Due to recent slow growth of my baby and reduced anmiotic fluid my Dr. may have to induce me next week (at 38 weeks). I am petrified of this happening as I was hoping for a spontaneous labour with minimal intervention. My baby is small and head is fully enaged in the pelvis.
Can those of you who have been induced give me some feedback as to what to expect?
Can you ask him for specifics? Baby growth slows down towards the end anyway (babies have their own unique growth rates too, so not reliable to compare on ultrasound averages) and also amniotic fluid reduces towards the end too. Perhaps you could look at natural forms of induction first, acupuncturist Iva Baloun on Collins Street in the CBD has a great success rate with my clients. Even having waters broken can affect your labour - one midwife saying the day she stopped rupturing membranes the less she noticed posterior or other stubborn position issues...
As yourself, do the risks of induction outweigh the benefits?
Induction - To Induce or Not Induce
^ Just adding to what Kelly said about rupturing membranes to start labour - my second labour was induced this way and my baby was malpositioned (head was deflexed and he was posterior). Just another reason I wouldn't have this done again...aah the benefit of hindsight.
Caro they can do it without rupturing membranes - my first baby my water was leaking, I was started on the drip and water wasn't broken until well into my labour.
Jac - I've had two inductions and two very different experiences. First baby was induced as described above. 18 hour labour, full on contractions the whole time (contractions with a drip induction are notoriously painful), gas, pethedine, epidural but I got her out in the end. Although it probably doesn't look that great on paper I had a positive experience with her birth and although there are things I'd change knowing what I know now, it was a pretty good birth for me.
Second baby, whole different story. Induced by rupture of membranes at 38 weeks. Knew baby was posterior but figured he would turn. No contractions started after about 5 hours so started drip. Laboured about 3 hours on the drip, almost ready to push and suddenly monitors start going off - baby's hearbeat was plummeting. He was in a bad position (sunny side up with his head tilted backwards) and every contraction was banging his forehead into my pelvic bones. I couldn't move around to help him move since I'd just had an epidural .... so off for a c/section. Obviously not very happy with that birth and still working through it.
Really think long and hard about this, inductions are not something to be taken lightly as you seem to be already aware. Knowing what I know now, I would never, ever have another one without a very VERY compelling reason. All the best with your decision.
There are no guarantees with birth, some labours are long, some short, some women respond quickly and easily to induction drugs, some find it excessively painful. Our uterus' are all different as to what they can tolerate ... hence why you will hear so many conflicting stories on inductions. So many factors come into play, baby's position, yours, drug strength, drug type, how ready your body is for labour etc...
There is no true comfort you can have from a CTG machine, studies and the Cochrane database review found that they don't improve outcomes and increase caesarean rates and instrumental birth.
The Cochrane Database of Systematic Reviews 2006 Issue 3
Copyright © 2006 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Plain language summary
Comparing continuous electronic monitoring of the baby's heartbeat in labour using cardiotocography (CTG, sometimes known as EFM) with intermittent monitoring (intermittent auscultation, IA)
Monitoring the baby's heartbeat is one way of checking babies' well-being in labour. By listening to, or recording the baby's heartbeat, it is hoped to identify babies who are becoming short of oxygen (hypoxic) and who may benefit from caesarean section or instrumental vaginal birth. A baby's heartbeat can be monitored intermittently by using a fetal stethoscope, Pinard (special trumpet shaped device), or by a handheld Doppler device. The heartbeat can also be checked continuously by using a CTG machine. This method is sometimes known as electronic fetal monitoring (EFM) and produces a paper recording of the baby's heart rate and their mother's labour contractions. Whilst a continuous CTG gives a written record, it prevents women from moving during labour. This means that women may be unable to change positions or use a bath to help with comfort and control during labour. It also means that some resources tend to be focused on the needs of the CTG rather than the woman in labour. This review compared continuous CTG monitoring with intermittent auscultation (listening). It found 12 trials involving over 37,000 women. Most studies were not of high quality and the review is dominated by one large, well-conducted trial of almost 13,000 women who received care from one person throughout labour in a hospital where the membranes have either ruptured spontaneously or were artificial ruptured as early as possible and oxytocin stimulation of contractions was used in about a quarter of the women. There was no difference in the number of babies who died during or shortly after labour (about 1 in 300). Fits (neonatal seizures) in babies were rare (about 1 in 500 births), but they occurred significantly less often when continuous CTG was used to monitor fetal heart rate. There was no difference in the incidence of cerebral palsy, although other possible long-term effects have not been fully assessed and need further study. Continuous monitoring was associated with a significant increase in caesarean section and instrumental vaginal births. Both procedures are known to carry the risks associated with a surgical procedure although the specific adverse outcomes have not been assessed in the included studies.
Abstract
Background
Cardiotocography (sometimes known as electronic fetal monitoring), records changes in the fetal heart rate and their temporal relationship to uterine contractions. The aim is to identify babies who may be short of oxygen (hypoxic), so additional assessments of fetal well-being may be used, or the baby delivered by caesarean section or instrumental vaginal birth.
Objectives
To evaluate the effectiveness of continuous cardiotocography during labour.
Search strategy
We searched the Cochrane Pregnancy and Childbirth Group Trials Register (March 2006), CENTRAL (The Cochrane Library 2005, Issue 4), MEDLINE (1966 to December 2005), EMBASE (1974 to December 2005), Dissertation Abstracts (1980 to December 2005) and the National Research Register (December 2005).
Selection criteria
Randomised and quasi-randomised controlled trials involving a comparison of continuous cardiotocography (with and without fetal blood sampling) with (a) no fetal monitoring, (b) intermittent auscultation (c) intermittent cardiotocography.
Data collection and analysis
Two authors independently assessed eligibility, quality and extracted data.
Main results
Twelve trials were included (over 37,000 women); only two were high quality. Compared to intermittent auscultation, continuous cardiotocography showed no significant difference in overall perinatal death rate (relative risk (RR) 0.85, 95% confidence interval (CI) 0.59 to 1.23, n = 33,513, 11 trials), but was associated with a halving of neonatal seizures (RR 0.50, 95% CI 0.31 to 0.80, n = 32,386, nine trials) although no significant difference was detected in cerebral palsy (RR 1.74, 95% CI 0.97 to 3.11, n = 13,252, two trials). There was a significant increase in caesarean sections associated with continuous cardiotocography (RR 1.66, 95% CI 1.30 to 2.13, n =18,761, 10 trials). Women were also more likely to have an instrumental vaginal birth (RR 1.16, 95% CI 1.01 to 1.32, n = 18,151, nine trials). Data for subgroups of low-risk, high-risk, preterm pregnancies and high quality trials were consistent with overall results. Access to fetal blood sampling did not appear to influence the difference in neonatal seizures nor any other prespecified outcome.
Authors' conclusions
Continuous cardiotocography during labour is associated with a reduction in neonatal seizures, but no significant differences in cerebral palsy, infant mortality or other standard measures of neonatal well-being. However, continuous cardiotocography was associated with an increase in caesarean sections and instrumental vaginal births. The real challenge is how best to convey this uncertainty to women to enable them to make an informed choice without compromising the normality of labour.
Hi, I was induced at 37 weeks because my waters had broken but labour was very slow to start. I was hooked up to a drip and machine to monitor my contractions and the babies heart beat. My labour was 6 hours long and I gave birth naturally. It was nothing like I expected as I went into full on labour with contractions a minute apart within the first hour. I asked for an epidural but was told that I was too far advanced for one. All in all, I would do it again. I have no problems being induced with my 2nd.
I was induced at 42 weeks after trying all sorts of things to bring labour on:
Gel was inserted at 6pm
Contractions started 45 mins later at 2 min intervals
After 15 hours of this, using TENS and the visualisation stuff I had practised, I had been fully dilated for ages, done stacks of pushing but DS' head was not going to come through. He was not distressed, so I waited 'my turn' for another 2 hours for the epi just before the c/s.
The original plan was to try more gel at 7am if labour had not established and then wait another 6 hours before starting the drip very very slowly. My OB was very understanding about my concerns about an induction and was happy to give me as much time as possible as long as we both were fine. He knows I am keen for a VBAC next time but says he is not happy to induce me or try for a vaginal birth if the next baby is as baby (DS was 4.67kg). I'll try to get my head around all that a bit further down the track.
What hospital are you booked into?
*Nessa*, what I posted was an independent evaluation of all available studies on the topic, Cochrane is an independent reviewer of studies.
See CTG's used to be used lots as it gave evidence (see: protection) for doctors - if something went wrong they could say that they had monitoring. But now, that is not necessarily a good thing and some want to get rid of them, not so much in AUS though. Inaccuracy rates are terrible with those things, they move, pick up mum's h/r, the placenta, and of course it is a machine so its not perfect.
Most people are not aware they have a choice. You can say no or ask for intermittent doppler monitoring instead.
I'm not being rude, but something I want to clarify which I hear alot. A natural birth is one without interventions - drugs - anything that interferes with the process of it happening on it's own. This doesn't mean the midwife coming in with a doppler and listening to your heartbeat, but moreso medical inductions, instrumental birth, pain relief, artificially rupturing your membranes, third stage injection etc. If you have those things but don't have a caesarean, then it's called a vaginal birth.
Just mentioning it as it can be very confusing for others, and I also think that because of the high rates of intervention our country has, it's sad to see the word natural birth become related to something which is highly intervened. So just trying to clarify, not being rude or saying one thing is better than the other - its just what it means.
hi jac i was induced at 36+6 weeks as one of my twins was very under weight and they didnt want to take any chances so was admitted to hospital at 3.30pm on March 30th 2005 at 4.30 the nurse placed gel on my cervix which was meant to make me dilate enough so they could break my water the next morning but the twins had other plans. They arrived at 12 that night. If i had a choice again id be induced as i was in hospital so if i needed anything i was there when you go into labor on your own you could be anywhere then youd need to rush to the hospital.
Thanks everyone for your interesting feedback.
Kelly - If I were given a choice I would have no problem whatsoever waiting for spontanoeus labour, or trying natural methods to induce labour. However, I can not argue the point if my OB thinks that the baby is better off being induced and born early. Imagine if I refused to be induced because I want a 'natural birth' and something happend to my baby (there is concern that my placenta may not be working adequately). I trust my OB's opinion but feel upset that I may have to start the process unnaturally. You asked if the risks of inductions outweigh the benefits - well if the benefit is a healthy baby that needs to be born to grow and thrive, I would say that's all the benefit one needs. I don't find it helpful to hear that inductions are not as good for mum/bubs as natural birth (even though I agree with this in principle) when I may not have a choice.
Kel - when the midwife said she stopped seeing so many OP babies once she stopped doing ARM, did she mean that these babies were in the position before hand (as i believe like 90% of OP turn before or during labour), or they were the right way and then turned OP?
Just in my case i was contracting for about 10 hours before the ARM, and the baby was the right way around. I believe he turned around 10 hours after this, but would the ARM have had anything to do with it? And with him getting stuck, or was that a result of being OP only?
Also, the wireless monitors that they had on me, are they CTG? I think next time i will refuse the CTG, it didn't prove much to me (i knew i was having contraction), and the intermitent doppler i had from the 2nd midwife onwards was just as reassuring that the baby wasn't in distress anyway.
To the opening poster, i had an induction do to very low fluid levels at 10 days overdue. I refused to drip (mainly cos of the stories i heard about it being so painful that you would need an epidural, one thing i def. did not want), and just had my waters broken instead. I believe it was a lot gentler induction (although i would more call it agumentation as i had regular contractions that were around 15 mins apart for around 10 hours before going to hospital). I think my waters would have broken that day or the next, but my dr had already given me 3 extra days and he felt it wasn't wise to continue on.
Although my labour in hospital went a lot longer due to no drip, it was manageable for the most part (nothing until 7cm, when i had gas, and morphine at 9.5 when my the baby turned from the right position into being posterior). If i had to have an induction again, i would for sure do it the way i did also. I had no gels as i was already almost 4cm that morning (i was 3cm on the friday before, when i was booked in), so can't comment on them. There are options for making inductions a bit gentler.. but i would say this, no matter if i was having a full on induction or not, being scared will slow your labour down. It might be good to read up a bit (there are a few threads about what to expect - i'll try to find them), because going in informed and calm will help you.
Thats just my opinion/experience, hope it helps :)
Jac, I chose to have an induction for my own purposes, and it was a good option for me.
I had my waters broken and my Ob was happy for me to walk around for a while until I decided I was ready for the drip.
Please don't take it as a given that you WILL NEED an epidural with the drip, as Kelly has said, it depends on how your own body deals with the drug. I personally did the induction with just gas, however with my first labour which was spontaneous I had all sorts of intervention including gas/pethadine/epidural and forceps. So for me personally my induction was better.
I totally agree with Yael, read up as much as you can and inform yourself of alternative pain relief methods, find out if you can have intermitent monitoring and lastly make sure you have a great support team working for you.
Goodluck with it Jac!
Jac - as I said in my first post my advice was to clarify with him if this really needs to be done urgently and how serious the situation is (you'd think he would have done it sooner if so tho) and you are very close to your due date so can it wait or not... without full information its hard to make a decision. The rest of my replies were in response to others posts.
Yes, I would much prefer to wait until as close to my due date as possible as I don't think my little one is ready this early (nor am I for that matter). Kelly, you have given me some questions to ask my OB though about keeping on going for as long as possible without intervention.
Yael - I like the sound of your "gentler" induction but I wonder if this would be possible if done 2 weeks early (ie. if cervix not softened and no contactions yet). I hope, if I have to have a full induction with drip, that I can manage without any pain medication (just natural methods). My pain tolerance is reasonable and I REALLY don't want an epi. unless I absolutely cannot manage without it.
I wonder if a TENS machine would still be useful with a full on induction??
Jac - i think it all depends on your body. My case was different in that i was already overdue. My induction was booked on Friday and i was almost 3 cm, and then on the Monday i was almost 4 when i went in. I had also been having regular contractions for 10 hours. I don't know, i might have done things differently if my circumstances were different.
But look at it this way, if you start with no drip you can always go on it after a few hours if nothing happens from the gel, but if you are on the drip, they generally don't turn it off (in case labour stops). I think i had a reasonable pain tollerance also, but i think you can't really predict these things until you are in them IYKWIM?. I also had a good support team with an excellent excellent doula who really help show me how to get things going and help me stay off the pain relief as long as possible.
I don't know about TENS but am planning on using it this time. You can always try it even if it doesn't work, you don't have much to lose.
I also had to have it b/c placenta was beginning not to function and fluid were low, but this was post dates also. For me, i also weighed up the risks and decided to proceed.
But if you obs isn't saying "no more than 3 days longer" like he did to me, than maybe is a concern but not critical at this stage. Def. speak to your obs about it, ask what the fluid levels are, and whats considered normal etc.
Good luck, its stressful and not an easy decision to make. But liek i said, stressing will on;y stop your labour, not help. Maybe have a relaxing massage or try some natural ways to get things going. EPO inserted vaginally is suppose to hep soften the cervix, so you might start going with them to see if you can gets things going quicker!
HTH :)
Jac
Have you had any internals at all? I only ask because at 38 weeks I was already 2cm dialated and my cervix had softened and all without any contractions.
I was induced at 39 weeks due to high BP. I was giving my first lot of gels at around 9 am which did nothing. I did want a second lot of gels as I was terrified of having my water broken but they ended up breaking my waters. I was pretty much in instant labour and whilst it was intense it was bearable. The only other intervention that occurred was a shot of pethadine and I was in labour for 5 hours.
It will depend on your body and your baby. Inductions certainly are intervention and can lead to more intervention but that is not always the case as evident from all the posts of different experiences here.
If he is looking at inducing you at 38 weeks have you thought of trying a few natural methods of helping to ripen your cervix etc. Take a look at Fletch's thread - there are some great tips there.
And just a point as well - I read in another thread that you can ask for the drip to be turned off once labour is established.
Good luck with it all.
Hi Jac, I have been induced 3 times as I was overdue and had fairly quick labours,6,6.5 and 4 hours. With my first and second I had the pethidine and the gas, with the 3rd I had no drugs. My water was broken each time and I was on a drip.
My last two came on their own without being induced and I had a drugfree birth for both of them as well.
This one will hopefully come on its own but if it doesn't I will be induced as they won't let me go over my due date due to medical reasons. I would rather go naturally but if I have to be induced then so be it, as long as the baby is born healthy and safe thats all that matters.
We haven't seen you in belly buddies for ages why don't you pop in and say hi, we have been wondering how you were going!
Michelle