Dr Rachel Reed is a Senior Lecturer and Discipline Leader in Midwifery at the University of the Sunshine Coast, Australia. She has provided midwifery care for hundreds of women in a range of settings in the United Kingdom and Australia. Rachel’s PhD explored women’s experience of birth and midwifery practice during birth. She is a writer and presenter, and is the author of the MidwifeThinking blog site. Rachel is originally from the North of England but now lives in the forest in Queensland Australia. Her new book Why Induction Matters is published by Pinter & Martin in September 2018.
Over to Rachel:
10 decisions you can make about your induction
Having your labour induced can be a positive and empowering experience. The induction process involves three stages. The first two stages, ripening the cervix, and breaking the waters, aim to prepare your body for induced contractions. The third stage of induction stimulates uterine contractions using syntocinon (IV medication). Within this process there are a number of decision you can make about how your induction is carried out.
The first step in the induction process is to ripen the cervix so that it will open in response to contractions. This can be done using medication (prostin) inserted into your vagina, or a balloon device placed in your cervix. Depending on how close to labour your body already is, this process can take many hours, or in some cases days.
- How do you want to organise your support person/s?
Do you want a different support person for this phase of the process, or the same one as you plan to have with you during labour. If you are staying in hospital overnight will this person be able to stay with you, or will they go home? If they go home when would you like them to return?
- What are your preferences for comfort measures and pain relief?
Most women experience some pain and discomfort during this phase. What are your preferences for pain relief, for example, hot-packs, warm shower, pain medications such as paracetamol?
Once your cervix is ripe and has opened a little, the next step in the induction process is to break your waters. This removes the fluid from around the baby making induced contractions more effective. Some women will go into labour themselves within hours of this procedure.
- After your waters are broken do you want to wait and see if you start contracting spontaneously?
If you want to wait, how long will you wait? What will you do while you wait? Walking can help the baby’s head move down and press on the cervix which may start contractions.
If you don’t go into labour after having your waters broken, contractions will be induced using syntocinon, a medication that is given via a drip into your vein. Before starting this drip an intravenous cannula (IVC) needs to be put into your vein.
- Where do you want your IVC placed?
It is best to have your IVC put into an area that does not inhibit the movement of your hand or catch on things as you move around. You can request that it is put into your least dominant arm. Placing the IVC in the top of your forearm, near your wrist (where a watch is worn) allows you to move your hand easily without discomfort.
- What is your approach to pain management?
Induced contractions are generally more painful than spontaneous contractions. Do you know about your options for pain relief? Do you want to start with no pain relief, or the least strong method, and move on to stronger methods if and when you need them? An epidural is the only method that can completely relieve pain during labour. If you know you want an epidural, do you want it set up and working before the syntocinonis started?
- What are your preferences for monitoring of baby’s heartrate?
Continuous cardiotocograph (CTG) monitoring is recommended during an induction because of the potential risks of syntocinon induced contractionsfor baby.However, there are options for you to consider about monitoring. If the hospital has cordless, waterproof CTG, you may be able to use it in the shower or bath. If the monitor available requires you to be connected to cords, you will still be able to stand up and move around next to the monitor. Also, consider if you want the monitor sound turned down to avoid being distracted by it. Or will you be reassured by hearing your baby’s heart rate? Do you want every heart rate pattern change explained, or do you only want to know if there is a concern?
- What are your preferences about vaginal examinations?
Vaginal examinations can confirm whether syntocinon is effective in opening the cervix. However, you can still decline vaginal examinations if you wish. You may decide to only have a vaginal examination if the baby is not born after a particular timeframe. Or, if there are any concerns about progress or wellbeing. You can also make choices about how a vaginal examination is carried out, for example, whether you want your care provider to explain what they find as they do the examination, or to wait until they have finished and you are comfortable. You may also choose not to be to be told specifics (eg. centimetres dilated), but rather be told whether you are progressing well, or not.
- How do you want to be supported while pushing your baby out?
Pushing that is directed by your care provider increases the chance that your baby will become distressed, and increases your chance of perineal tearing.You can ask you care provider not to direct pushing and support you to follow your own bodily urges. If you have an epidural you may wish to have it turned down so that you can feel some pushing urges. However, this is not necessary because babies can be born without any pushing as the uterus moves the baby down with each contraction. If you do want some direction to assist you to push with an epidural, waiting until the baby is low enough in your vagina to be able to see the top of his/her head before pushing reduces the risks of directed pushing.
- Choosing a birth position
Consider birth positions that increase the size of your pelvis and reduce the pressure and stretch in your perineum, for example, kneeling on all fours or lying on your side. Avoid a semi-reclined birth position because it increases the chance of tearing.If you have an epidural you may need some assistance to get into a good birth position.
After the birth of your baby you will be given an extra boost of syntocinon to help the placenta detach, and reduce the chance of you bleeding.
- When do you want your baby’s umbilical cord to be clamped and cut?
The transfer of baby’s blood from the placenta usually takes around three minutes. You can request that the cord is only cut after it has stopped pulsing and is completely white (empty). You can also ask for the extra syntocinon to be given after the cord has stopped pulsing so that it does not transfer through the placenta to the baby.
Find out More
Why Induction Matters by Rachel Reed is published by Pinter & Martin £7.99. Induction of Labour: Balancing Risks and Induction of Labour: A Step by Step Guide are both available from midwifethinking.com.