Reasons, methods, risks and benefits
Most babies are ready to be born between 38 and 42 weeks by the releasing of hormones signalling to the body to get ready for birth. Most women are envisioning themselves going into labour naturally but sometimes nature needs a little help. Getting an induction can be a tough decision to make and this should be discussed in a transparent way with doctors/midwives looking after the expectant woman. Currently about the 23-29% of births are being induced compared to only 12% in the 90’s.
For one reason or another, sometimes inductions become necessary to avoid endanger the mother and baby’s life. Induction will be offered to all women who don’t go into labour naturally by 42 weeks, as there’s a higher risk of stillbirth or problems for the baby beyond 42 weeks. It is however important to note here that some women gave birth naturally with no medical interventions until week 44! Yes you’ve read it right. But finding a doctor that will support in this direction will be very challenging not to say impossible in the UAE.
There are however a couple of criteria’s that have to be met to ensure induction is purposeful and not based on some doctor’s convenience to speed things up or to allow your doctor to go on vacation sooner (yep, it happens a lot!)
Some of them are:
· If a woman’s water breaks before going into labour
· If either or both mother and baby’s health are compromised for a medical reason such as placenta previa, pre-eclampsia, gestational diabetes
· Fetal growth restrictions such as a baby measuring significantly smaller than his/her expected weight at this stage of gestation compromising his life outside the womb
· Babies with the shoulder dystocia usually when the baby is too big and can get get stuck in the pelvis
· When the baby is not getting sufficient/adequate nutrition from his placenta.
What parents should ask to their care providers:
A woman should not get her labour induced if she can’t get a ‘yes’ to any of the below questions:
3 questions for parents to ask before getting an induction:
1. I am healthy and safe (mother)? Is there any medical reason (high blood pressure, kidney disease, gestational diabetes or any other particular illness that can impair the mother’s health to bear the pregnancy any longer). If the answer is yes to this question, then the mother can follow up with another question number 2.
2. Is my baby healthy and safe? Is the baby having any medical conditions, or is affected by his mother’s conditions?
If the answer is ‘yes’ to this question, then the mother can follow up with question number 3.
3. Is my baby’s safe and healthy in his current home/environment? (Placenta, amniotic fluid, uterus). Beyond 42 weeks and sometimes even before, the amniotic fluid can diminish and not provide enough nutrients to the baby. The placenta can also see its function impaired beyond a certain point in late pregnancy and so not fully function as he is intended to. For instance, not acting as a barrier against infections.
If a woman gets a ‘yes’ to these 3 questions, she may discuss alternative to naturally induce her labour or get offered a membrane sweep which is an induction option.
To carry out a #membranesweep, the midwife or doctor sweeps their finger around the woman’ cervix during an internal examination. This action should separate the membranes of the amniotic sac surrounding your baby from your cervix and releases hormones (prostaglandins), which may kick-start labour. It can be very uncomfortable expect and lead to some period-like cramps and slight bleeding. If labour doesn't afterwards, a medical induction will be performed in a hospital maternity unit.
When it comes to labour induction, there is more than just one way it’s done when needed and necessary.
#Prostaglandins. If this is the case, your doctor and midwife will explain your options to you so you can decide whether or not to have your labour induced. The use of a synthetic form of prostaglandins that comes in several forms. Prostaglandins are hormones naturally released and present in the woman’s body that helps ripen, soften and prepare the cervix for labour.
The first form is a cervical gel placed in the vagina, near the #cervix, by your doctor or midwife. The second form is a prostaglandin called Cervidil, a medication on a tab with a string attached that’s placed near the cervix.
Another form is Cytotec (misoprostol) that can be taken orally or vaginally every 36 to 46 hours depending on if the drug has been taken orally or vaginally to help ripen the cervix. This method might not be used by the doctor for mothers who previously had a C-section as it may cause hyper stimulation causing #contractions too powerfully or frequently and provoke a rupture of the womb (#uterinerupture). Oral and vaginal are both equally effective however oral administration reduces the risk of vaginal infection.
Oxytocin (Pitocin). If the prostaglandins work to soften and shorten the cervix (this is often called a “favourable” cervix), through an IV line. #Oxytocin is naturally produced by your body to help the uterus contract. It may also be called by its synthetic name, #Pitocin. Oxytocin is generally not used on its own before the cervix is considered favourable because it’s associated with a higher rate of C-sections. Both oxytocin and prostaglandins can reduce your baby’s heart rate, which is also why monitoring is used to make sure that all is well.
#Amniotomy. An amniotomy is where the doctor uses an instrument to break the #amnioticsac, allowing amniotic fluid to leak out. This is uncomfortable but not painful. Again, this is usually done once the cervix is favourable, and oxytocin is used to keep labour consistent. Once a woman’s water is broken, there’s no turning back because there’s a risk of infection since the amniotic fluid has left the uterus. With this method, there is also an increased risk of cord prolapse usually in hospital.
Induction of labour may take a while, particularly if the cervix (the neck of the uterus) needs to be softened with pessaries or gels. Once labour starts, it should proceed normally, but it can sometimes take 24 to 48 hours to get you into labour. The good news is that pain relief are available to all women being induced. It is however important to point out that women who are induced may (usually or not!) experience more painful and stronger surges/contractions than the ones they would have experienced when labour starts on its own.
Many women have reported to experience non-stop contractions or a more frequent and powerful waves of contractions compared to women having had a natural start. So, women must be prepared to experience a more ‘painful’ or challenging labour with less rest than they would normally have in between contractions.
They are then more likely to ask for an epidural which might lead to a higher rate of instrumental and assisted delivery. By numbing the woman’s lower body part, it increases the need of guided pushing. Not feeling her body entirely, means that the mother is more likely to be pushing either too hard or not enough since she does not feel the surges and urge to push or not.
Another important inconvenience of being induced is being constantly monitored to keep an eye on the surges and their intensity as well as monitoring the baby’s heart rate which might drop because of the intensity and frequency of the contractions.
If induction is unsuccessful, the obstetrician and/or midwife will assess the condition and the baby's and may have to carry out another induction or a caesarean section.
There are also a few natural induction methods worth giving it a try such as sex, spicy food, physical activity, castor oil, essential oils etc…). I'll be explaining in more details each one of those with their advantages in another blog post.
To sum up, the most important things are knowing what the reason(s) is/are for being induced and understanding the different methods of induction, along with the risks and benefits. The goal being to ensure that both mother and baby achieve a safe and healthy delivery.
Last personal note. Mummies, connect with your baby and talk to him/her so she feels safe and loved enough to come on her/his own term. Always remember this: there is no wrong way for your baby to come to this world.