Active Labour and Induction? (long-ish post)

I've just hit 40 + 6 today, and have induction booked for next Wednesday (41 + 5). I have reservations about routine induction, although I do understand that I am perfectly within my rights to refuse it. (That's another story though!)

I have been having strong BHs and intermittent contractions (nothing regular or sustained) since 37 weeks. As of today I am 1cm dilated but bubs has not yet engaged. So, some progress. He is still determinedly posterior, although I know that there is a good chance that he will turn either prior to, or during labour. I also know that ARM and induction are not favourable conditions for a posterior bubs turning in labour.

I have been doing all of the things which might help to convince kiddo that it's time to make an appearance, and am not too stressed about the situation. Hopefully he'll come out in time for a natural and active birth! I know what the likelihood of increased intervention is once induction takes place so I want to be as prepared as possible.

I know that intermittent monitoring is preferable to CTG monitoring as it allows greater scope for movement. The hospital that I have attended has not required me to be lying down for CTG monitoring in the past, so I hope at the very least to be on all fours and rocking and not entirely restricted in movement if CTG monitoring is absolutely required.

My question is, what active birth methods (if any) have people found to be successful with induction using syntocinon? Is there anything that will help when restricted in movement? (or, can somebody point me to a thread with useful tips and tricks - I had a look but couldn't find anything specific).

Posterior labours are typically slower to start so patience is so important. I wouldn't focus on the synto, which will leave you more likely to have an epidural and even less likely baby will turn and more likely a c/s... happened to my client last night. Induced spot on at 42 weeks with a posterior bub (already 1.5cm), waters were broken and nothing happened at all for around 5 hours so she agreed to the drip (which she hated as she kept saying she felt restricted 'caged' and couldn't move around), had intense labour pain for another 5 hours (4 in 10min contrax) and internal revealed still 1.5cm. She had an epi, so drip was pumped up, baby became stressed, drip turned down but to late - emergency c/s.

I'd be working harder to move that bub, because I have seen this scenario happen a couple of times now. The ironic thing is the midwives have never been able to tell the baby was posterior at the time, I actually insisted at this last birth that baby was, because there was so much trouble trying to get the heartbeat, mum had backpain during contrax, nothing happened with the waters were ruptured and the drip was doing nothing. I am not saying this will happen to everyone, but women do need to know and prepare for the fact that induction does fail. Women's bodies aren't designed to cope with a quick, intense early labour stage (from the drip) and especially not when their body and baby is not ready.

To show you how clever babies are... and I have told this story many times, but when mum was pregnant with me, I was breech..... born 9 days late but had managed to turn head down the day before - so on the 8th day I turned. Should I have been born in 2007, I would have been born over 3 weeks early as I would have been a c/s babe at 38 weeks.

Poeterior babes are birthable. Its not a woman's failure to progress here. It's the medical system's failure to wait.

^ What she said lol.

During my induced labour I found using a birth ball really helpful - I sat on it and leaned my upper body on the side of the bed for many many hours, just rocking and bouncing gently. It helps keep you open and encourages baby to move down. So definitely ask for one of those.

It sounds like you have a really good understanding of what the issues are and what you need to do to get this to happen your way, I guess I'd just say hang on to that confidence in your body and your baby (who will come out eventually ;) )

Thanks so much for taking the time Kelly - especially after your very very long birth yesterday you must have been absolutely exhausted. I really appreciate it!

These are exactly the things that I have been concerned about - I think that you are exactly right - I should really work to get bubs turned and hopefully out before then! So far I don't think the strategically placed neon exit sign is working. Sigh... ;-)

Should I get to induction date and he's still posterior, well I am just going to have to be prepared for a fight on my hands to get them to wait for a reasonable amount of time after ARM until they administer the synto. You've given me some great ammunitition to go in fighting with if I have to!

And in the meantime - lots and lots of 4WDing, walking, and you know what else... (LOL!). I'm just about to ring my masseur/reflexologist and see if I can get in to see her today so this will help.

Thanks again, I really do appreciate it and hope that you had a lovely restful night's sleep last night!

P.S. Flea, just saw your post - thank you so much - that's great advice!

suse, i was induced at 42weeks with a posterior baby and although it was a very intense labour, just wanted to let you know that he turned during the labour and even though i was threatened with a c/s, i ended up having him vaginally. best of luck with everything.feel free to pm me if you would like to ask me anything more

I have been induced twice and spent many hours hooked up to wretched drips but trying to be as active as possible. Kelly was at my last birth and helped me negotiate a very low dose of oxytocin which really helped even though the hospital staff became impatient I gave birth with a minimum of intervention. It wasn't available at my last birth but I recall from my 2nd labour that kneeling into a rocking chair facing backwards hugging the headrest was a really good position after laboring very actively for hours. It was a nice thick leather upholstered rocking chair. Also, getting down on the floor kneeling into a beanbag. Also kinda take it easy to start off, remain vertical but don't walk for hours or you'll get tired out too fast. This is what happened in my second labour and I got so tired I became compliant and open to suggestions of intervention... luckily my OB didn't take advantage of that and the midwives were encouraging not impatient. This is where active but stationary movements like sitting straddled on a fit ball leaning on your bed, bouncing gently is really good.

Thanks so much guys - that's fantastic advice!

I have an acupuncture session booked for 12:30 today, (YAY!) so hopefully the little fella can be convinced to make an appearance on his own, but if not, you've all given me some really good things that I can try (as well as a bit of hope too!).

41+5 isn't generous. I would be pushing for more time before induction, not more time after ARM. Because once those waters are broken, its even harder for baby to move into anterior position.... plan to let your baby come in his or her own time, then if mum or bubs isn't happy or healthy then look to induction. You can negotiate with monitoring every day or scans. Ironically, my nanny who is here today just got an SMS from a friend who had an unneccesarian when she was induced and it also failed after intense labour.

Hey Suse

some great advice here :)

as Kelly said...if your waters are broken with the baby in the posterior position this is the way he will engage in your pelvis...women with intact waters with baby in the posterior position, labor can be slower, but the process allows the babes head to rotate easier and engage just prior to birth in the anterior position

once your waters are broken the Dr's generally prefer the baby to be born within 24 hrs...due to the risk of infection after this

sometimes no matter what we do an induction is necessary :)

some wonderful suggestions for an active labor...forward positions which encourage great pelvic opening and optimal positioning of the baby in the pelvis are achievable everywhere...bed, bath, shower, hallway ;)

the post dates subject causes a great deal of debate...but as a m/w I always err on the side of caution...after 42 weeks the placenta is not functioning at its optimum, which naturally has follow on effects to the baby...so sometimes its about, ok I need an induction but I will do it my way...my body, my baby, my birth...so if you want a few more days you will almost certainly be encourged to have a baby monitoring session so they can ensure that all is ok with your baby...I know that Dr's can be so pedantic sometimes, but remember they are taught the medical model and will always be cautious :)

nipple rolling encourages the release of oxytocin which stimulates contractions
orgasm does the same thing...not that I felt particulary like a hot sex session when I was due ;)

sending you lots of welcoming baby thoughts

xx yogababy

I'm sorry to hijack Suse, but I have question. My baby was BORN posterior despite me keeping very active and in water during my labour. I did have PROM and delivered him 14 hours later, is that why he didn't turn do you think?

Suse, I wish you all the very best. You sound very well informed, and I'm sure you will do a fantastic job of birthing your baby. My advice for a posterior labour is to make use of a deep bath if possible, and stay active. You don't want to be on your back for one minute! Lots of walking, rocking your pelvis etc. The birth ball is a great idea, anything to open your pelvis up. Good luck hun, can't wait to hear how it all goes.

Suse - I'd second the bath suggestion. I had an induced (but not posterior) birth, and the bath was a lifesaver. Even though I was attached to a drip and a monitor, I was still allowed in the bath.

Good luck!

Hey sezjm

sometimes with PROM the babes head will engage in a posterior position...leading to a posterior labor...but an active labor, with good postioning meant your pelvis was as 'open' as it could be for your baby to birth in the posterior position or 'sunny side up' :)

if you have a roomy pelvic cavity your baby will birth posterior..if you had perhaps been fearful, in bed, epidural etc you may well have ended up with either an instrumental delivery or a c/s

hope this answers your Q :)

xx yogababy

Suze I was induced because my waters broke and after two days I just couldn't kick my body into labour. I was continuously monitored and had the drip. To answer your question about what positions you can do I can only share what I did.
I spent early labour sitting on a birth ball with my legs wide while leaning forward with my belly between my legs. This position is great because you rock, bounce, stand up and sit down easily and your partner has full access to you back so he can rub it, hold hot packs on it and you can also lean back into him to rest during contractions. He can also sit in front of you so you can lean on him for support/rest.
Don't be afaird to use the bed as a tool. The beds these days have some wonderful instruments which can be attached to them like a squatting bar and the back of bed can be elevated so you can kneel against it with beanbags/pillows helping to support your belly.
Also using the floor as well. You can kneel with your partner in front of you so you can rest on his knees/lap which can have a pillow on it to make it more comfortable. You can also be on all fours as well. Once again you can rock your pelvis and partner has full access to your back.
You can also walk around too. I know it is limited distances but in labour you don't want to walk a marathon anyway. Using your partner you can stand either facing him or away from him and squat or rock or whatever you need to during a contraction and then lean into him and rest between.
I hope this has given you some ideas that you can do even if you have to be induced. All of these suggestions you can do while being monitored and try to keep your pelvis open to give bubby room to turn.
Best of luck.

(P.S. My DD was posterior until a few hours before my labour so bubby could still turn because there is time).

I was induced but fortunately my OB seems to be one of those rare ones that would rather let nature take its course as much as possible. He took my induction very slowly - one round of gel in the morning then another at about 6pm, ARM at 8am the next day and then syntocinon at 1pm when my contractions still hadn't progressed enough (this was my choice, he would have waited longer for the synto if that had been my choice). DD was born at 10.17pm. Once the synto was going I could still use the shower (didn't have a bath in my room unfortunately but was told that if I had had one, I could have used it), go for walks through the corridors with DH, use the birth ball. Basically, I could do everything I could had I not been induced, just was doing it with a portable monitor attached and a drip stand. DD was posterior too, but turned prior to the synto being hooked up.

I'm really grateful for the OB I had, and would definitely have been fighting if he had tried to push me faster. I did end up with an epidural - was completely exhausted by the end of the second afternoon and needed to get some sleep.

Good luck - hopefully your bubby will take matters into his own hands and move things along for you.

Thank you everybody for taking the time to give me such wonderfully helpful info!

Kelly - unneccesarian - I love it! I agree that 41+5 is over-cautious on the hospital's part, especially as I have had a low-risk pregnancy in all regards. The option is always there to refuse the induction if I don't think it's justified, but I'm really hoping that I'm not going to have to make that decision! So if bubs does not respond to encouragement to come out on his own before then, all I can do is weigh up all of the options, get as much information as I can, and trust that my instinct will lead me to the right decision!

May I ask either yourself or Natalie what is probably a stupid question? Currently bubs is ROP. If they rupture the membranes before he has engaged, then there is less likelihood that he will turn naturally into a favourable position before engaging, yes? So if he is still in the ROP position when they rupture membranes is this more likely to cause a failed induction because he'll be unable to turn into a favourable position and could get 'stuck'?

From what others have said, it sounds like it's not necessarily impossible that he'll turn during labour, but I have heard that the caesarean rate for posterior positioned inductions is 1 in 3 - would the likelihood increase for a ROP positioning?

Sorry for the million questions!

Hey suse

great Q

if they rupture your membranes with baby in an ROP position then he will engage in this position...which means he has further to rotate to move into an anterior position to be birthed...this is why posterior labors are known to be longer and more intense...the uterus is working hard to turn the baby ;)

all is not lost...foward positions...liks some of which i sent you...encourage the optimal opening of the pelvic cavity and allow for an eaiser rotation of the babies head

all this said suse...babies are amazing in their way of choosing the way they will be birthed, an indicator of personality ;)

remain positive, calm and relaxed...empowered with your birth plan and you will do great

xx yogababy

:)...your baby being head down in the pelvis indicates that he will fit...you will do really well, and I look forward to hearing all about it

xx