Inducing a pregnancy: What happens if you are overdue?
PATIENCE is defi nitely a virtue during pregnancy. Your estimated due date of delivery has arrived and you are ready to meet your new bundle of joy. Your birth plan is written, family and friends are on stand- by and your hospital bag is packed by the door. But then the day passes and nothing has happened - not even a twinge!
You continue to be patient and may even try some traditional old wives' tales to get things moving; however, baby may be perfectly happy to stay ' in utero' and an induction date may be agreed upon between you and your doctor.
A post- term baby is one of the commonest indications for induction. You will be offered an induction some time between 41 and 42 weeks to prevent your pregnancy continuing beyond this time as risks of prolonging it are more serious then the risks of induction.
Other common indications for induction include: Rupture of membranes (waters breaking) without any contractions after a specifi c period of time Raised blood pressure in pregnancy Twins Diabetes in pregnancy The baby may not be growing appropriately There may not be enough amniotic fluid around your baby Certain medical reasons which may pose as health risks to the woman in continuing the pregnancy.
There is a more natural way of encouraging your baby to arrive if your due date has passed with no sign of natural labour starting on its own. A healthcare professional may offer a ' membrane sweep'. This is an internal examination by a midwife or doctor from 40 weeks onwards. It is simply a 'sweep' of a finger around your cervix (neck of the womb). A membrane sweep can help stimulate labour by separating the membranes around your baby from your cervix thus releasing hormones called prostaglandins, which may kick start your labour within the next 48 hours.
A membrane sweep may feel uncomfortable. Ask questions or read information about the procedure before it is carried out. It may be the case that more than one sweep is necessary for success. Breathing and relaxation techniques may help while it is being done. There may also be some blood spotting and irregular contractions following, so be sure to contact the hospital if you have any concerns.
A membrane sweep is generally offered to all women before starting other formal methods of induction.
Labour induction is the process of starting labour artificially using medications or other medical techniques.
Three main methods are used to induce birth: prostaglandin gel, breaking of the waters and using a syntocinin drip.
Prostaglandin gel is used if it is not possible to rupture the membranes.
A prostaglandin gel contains the hormone prostaglandin which will be inserted into your vagina. The cervix has become thick, long and closed, protecting the baby inside the uterus from infection, therefore it needs to shorten and soften, bringing about changes that make it possible to rupture the membranes. Contractions may often begin at this point but, if not, reassessment will take place around six hours after the first gel where a second dose may be required.
Prostin gel may not always be required for an induction as the cervix may be favourable, particularly in mums who have had a baby before.
Rupture of membranes
Once the cervix is suitable, your healthcare provider will make a small break in the amniotic sac during a vaginal examination. This is done using a thin plastic hook similar to a crochet needle and will rupture the bag of waters surrounding your baby. You will be fully informed of what is happening and the procedure does not take long. Your midwife or birth partner will support you throughout. The fluid is usually clear and you will notice either a constant trickling or a large ' gush' of fluid following this procedure. A spare nightgown and spare underwear can be very useful at this point! Your midwife will monitor the baby after the waters are broken to make sure baby is coping well. The goal of this procedure is to assist the descent of baby's head and bring on contractions. Artificial rupture of membranes may be enough to induce contractions but often a syntocinin drip is necessary to ensure labour progresses.
This is a synthetic form of the hormone oxytocin. It is given via an intravenous drip in your arm. The aim of syntocinin is to induce or enhance contractions helping your cervix to dilate. It is started as a small dose and then increased until labour is progressing well. The baby is monitored closely during this time. These contractions tend to be more painful then natural ones; your midwife will guide you on mechanisms of coping and help assist you with your pain relief choices at this stage.
Trina Tracey ( RGN RM) is a registered midwife at Mount Carmel Maternity Hospital, Churchtown, Dublin 14. For more information about maternity packages at Mount Carmel, contact Bairbre Keane or Sally-anne Doddy on t: 01 4063401 or e: firstname.lastname@example.org
Mother & Babies