Induction of Labour
While the majority of pregnant women go into labour naturally, some women need a little bit of help. Perhaps they are over their due date or have a medical issue that warrants giving birth soon. Whatever the reason, if you are going to be induced, you will likely have questions. Will it be painful? How is it different from regular labour? What will be used to induce labour? Put your mind at ease and get a better idea of the process by reading on.
The most common reason for inducing labour is due to going over dates. Other reasons include diseases of pregnancy (eg. preeclampsia), poor growth in the baby, or unexplained bleeding at term. The aim when inducing labour is to make it as much like a normal labour as possible. By doing this, the chances of a normal delivery are increased, and it it needn't be more painful.
How are Contractions Started?
Oxytocin has been produced in the laboratory and the synthetic drug is used to start the uterus contracting. Unfortunately, it is not well absorbed in the stomach and needs to be given by a drip. This route of administration also means that the concentration of oxytocin can be increased or decreased should your contractions be too intense or not strong enough.
Breaking the Waters
Once the membranes have gone, it is usual to start oxytocin to get the contractions started. Sometimes, particularly if you've had several babies before, your obstetrician may suggest you get up and about for a couple of hours to see if you start contracting on your own. If its your first, there's little to be gained by waiting and oxytocin is started.
My Cervix is Still Closed or 'Unfavourable'
If you go to be induced and your cervix is still thick and/or closed, you will most likely have a prostaglandin (Prostin) gel or pessary inserted. This brings about these changes, making it possible to rupture the membranes. The gel typically takes about 6 hours to work. Some hospitals put the gels in at night, then re-assess you in the morning. Some start in the morning and try and get you started at tea time.
Using the prostaglandin gel makes your labour much more natural if the cervix is thick. It certainly reduces the number of caesarean sections, which used to be associated with inductions of labour in women with an unfavourable cervix. Sometimes, it is necessary to use more than one gel treatment before ARM is possible. Many women start contracting and go into labour a few hours after having the gel.
Is it More Painful Being Induced?
Some places (especially in the US) don't use prostaglandin gels, as it has only recently been licensed, although their use is increasing. This means that contractions are started with an unfavourable cervix, often with the membranes still intact. So, not only is it unnatural for the contractions to start with the cervix still thick, the contractions are less effective.
When oxytocin is started, contractions do come on more suddenly than they might do if you went into labour spontaneously, so you've not been prepared by the early/prelabour contractions. The contractions aren't necessarily more painful per se, just that they started more quickly. It is usual to start the drip slowly and increase it gradually as your contractions start. Aim for three to four contractions in 10 minutes, which is about the same as established natural labour. The drip can be turned down as well as up.