2. ARM (Artificial Rupture of Membranes)
Should your cervix be favourable and your baby in the pelvis, this option may be given to you for an induction. The waters will be broken in the hope this will lead to labour, however often you are given a very short space of time for contractions to establish – sometimes only an hour or two – before being put onto an i/v (intravenous) oxytocin drip. Of course, once the membranes have been ruptured, you are also on a time line as your chance of contracting an infection is increased. Some midwives have also noticed that the early rupturing of the membranes can result in more posterior or malpositioned babies.
If your labour is not progressing after the membrane rupture, you will likely have a syntocinon drip put up (which you can consent to or not consent to – it is your body and your choice), possibly followed by pain relief and depending on the option you choose for pain relief, you may require assistance by the way of an instrumental delivery. All this is called a ‘cascade of intervention’ where one intervention leads to another and another and so on. However some women will go on to labour well and not require all these things – it’s just something to bear in mind from both sides.
3. Artificial Oxytocin (Syntocinon)
Syntocinon is administered via an intravenous drip and may be used if your waters have broken but there are no contractions, or if contractions don’t start up on their own. Because you are having this drug, you will be required to be monitored continuously as your doctor will need to know what effect this is having on the baby. So if you planned on having an active labour and moving around freely, this could leave you confined to the bed. Being restricted to the bed, reclining or semi-reclining during labour works against gravity and are not particularly helpful to the normal processes of labour. It also means that you won’t be able to use a bath and probably a shower for pain relief too. You can still use a bath and shower for pain relief with intermittent monitoring, it’s just more awkward so it will depend on the hospital and staff on at the time.
It may be argued that you will be induced starting at a low dose which may bring you some comfort at the time. But this ‘low dose’ will be continually increased during your labour, usually every half an hour the dose will be doubled – so you can imagine how quickly this builds up until you start labouring at the rate required and so your labour keeps progressing. Once you are on an oxytocin drip, most doctors will say that unless your baby becomes distressed, they will want the drip on until your baby is born, so your labour doesn’t stop. So if you decide you don’t want it after an hour or so, or it gets too much, know that you do have the choice and power to have it turned down or turned off – however if your labour slows or stops they will want it back up again. Sometimes it just takes a little syntocinon to get labour going, however by accepting an induction in this way you do run the risk of requiring the drip for the whole labour.
An example of a dose you might have prescribed is as follows:
10u of Syntocinon added to 1000mls of fluid. The drip rate is usually started at somewhere between 15-30mls per hour. It is then increased by somewhere between 15-30mls per hour every 30 minutes.
So if we were to start with 30mls per hour, after 30 minutes the rate would be increased to 60mls per hour, and after 1 hour the rate would increase to 90mls per hour.
Side effects include:
- Hypotension (low blood pressure)
- Water intoxication
- Hypertonic uterus
- Uterine rupture
- Uterine inversion
- Stillbirth
- Tachycardia
- Heart abnormalities
- Nausea
- Vomiting
- Diarrhoea
- Because it acts on the smooth muscles asthma could be a problem
This is taken from the packaging of Syntocinon which has been recently updated:
“ADVERSE REACTIONS
The following adverse reactions have been reported in the mother: Anaphylactic reaction, Postpartum hemorrhage, Cardiac arrhythmia, Fatal afibrinogenemia, Nausea, Vomiting, Premature ventricular contractions, and Pelvic hematoma.
Excessive dosage or hypersensitivity to the drug may result in uterine hypertonicity, spasm, tetanic contraction, or rupture of the uterus.
The possibility of increased blood loss and afibrinogenemia should be kept in mind when administering the drug.
Severe water intoxication with convulsions and coma has occurred, associated with a slow oxytocin infusion over a 24-hour period. Maternal death due to oxytocin-induced water intoxication has been reported.
The following adverse reactions have been reported in the fetus or infant:
Due to induced uterine motility: Bradycardia, Premature ventricular contractions and other arrhythmias, Permanent CNS or brain damage, and Fetal death.
Due to use of oxytocin in the mother: Low Apgar scores at 5 minutes. Neonatal jaundice, and Neonatal retinal hemorrhage.”
