I've been booked in for an induction, what happens next?
There are various reasons why women are booked in for a induction. The most common reason is because of prolonged pregnancy. The NICE clinical guidelines suggests anyone who is over 40+5 weeks should be offered an induction to avoid the risks of prolonged pregnancy.
Now it's important to remember when offered any clinical procedure and making birth decisions, always look at the benefits, risks or alternatives.
So if an induction is offered, ask your midwife/consultant, why has this been offered? What are the risks and the benefits? Where is the data to support this? What are the alternatives?
When you have the full picture, facts and evidence, you can then make a fully informed decision as well as prepare or adapt your birth plan.
So if you have been offered an induction and you agree and the date has been booked, what happens next?
On the day of the induction, the likelihood is you will be asked to call the Triage ward of the maternity unit, to arrange a time for you to come in. Be prepared depending how busy the maternity unit is, it might be suggested to change the date of the induction to a different day, especially if the unit is at full capacity or there is not enough staff to maintain safety of more admissions.
Once you are at the hospital, the method of induction will then begin. The aim at the beginning of the induction process is to soften and ripen your cervix, in preparation to break your waters (amniotic sack surrounding your baby) to get labour started.
This is done by inserting a pessary into your cervix to start the ripening process.
Depending on the maternity unit/hospital you are going to, each maternity unit will have their own processes and practices on which ones they use.
However these are the different pessary's which are used at the moment:-
Propess is a pessary containing the hormone prostaglandin. This is released naturally by the body in labour, to soften or ripen the cervix. Propess will be inserted into the vagina and
behind the cervix, and can remain in for a maximum of 24 hours before being removed.
This hormone is slowly released during this 24 hour period with the aim to open and ripen the cervix.
As this is a slow releasing hormone pessary, in cases where you and baby are both doing well and there are no other medical complications, you are able to go home during the first 24 hours. You will be asked to return in 24 hours (unless otherwise indicated) for reassessment and removal of the pessary.
When the pessary is removed, if you want to use the Birthing Unit rather than the Labour Ward, an initial CTG will be required to rule out fetal hypoxia (which is when baby is showing signs of distress or lack of oxygen) If baby is coping well and there are no other medical factors to consider, then the option of using a Birthing Centre could be available.
Dilapan are non-medicated soft rods (similar to a cotton bud) made of hydrogel, which absorbs the fluid from the cervical tissue. These can remain in for 12-24 hours and can dilate the cervix enough so your waters can be broken.
Dilapan is the recommended method of induction for those who are having a VBAC birth (vaginal birth after caesarean section). Women who have had previous C-sections should be offered Dilapan-S as the method of induction.
Prostin is a pessary in the form of a tablet or Gel containing the hormone
prostaglandin. This is inserted into the vagina, behind the cervix and releases
the hormone over a 6 hour period.
Prostin will be typically used for those women who have had a prolonged rupture of membranes (waters broken for more than 24 hours) and labour has not started.
It will also be used as second method if Propess has been used initially but has not opened and ripened the cervix enough to break the waters.
If the pessary has been successful and waters have been broken, then chances are you will go in labour spontaneously. However sometimes this may not be enough and an oxytocin drip may be required to encourage and stimulate labour.
As the induction process can be long, it's important to be prepared and take things with you to the hospital to keep you occupied during this process.
Bring plenty of snacks and drinks, your ipad/music so you can watch and listen to things. An eye mask and earphones so you can block out any noise or lights. Any anything else which is going to help keep you conformable and relaxed.
You want to stay relaxed and calm so you can assist your body with everything that is happening.
Once labour is established, don't forget to use all your breathing and relaxation techniques and use all the comfort measures which work for you.
I have plenty of posts on my social media accounts detailing all the things you can try and how to stay calm and positive throughout labour.
If you do have any concerns or questions about inductions, don't be afraid to speak to your midwife or consultant, the more information and informed you are, the more ready and positive you will feel :)