Miriam's casebook - An induced birth
Rebecca and David's first baby was born in hospital, six days after term. Rebecca had no complications during her pregnancy and had decided to have her baby at a private natural birthing centre. However, things didn't go to plan and their baby was born in their local hospital after induction. The birth was induced because Rebecca's waters had broken and, after 48 hours, labour had not started.
Why is a baby induced?
Induction is a standard hospital procedure and is quite common. Births are induced if labour hasn't begun 14 days after the woman's expected delivery date (known as post-maturity) or a maximum of 48 hours after the waters break. Other reasons include complications in late pregnancy such as maternal high blood pressure, pre-eclampsia, and suspected placental insufficiency, though in emergencies a Caesarean is likely to be done.
Wednesday and Thursday
Rebecca's waters broke on a Wednesday morning about two days after her due date, before any signs of labour had appeared. It's quite normal for this to happen, and can be caused by pressure of the baby's head on the membranes of the amniotic sac. It's also quite normal not to go into labour immediately after the waters break. Once the waters have broken, there's a small risk of infection for the baby and most doctors advise an induction within about 24 to 48 hours.
Rebecca and David went straight to the private birthing centre they'd booked into. Their baby's heartbeat was monitored and the baby showed no signs of distress. But, no signs of labour had appeared by Thursday morning, and the medical staff recommended that if labour hadn't begun by Friday morning, 48 hours after Rebecca's waters had broken, they should go to hospital.
Friday and Saturday
Friday morning came without any signs of labour starting, so at 8am David and Rebecca went to their local hospital, where the senior registrar in the maternity unit decided that Rebecca should have an induction.
Rebecca was given a prostaglandin pessary at 9am. Prostaglandin can be very effective in inducing labour, though many women need more than one pessary. In Rebecca's case, the first pessary didn't work, nor did a second pessary given about six hours later. Rebecca had to spend the night in hospital.
On Saturday morning the hospital staff decided that a syntocinon drip was needed to start Rebecca's labour. Syntocinon is a synthetic form of oxytocin, and because it's given intravenously, it works very quickly. However, the labour ward was very busy that day and although the drip hadn't been given, Rebecca's labour finally started spontaneously at about 6pm.
Rebecca's labour progressed very slowly. She had gas and air, and then pethidine as her contractions were proving painful. By about 4am on Sunday, Rebecca's labour had progressed enough for her to be taken to a delivery suite.
Contractions were beginning to be very painful indeed, so a mobile epidural was given, which helped Rebecca manage the pain and meant that she could rest for a while in between each contraction. A “mobile” epidural is so called because it numbs feeling from the chest to the knees, but still allows some movement, standing, and even walking. A stronger full epidural means that a woman can't move her legs much at all, and makes it harder to push.
After several hours of contractions, a vacuum extraction was needed at the end to deliver the baby's head. Rebecca gave birth to a beautiful baby boy at midday on Sunday. He weighed in at 4.3kg (9lb 10oz) and was perfectly healthy.
After the birth
Not surprisingly, Rebecca was absolutely exhausted after being on the verge of giving birth for so long, and David was pretty shattered too by all the anxiety. Unforeseen eventualities can play havoc with the most carefully prepared birth plan, and induction is one of them. With the benefit of hindsight, Rebecca and David now feel that they'd have been better off letting nature take its course from the beginning. They've learned a lot from the experience, though, and feel that next time, if appropriate, they'd like to take a long, slow labour in their stride, relaxing at home during the early stages. Then they might be able to have their baby at their preferred birthing centre, although theirs is staffed by midwives and tends to refer special cases like Rebecca's to hospitals anyway.
However, they also understand that the hospital was following standard procedures to ensure the safety of Rebecca and her baby son and that everyone was doing their best to help. And of course, they were completely thrilled with their new arrival, who's more than made up for all the trials of the past four days!
Why is labour sometimes long?
Induction should always be done for good medical reasons but it can affect your labour. It can mean that labour is rather long and drawn out, which is why I always advise pregnant mothers to rest as much as possible in the last weeks of pregnancy. Rebecca's baby was a big boy and his size made his passage through the birth canal very slow. Vacuum extraction was needed at the end because he was so big he got stuck, even though Rebecca was fully dilated.
Prostaglandin pessaries, which work by softening the cervix, don't always “take”. On average, two or three pessaries are given, with some women needing up to four - though this is unusual. It's necessary to wait for several hours between each one, which meant that Rebecca had to spend a long time in hospital rather than relaxing at home.
Induced labour can be more painful than natural labour. The prostaglandin means that the onset of labour is speeded up, and the contractions are more severe, and tend to be closer together. This makes it harder for the woman to use “natural” forms of pain relief such as massage or breathing. Statistics show that women who have induction are more likely to need pain relief such as epidurals.
Miriam's top tips
Induction is a standard procedure and quite common, especially in older mothers. My advice is to:
- rest as much as possible towards the end of the last trimester, so you have reserves of strength to cope, if need be, with a long labour
- write a birth plan while also bearing in mind that unforeseen circumstances may mean you'll need to be flexible about the kind of birth you have
- remember your health and that of your baby are the prime concerns of your carers.
Get more on this subject…