I wanted to start to write on the subject of induction of labour - a decision you may face in the later stages of your pregnancy, or even before.
With my third baby due in June and with a history of slightly ‘longer’ pregnancies, the topic of induction of labour is already starting to creep into my thoughts. The word ‘longer’ is definitely the wrong word when it seems to be my natural length of pregnancy, but I will use it to keep things simple!
Induction of labour can seem a huge topic, and the idea can be overwhelming at first. Otherwise, it may feel like ‘no big deal’ to you, just a pretty obvious next step if your pregnancy goes beyond what your particular hospital advises, and at least you get to know the baby is coming, right?
Perhaps a comment or text from family or friends makes you feel that medically inducing your labour is the automatic next step. People say ‘They don’t let you go over more than 10 days though, do they?” or something along those lines, which then sets your brain off into overdrive!
Or maybe it’s the pressure you are putting on yourself to ‘deliver the goods’. Everyone is eagerly awaiting the date you specified, because no one likes a late delivery, do they? When the date comes and goes, you start to feel you’re a massive fraud…. cue demanding text message… ‘So… where is THIS BABY!’
If you check out the NHS online information for induction of labour to help you make your decision, it can seem that the answer is pretty black and white. You may read between the lines and come up with the conclusion ‘oh yep, it may hurt a bit more for me, but it’s the best thing for my baby’. However, there is far more to it than this.
An absolute must read for any pregnant woman is “Inducing Labour” - Making Informed Decisions by Sara Wickham for AIMS (the Association for the Improvement of Maternity Services). The information in this booklet can be a real eye opener and provide a great deal of support when you are faced with deciding whether you actually need an induction.
AIMS ‘provides independent support and information about maternity choices and raises awareness of current research on childbirth’- the association actively supports both parents and healthcare professionals. It’s all up-to-date research, evidence-based and written in a way that is really simple to digest and gives you all the information from both sides so you can make your own decisions.
I wouldn’t wait until you’re 40 weeks to read it, as your midwife’s pen is poised and waiting to write down your decision in your maternity book… read this book well beforehand, so you have had time to think and you can then discuss with your midwife if you need to.
With my third baby on the way in June this question of inducing labour, (or more accurately, the pressure I may face to artificially induce my labour) is already starting to slightly weigh on my shoulders.That is because of my own experience of induction, plus the knowledge I have through my Hypnobirthing teacher training.
My personal history is that I decided to agree to medical induction for my first labour, the reason being I was just over 41 weeks - a decision I wouldn’t have repeated, given the chance again. For my second baby I agreed to a total of 3 sweeps, and I waited for spontaneous labour, which started naturally at 42 weeks + 5 days.
For baby number 3, I’ve totally accepted the fact that it is very likely that my natural gestation is around the 42 weeks + mark, as baby number 2 was born with absolutely no signs of being ‘overdue’ at all (longer fingernails, cracked skin, meconium staining, no vernix, ‘big’ baby etc).
The question I am asking myself now is - will I accept a sweep when it's suggested at 40 weeks, or before? A sweep is likely to be the first step to inducing labour that you are offered, and it will probably be just at your midwife appointment, as it’s now pretty routine. Basically, the midwife or doctor will sweep their finger around the opening of the cervix in a hope to stimulate contractions.
Many believe it’s a bit of a non-event and no harm can come of it - so, if anything, it might just save you the pressure of further more invasive induction methods, which I think many caring midwives are hoping for you when they do it!
But - it is still a form of inducing labour, so you still need to question why you are doing it and if it’s right for you. Women have reported crampy sharp pains after sweeps, and believe it has then gone on to affect their labour negatively - some say it brought on false labour.
The risks of a sweep which are listed in the AIMS booklet are:
· Discomfort
· Bleeding
· Irregular contractions
· May only bring labour forward by 24 hours
This absolutely does not mean you will experience all the above if you decide to have a sweep but they are the risks, and sometimes you may not hear of the risks. It is good to also know that it may do absolutely nothing to induce labour and just leave you feeling a bit sore. You may feel that you don’t have a chance to think during your midwife appointment if you would like to have a sweep or not, so it’s best to consider before.
“ Routine use of sweeping of membranes from 38 weeks of pregnancy onwards does not seem to produce clinically important benefits. When used as a means of induction of labour, the reduction in the use of more formal methods of induction needs to be balanced against women’s discomfort and other adverse effects (Boulvain et al 2005:2).
I question myself whether the sweeps I had did affect my labour, as although I had an incredibly positive experience and did everything I could do to facilitate a swift labour, after my final sweep at 4pm I did then experience quite crampy sensations immediately afterwards and into the evening (which then did turn into labour)
Whether my experience would have been different if I had left well alone I don’t know, or perhaps if I hadn’t had the sweeps I would have then been faced with the question of how much further I wanted to continue into the pregnancy.
My feelings now are that when the time comes if I’m fit and healthy and so is the baby, I may just leave well alone…
