Induction of Labour

Being induced, or having an induction of labour is becoming more common, so this blog will be an overview of the methods of induction and what to expect. Knowing the process of an induction, the benefits, risks, and tips can help you in the lead up to your birth. Seek all the information you need to make an informed decision and do your own research to decide what is best for you and your baby regarding your birth plan. Inductions play a very important part when needed, however, there's no doubt that inductions are being recommended more and more frequently, often with no evidence based reasoning to support them. 

An induction of labour is when your labour is started artificially if it is determined that you or your baby will benefit from labour being brought on rather than waiting for spontaneous labour to occur. Discuss with your healthcare provider the risks and benefits of waiting for labour to start spontaneously versus being induced, and make the decision you feel comfortable with. If being induced is something you do not want, you and your partner have every right to refuse as long as you understand what risk this may pose for you or your baby. Every situation is different so it is very important to chat to your OB or midwife regarding your circumstance before deciding.

Reasons to be induced:
There are many different reasons to why your healthcare provider may recommend an induction, or it may be your preference due to social reasons.

Main reasons include:

• Past your 'due date' (induction may be suggested after 41+3)
• Your waters have broken but you haven’t gone into labour after 18 hours (as risk of infection increases)
• Your baby’s growth has slowed or stopped (intrauterine growth restriction)
• An ultrasound has determined your baby to be 'small' or 'large' for gestational age
• Medical reasons; you have high blood pressure, diabetes, kidney problems, cholestasis, or are taking blood thinners
• Personal or social reasons

There are different methods to induce labour, sometimes only one method is used but often a combination of methods is needed. To determine the best method of induction for you, your healthcare provider might recommend a vaginal examination to check how ‘ready’ your cervix is for labour. The most common methods used for an induction of labour are; prostaglandin gel, a balloon catheter, breaking your waters (artificial rupture of membranes) and using a hormone drip (syntocinon infusion). The main aim is to encourage your cervix to soften and open enough for your healthcare provider to break your waters. Once your waters are broken, your midwife will commence the hormone drip at a low rate and gradually increase it until you are having regular, strong contractions and progress into active labour.

The induction process:
It’s important to be aware that the process of an induction can be lengthy depending on how ‘ready’ your cervix is (however keep in mind, that this isn't always an accurate description of how your body is or will progress). Induction is different for every woman, sometimes being induced can be quick and other times it can take longer. The beginning of the process will differ depending on which method is used as mentioned above, so ask your healthcare provider to explain the method they are recommending and what it involves. Different hospitals have different processes - so be sure to ask ahead of time what to expect. 

Because an induction involves bringing on labour artificially, it is important that you and your baby are monitored closely through this process to help keep you both safe. A CTG monitor will be recommended, and if you agree, it will be strapped in place before your induction begins and throughout the process to ensure bub is happy. Your observations (blood pressure, heart rate, temperature) as well as baby’s heart rate will be regularly taken.

The process generally involves assisting the cervix to soften and open slightly, enough to break your waters, before then commencing on the oxytocin drip. If you present to hospital, and your cervix is closed / hard (very normal) and your waters are unable to be broken - a cervical 'ripening' agent will be discussed. This might be a small pessary that sits behind your cervix or a gel that is inserted with your consent. This will stay in for several hours (often overnight). If after the suggested time, your cervix is soft enough to break your waters - the OB or midwife will move to this step. If at this point your waters cannot be broken, there will be a discussion between you and an OB around next steps. These may include another dose of the cervical ripening agent, or a balloon catheter to manually open the cervix. 

After your waters have been broken, if you are not experiencing contractions, oxytocin or syntocinon infusion may be commenced. If this is used you will need a cannula (thin plastic tube) inserted into a vein in your hand or arm to administer the medication via a drip, and you will be connected to the CTG monitor at all times to continuously track your baby’s heart rate. Being attached to the drip pole and CTG machine can restrict your ease of movement, although you can still move around if your hospital has a wireless monitor. Being induced may also influence your ability to use a bath or birth pool in labour (remember hospital policy isn't law though!) although you can still use the shower if your hospital has a waterproof monitor. Often women mention an induction to be more intense than spontaneous labour, so the chance of you needing pain relief, such as an epidural, may be higher. Always speak to your midwife during your induction to discuss or request pain relief as you want it. 

Tips for being induced:

• You can still facilitate a positive birth experience with an induction. Stay positive leading up to your induction, listen to podcasts and research ways to help improve your experience
• Having a known healthcare provider that you trust and a good support team (partner, friend, doula) with you through the process will be beneficial
• Create birth preferences and ensure your healthcare provider knows what your preferences are before the induction, including what pain relief you may want
• Create a relaxing birth environment and set up the room how you want it. Ways to do this include; dim lights, have candles or fairy lights, play music of your choice, diffuse oils that are familiar to you, move furniture so you have space to move around, place affirmation cards or photos of other children on the walls
• Build your own supply of endorphins (pain-relieving hormones) through physical touch from your partner or a TENs machine. I hired one through Bliss Birth which was incredible, super easy and would highly recommend. Use code BBKR for a 10% discount. 
• Stay well hydrated during your induction and labour. Using the Motherhood Hydration Powder is a great way to replace electrolytes and fluid during and after labour (use code Bump10 for a discount)
• Encourage natural oxytocin production by being affectionate with your partner; cuddle, dance, laugh, get them to massage you. Ask your healthcare provider to give you as much time as possible on your own without them in the room so you and your partner can have space and privacy
• Stay active in upright positions, use a birth ball, change positions frequently, do lunges and squats to help your baby get in an ideal position

I hope this blog helps you feel empowered and excited ahead of your induction. 

*This is general advice only and does not replace the need for medical advice*.