think.they will.allowe to have pethidine or mepaid I don’t want epidural as this has caused back problems from my previous labour. Please can anyone answer my questions.before tomorow :/
It would be unusual for you not to be offered some form of pain relief during an induction. Ask before they start the procedure.
One of the worst totally un supporting style of writing. Totally negative and totally scares the hell out of people who are about to be induced. Go get a break and stop writing such nonsense!
I have one induction and two natural births, i was not informed as what was going to happen so i was even not aware that i was being induced, the pain was horrible even two days later i was still in pain but as for natural birth it was just calm pains which lasted for few hour and after that were gone.
I’m overdue & set to be induced tomorrow as I have developed toxemia. The doctors see it as a risk leaving me to go into labour naturally as my cervix has only just started to soften & that is why the decision was made. I don’t want to have to have an epidural as I am very lucky to have gotten pregnang at all & even though I will not be able to have a ‘natural’ birth, I am wondering what the chances are of having a vaginal birth as c-section would be my last resort?
Hi Ayla
If you have toxaemia (pre-eclampsia) ie. abnormal blood and urine results then your pregnancy is not healthy and it may be best to give birth before you or your baby deteriorates. If you are induced bear in mind that the pain is likely to be different and more difficult to cope with than a natural labour. So, if you end up opting for an epidural don’t beat yourself up about it. I don’t know what your chances are of having a vaginal birth because this will depend on how ready your body is to birth, how you and baby respond to induction and many other factors that I cannot assess. I hope all goes well for you. Come back and let us know.
How common is it for women to go through an induced labor and not take the epidural ?
Based on my own experience as a midwife caring for women during induction…
It is rare for a first time mother to get through an induction using IV syntocinon without an epidural. It is common for women who have previously given birth to get through an induced labour without. It seems that syntocinon induced contractions are the part of induction that is most significant re. needing an epidural. Women who just have an ARM or prostaglandins are more likely to be able to cope without. And more women who have previously given birth will go into labour without the need for syntocinon i.e. after an ARM, or will only need a little syntocinon and birth quickly. And of course it is very depend on the individual woman and her preferences.
My wife was induced labour at 14pm and again at 20pm the same she ended up bleeding to death after she delivered around 2am the following morning. Is it ok to induce labour twice in one day?
I am not sure what you mean by ‘induce labour twice’ – giving prostin twice is common.
I am sorry for your loss.
My brother wife was in labor for 15 hrs because the hospital said that she had high blood pressure 140/ 95. She was induced at 730 am and by 530 pm she said that she didn’t feel like she was in labor so they gave her the 5 dose and then the midwife waited until 945 pm to break her water. After about 15 mins her placenta detach and they did a emer. C section. The hospital didn’t have the baby’s blood type on hand and then he was med flighted to another hospital. The baby passed away 4 days later. I feel that he was a health baby all during the pregnancy and now they have to deal with the lost of there son . Any suggestion on this would be help
I am sorry for your family’s loss. Placental abruption (when the placenta detaches before the birth of the baby) is a complication of induction. Unfortunately this situation does happen sometimes which is why the woman and baby need to be closely monitored and there should be quick access to an operating theatre. If the woman had pre-eclampsia (a symptom is high BP) then the baby may have been compromised because of that too. I hope the parents are being supported in their grief.
I wish I had seen this 7 years ago. I was induced for no reason. My doc said that 40 weeks was enough and that induction was perfectly safe and had little risk of cesarean. It was my first pregnancy and I trusted her. The induction was a horrible experience. It failed and I had to have a cesarean. Now I know that over 50% of first time mother inductions fail. I regret agreeing to it to this day. It’s an awful thing to live with thinking “what if”. What if I had waited and just done it naturally?
I hope that other mothers in my situation see this and save themselves from going through what I did.
There are many things I regret about my first birth too. However, we did the best we could with the information and support we had at the time. And we can make sure that women now have adequate information and support to make their own decisions about birth. Thank you for sharing your experience. How we are treated in birth has a long lasting impact.
Like the Page to the Max. Have learnt alot.
Dear Rachel, I’d like to hear if the baby can lose weight before being born without it being a problem? I have heard the risk of the baby not getting enough nutrition as an argument for induction and today my mom told me, she was induced when I was born, because she still hadn’t given birth after two weeks, and after the birth she was told that I’d probably lost some weight, that I had been bigger. But I had a pretty normal size and was healthy so I was wondering if it’s necesarily a problem if the baby loses some weight?
There is no way for anyone to tell if a baby has lost weight. Ultrasound can’t accurately estimate a weight. So, I’m not sure why they thought you had lost weight. I wonder if you were quite small because you hadn’t reached full term yet and the care provider needed to give a reason for you being smaller than expected… rather than consider that you weren’t actually two weeks past your guess date?