induction for GD

[teachmum]

I was speaking to my OB the other day about preferring to go into labour naturally rather than be induced. I've done it both ways and spontaneous labour is definately better (although no less pain!)

I've done the research and I know ultrasound aren't accurate for measuring size, etc but I have accepted that I will be induced.

The OB said that they use a catheter and balloon to open the cervix and once this was done we could wait and see how the labour progressed. What do you think? Has anyone had any success using this method.

[cindyb]

Been induced before but no balloon - I havent heard of anyone having this before - sorry i cant be of any help!

[paradise lost]

Haven't had it done but know about it. Foley's catheter induction they call it. The catheter is like a little balloon on a tube. They put the (deflated) balloon through your cervix and slowly inflate it. Inflating separated the cervix from the membranes (like a stretch and sweep but without fingernails/infection risks and without having to repeat it again and again because it stays in). The pressure of the balloon mimicks the pressure of the baby's head which is supposed to kick-start the oxytocin/contraction/pressure on cervix/more oxytocin/more contractions/more pressure cycle which begins labour. As the cervix dilates the catheter eventually falls out and by then labour is sometimes established (30-60% of the time, depending which study you read) and the remaining women will need to be given intraveanous pitocin to get labour going.

In terms of risk to baby and mother it is one of the safest options for induction because it does not add anything to the system (like drugs) which one or both can react badly to, and if it doesn't work they can take it out and try another day. The studies i have read indicated pretty good outcomes, here's a few quotes...

Forty out of 52 patients delivered vaginally, 4 patients failed to progress and the procedure was terminated in 2 patients who developed foetal distress. Five patients had thin meconium stained amniotic fluid with borderline pelvis and were then up for caesarean section. One patient had cord prolapse and was then up for Caesarean section. In one patient the catheter was reinserted for another 6 hours when the cervix failed to dilate. There were no cases of infection, ruptured membranes, haemorrhage or other complication attributed to balloon catheter use.
Mean induction to delivery interval was 8 hours.

Cervical ripening with extraamniotic catheter possesses the advantage of simplicity, low cost, reversibility and lack of systemic or serious side effects.

However ripening with Foley’s subsequently requires oxytocin stimulation augmentation.
While the effect of Foley’s catheter might not be as pronounced as extra amniotic prostaglandin, it is sufficient to allow a successful induction of labour and reduces the induction delivery interval from what it would have been with an unripe cervix. Cases of uterine hypertonous and foetal bradycardia have been reported following the use of prostaglandin (Mackenzie and Embery 1978; Mackenzie and Embrey 1979) and this necessitates cardiotocographic monitoring when these potent agents are used. This does not apply to the use of Foley’s catheter which is cheap and easily available.

So basically it is likely that so long as baby is engaged (which will make cord prolapse impossible) and your body and baby are somewhat ready for labour (which will mean you won't go into the failure to respond group - though if you DO, you can say to your Ob you'll go home and come back in a few days if you have the foleys catheter, if you have prostin gels you have to stay in until the baby is born, which, if your cervix doesn't respond and ripen, will be by c-section) this will be the safest of the medical induction, though obviously, as you know yourself, no induction can be termed "safe", sometimes it can be the safer option and it is down to the individual and their care providers to make these decisions.

Best of luck hun.

Bx

[teachmum]

Thanks hoobley for taking the time. It makes me feel better about the induction and hopefully my body will repond and be able to follow its natural course.

[paradise lost]

No worries hun, i researched it for someone else a while back and if no-one asks about it, it's just in here clogging up my brain. Better to use it eh?

The closer you are to your EDD the more likely you'll be ready - you could also try some gentle cervix-ripening things before the induction if you wanted to? Like sex, evening primrose capsules inserted next to the cervix and so on. You never know, they might check you at your 37wk appointment and find you ripening already or scan you and find bubs isn't that big afterall. WHen are they planning to induce?

Bx

[teachmum]

If there are no other complications then at 38 weeks. With both my other pregnancies my cervix ripened well and I was 2cm dilated one or two weeks before. I've been having regular scans because of the GD and the last one showed he was about three weeks ahead in size but tummy size was good.

My second son was ahead of dates according to U/S and he was 9lb 10oz so the chances of this baby being big is pretty high. The main argument is the fact that the placenta breaks down and this can happen faster due to the GD. When I asked what tests they do to check this the OB said they didn't have one but she'd seen enough GD placentas in her time. She's quite good and always willing to discuss things. I do like the fact she's not going to give me the drip straight away to move things along.

I'm sure hubby will be only to happy to help ripen the cervix!

[paradise lost]

ROFL! I hope hubby enjoys his task!

The usual test for checking if the placenta is functioning well is to check amniotic fluid levels by ultrasound (i was 11 days overdue when DD was born and had had 2 fluid scans bu then) they scan the areas where there should be a big pocket and measure the depth from uterus to bubs. They can also scan the plcenta to look for grainyness (indicating age though smokers can get it anytime). Mine were always ok and DD didn't look overdue when she finally came out (plenty of vernix, no flaky skin, no calcification of the placenta) so it depends on how fast or slow you "cook" your babies i think.

Yeah, i like the idea of the Foleys too and if i HAD to be induced it's the option i'd ask for. When they booked me for my induction on EDD+14, which we escaped by 3 days, i made them write in my notes "DOES NOT CONSENT TO PITOCIN INDUCTION" so they couldn't do it. LOL.

Bx