Induction of labour

Induction of labour – Decisions you can make if you have an induction of labour

You’re reaching the end of your pregnancy! You can’t wait to meet your baby – and maybe you’re a little anxious, too! You go to see your midwife at maybe 38 or 40 weeks and they tell you you’ll be having your stretch and sweep and be booked in for an induction sometime soon.

But hang on – is this actually what’s right for you? First of all have a look at our article about making a decision about whether or not to be induced!

If you decide to go ahead with the induction you also have loads of choices that you can make, if you know that there are choices! Normally you will just be told what will happen next, but there are many different options as the induction progresses. Read on to find out more.

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Stretch and sweep

A stretch and sweep, sometimes just called a sweep, is a form of induction. The vital thing to remember here is that even if you are told that you’re being booked for a sweep, only you get to decide whether this happens or not. You choose who, if anyone, gets to put their fingers inside your vagina and you also have the right to say no! A vaginal examination is a very personal procedure, it is your choice.

The aim of the sweep is for the midwife or obstetrician to reach into the neck of your cervix (your cervix is a small tube, that is closed with a gel inside to protect your baby). If your midwife is able to place her fingers into the tube and feel for the membranes, then they will be able to do the sweep. If your cervix is closed and they are unable to reach inside the cervix, then they will not be able to do a sweep.

If you have not given birth before, your cervix will be fully closed before it becomes softer around term, if you have had a baby before it is more likely that it will be a little open, however will still have the fantastic protective jelly, to protect your baby.

The reason that a sweep is offered, is because it’s thought to help encourage hormones that will encourage more tightening’s. However, your body has probably been doing this very well by itself. It takes days and even weeks for the muscles in your womb to get ready for labour to start. This is a positive thing, even if it doesn’t always feel like it! Your baby will give the signal for labour to start when it’s ready!

If a sweep does work, your body and baby will very likely have been ready, so the sweep probably just tipped the balance of hormones!

If you decide to have a sweep and it seems not to be working, try not to be too disappointed, it means your baby and your womb have a little more preparing to do first. Be nice to yourself and do things that make you feel happy till you are both ready.

You may feel that you are unsure about saying yes or no. If so you can tell your midwife that you’ll wait a few more days, or let them know that this is something that you do not want to have. You can always change your mind at any time.

Whether or not you decide to have a sweep, if your pregnancy lasts longer than 40 or 41 weeks it is likely that your midwife or doctor will want to book you in for an induction of labour. Again, no matter how they word it, the only person who can decide whether an induction is right for you, is you. You can say no – or you can say you’ll wait a bit longer. You can always change your mind and book it in even if you’ve said no when it was offered to you.

It is common for a first pregnancy to last till 41 weeks and 3 or 4 days! So you are more likely to go past 40 weeks than have your baby before 40 weeks. Only around 5% of babies are born on their ‘due date’.

The National Institute for Clinical Excellence also known as NICE, says that women with non-complicated pregnancies (women and people with straightforward pregnancies) should be ‘offered’ induction between 41 and 42 weeks. They should also be offered monitoring of their baby twice a week, or the option of just waiting for labour. All of these are equally valid options.

There are many changes that need to take place for labour to start, so if you are 37, 38, 39 or even for some 40 weeks, it is more likely that it will take longer as these changes are less likely to have happened.

Real Birth Teacher’s will explain all these changes to you and share skills, around birth planning and preferences for induction of labour should you choose to have one, or if you are recommended one for a medical reason such as pre-eclampsia rather than simply the length of your pregnancy.

Your decisions in an induction of labour

The steps of induction after a sweep are:

A pessary, gel or mechanical device which will hopefully open your cervix a little
Artificially breaking your waters
A drip of a medication called Syntocinon which is an artificial form of the labour hormone oxytocin

Not everyone has all of these during their induction, should they choose to have one. Sometimes, the medication or device used to open the cervix triggers the body to start labouring itself and no further intervention is needed.

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Sometimes the waters need to be broken as part of the induction, and for many the process needs the Syntocinon drip because the body just isn’t ready to give birth so it needs to be forced into labour. Unfortunately, even then there’s no guarantee that labour will progress and again, this is not our bodies not working, it’s the fact that medical induction simply doesn’t work for everyone.

At any point in the process you can decide to stop or rest if you want to. For instance, if the pessary isn’t working well you might decide to have it removed and go home for a day or so. Relax, get your bearings and then go back and try again, or you can even decide to stop the process here and wait for spontaneous labour.

If your waters break (release) or are broken for you there’s an increased chance of infection. Every vaginal examination you have will raise this risk so avoiding them, or minimising them, might be something you want to consider. You can still decide whether or not you want to progress to the Syntocinon drip or not, even after your waters are broken, but you may also wish to consider whether to go ahead with them being broken in the first place, especially if the drip isn’t something you’d want to have.

What is the Syntocinon drip?

Syntocinon is a hormone drip that will go directly into your blood through your veins. This means that you will have to have a cannula (a thin plastic tube). Because there is something that is artificial into your body creating tighenings, you will now be monitored in more ways.

This means that you will be encouraged to have continuous monitoring of you and your baby. Baby’s heart will be monitored and so will the tightening’s you are having.

This is likely to mean that you are attached to a machine, however most hospitals do have wireless monitoring options too, meaning you can still move around. The Real Birth Workshop can show you several ways to stay more mobile during a more medicalised birth including if wireless machines are not available.

During an induction you can walk around, be active, and get into positions which are better for labour such as leaning forward over something, or being on all fours. If you decide to have an epidural and can’t move your legs as easily, lying on your side or getting onto your knees supported by loads of pillows or a ball, is better to help your labour than being on your back.

If you have a drip, ask for a drip stand with wheels to help you to stay mobile. If you agree to be continuously monitored you can also ask for a version of the monitor called a telemetry system, which is wireless and gives you more freedom to move. Just remember, labour works best if you can stay active and upright (in between resting when you need to) so even if you’re told to lie still you can make the decision to move around if you want to!