Taking the mystery out of induction of labour.

What is induction of labour?

Induction of labour is any process that exerts external influence to try and start the body's process of labour and birth. This may include anything you try to do yourself such as having sex or eating curry and anything you have done by a holistic practitioner such as a chiropractor, acupuncturist or reflexologist to help your body do what you want it to do.

It also includes the 'stretch and sweep' or 'membrane sweep' procedure which involves your care provider inserting their (gloved) finger into your cervix and separating the membranes holding your waters away from the cervix with a circular sweeping motion. This is not always recognised as part of the induction of labour process but it is an intervention with the object of starting labour off. As with any intervention your care provider needs to make sure you're making an informed decision on whether or not to accept that intervention. So, they will be very happy to help you go through the benefits, risks and alternatives with you and to let you know what will happen if you do nothing. You can ask as many questions as you need and think through what your instincts are at the time before making your decision.

This way of thinking through your choices is very useful and you will notice we frequently reference it. We remember it with the acronym BRAIN.

Medical Induction Process

This process starts with you being admitted to hospital and having the usual checks to be sure you and your baby are healthy. An internal exam is given which allows your care giver to assess if your cervix is open enough for your waters to be broken. If it is then you skip to that step if not you go through a process of 'cervical ripening' which means moving your cervix from long and closed to short and slightly open. First a pessary is inserted into your cervix, either an artificial version of a hormone prostaglandin called prostin or a balloon catheter (a small absorbent rod that gradually expands to mechanically open the cervix). If this is effective you will then be offered a 'rupture of membranes' which allows your baby's head to press down onto your cervix and hopefully to tip your body over into the process of labour and birth. Sometimes your body will tip over during the first process (usually if it was very close to spontaneously beginning to labour anyway) and sometimes even after your waters are broken contractions won't start. Depending on how your body reacts to these interventions further interventions may or may not be offered. The process is individual to you and to how busy the labour ward is at the time. It may go faster or slower than originally anticipated.

Here are some flow charts produced by our local maternity department. Your care providers may assume that once you agree to start the process, you're expecting to agree automatically to each next step in the interventions process. However, they should also be clear with you that you have the right to make an informed decision about each intervention and that you can change your mind or make different decisions when it feels right to you.

Since these charts were produced, in Portsmouth, it has also become possible for anyone being induced to choose a balloon catheter rather than a prostin pessary. It's no longer just available for those who have had a previous caesarean birth.

The hormone drip.

If you go into labour after the induction process up to the point when your waters have gone you have every chance of going on with your original birth plan including water birth and active birth. However, if you don't start to have regular strong contractions shortly after your waters are broken you will then be offered a sytocinon drip (a synthetic form of the hormone oxytocin which among many things acts on the uterus to cause it to contract). In order to agree to the hormone drip, which as before is something you can talk through the benefits, risks, alternatives and what f you do nothings with your care provider before deciding on your instincts, you will also need to agree to continuous monitoring. This may limit the amount of movement you are able to do but you may still be able to stand or kneel. At this point you may find the methods you've been using to work with your contractions continue to be effective or you may find you want to talk through other alternatives such as an epidural with your care providers.

Many people who choose to use the hormone drip and/or an epidural will go on to have their baby without any further assistance. However, if the pushing stage of your labour goes on longer than expected you may be offered an assisted delivery (either vacuum-cup or forceps) or a caesarean birth. This is another point when you may want to go back to your BRAIN decision making tool. As always, your decision is totally individual to you.

More details on the process of induction of labour can be found on the NHS website and on the NICE website.

Why Might I be Offered and induction of labour?

ometimes induction of labour is offered because there is a concern for the wellbeing of you or your baby that means your care providers feel it would be safer for baby to be born now. One example of this is with pre-eclampsia. Sometimes induction of labour is offered after your waters have gone spontaneously but you haven't started having strong regular contractions within the first 24 hours and your care providers are concerned you or your baby might contract an infection. Sometimes induction of labour is offered because your baby seems to be bigger or smaller than expected.

But the most common reason you will be offered induction is to prevent 'prolonged pregnancy' which is defined as longer than 42 weeks. However, it's more and more common for various reasons for people to be offered induction before this point. Often induction at 41 weeks may be standard due to how long inductions can take and care providers wanting to try and ensure babies are born before 42 weeks. People who are over 40 years old and pregnant, people who have regular or gestational diabetes, babies conceived via IVF are all frequently offered induction at or before 40 weeks of pregnancy.

Because induction is part of the usual care plan offered to everyone by 41 weeks it can often be mentioned in conversation during routine appointments from as early as 36 weeks pregnancy.

Is induction of labour the only alternative? Am I being difficult if I would prefer to avoid induction?

As with every intervention induction of labour no matter how it's presented is an offer and there are risks as well as benefits and alternatives you can choose if your instincts tell you, they would be better for you. The main alternatives are what's called 'expectant management' - closer monitoring of your health and your baby's health until spontaneous labour begins- or planned caesarean birth.

If you are having a normal healthy pregnancy, you're not being difficult even if you let your care provider know in advance, you're not planning to have your labour induced and would prefer they leave any discussion of the option until you bring it up or there is a medical reason, they are suggesting immediate induction of labour. You're also not being difficult if you say I'll have to do some more research can you provide me with more information relevant to me personally to help me make my decision. And you're very much not being difficult if you say thanks for the offer but I will decline for now and chose expectant management.

If I consider all the options and decide induction of labour is right for me what can I do to help myself have as positive an experience as I can?

Knowing what to expect can be really helpful, talk through the process at your local hospital with your midwife or doctor, know what the facilities you will have access to will be, know who can be with you to support you and when they can be there.

Be prepared for this to be a long process. Sometimes, when your body was pretty much ready anyway induction works quickly and usual processes take over and babies are born quickly so still be prepared with all the plans you had made for spontaneous labour to help you work through your contractions, hypnobirthing, breathing, movement, using water etc.

But also, be prepared to keep yourself busy and relaxed and not wondering how much longer it's going to be. Take your own favourite and comforting smells with you, your own pillow or blanket or your favourite essential oils or your mums jumper that smells like her for example. Take and eye mask and headphones or earplugs and sleep if you can. Take a good book or download some funny TV or a funny podcast to take with you. Go for a walk, go relax in the cafe, go meditate or pray in the chapel or prayer rooms, do some gentle movement from your birthing class or pregnancy yoga, phone a friend, facetime your family, bounce on a birth pool, slow dance with your partner, snog a little bit, get your partner to give you a head massage or a foot rub, basically anything that makes you feel relaxed and happy.

Information is your tool to use as it helps you.

As with everything we post we hope you find the information useful and that it helps you to think through your own personal decisions. But we're very clear that we're not offering advice. Our only advice is to talk to your midwife or doctor and make sure you get all the answers you need to make your own informed decision.

You're invited to come and hang out with us.

We have 2 monthly meet-ups check out our home page for up to date details.

Five Ways Information Can Be Your Best Friend for Pregnancy, Birth and Beyond.

1. Information is Not Advice.

Everyone has their own life experiences and opinions which may colour the way they present information and make it seem a lot like advice. Sometimes our own understanding of the world, or previous experiences, can make us feel pressured to make choices that feel implied by the information someone has selected to give us. An important thing to be aware of, and a skill to learn during pregnancy that will serve you very well as a parent and through life, is how to filter what you hear so you can spot the information and separate it from the advice so that you can decide what the right choices are for you. One example of this might be when you’re offered an induction of labour. You will be given information about why you are being offered an induction of labour by your care provider. Some of this may be in the form of advice to take up the offer. You might then think "I’m not sure if this is the right choice for me" and want to chat through with a friend. Your friend may have had an experience of having labour induced and may have negative memories from that. The information about her experience may also feel like advice. You might then also look up information on the internet about induction of labour (if you decide to do this, you’re very welcome to ask in our Facebook group if anyone knows any reliable sources of accurate information) and you may find that information is presented from many different perspectives. Ultimately, however, you will find some things resonate with you and this information is useful for your own decision-making process. Then you are able to discard the other information and advice which isn’t helpful or relevant to you. This can help you feel really confident in your own decisions and is a life skill which can help with your confidence as you learn to parent and throughout life.

2.You can always ask for more information.

This is especially relevant when navigating the maternity system. If you find yourself being told “we will do this then we will do that” but you don’t understand why or if you have to go along with it if it doesn’t feel right for you; don’t be shy to ask “can I have more information about why this is being offered?” Here’s some information you might find useful: your human rights don’t change when you’re pregnant or birthing. Want to know more about your rights then check out Birthrights Website. You have the right to make your own decisions, you don’t have to persuade anyone to support those decisions. Your health care providers have the responsibility to ensure you have all the information you need to make a fully informed decision about anything they offer you and to provide you with unbiased care whatever your decisions.

3. You can control the flow of information.

There is such a thing as too much information sometimes. Sometimes we find it comforting and helpful to have a lot of information but sometimes we can be overwhelmed by all the information. Another useful skill to learn during pregnancy, that will be very helpful in life and especially when parenting, is to control the flow of information to a level that’s positive for you. Remember, you can unplug from the internet and especially from social media if the information about other people’s lives is making you feel anxious or overwhelmed or inadequate. Remember, people are picking the best bits of their lives to share on social media and "comparison is the thief of joy" (Theodore Rosevelt). Pick out the information that’s helpful to you when you need it and shut out the information that’s not helpful to you. You’re always welcome to come and post in our Facebook group any time you’re feeling overwhelmed or worried or anxious; it’s a safe space to find other people who will say “oh yes me too” and “you will get through this”.

4. Information helps you find your people.

When looking for information you will always come across other people who are also looking for information. When you ask questions and listen to how people present information and share their experiences it is a really good time to get to know people who see the world in similar ways to you, people who share perspectives and values with you. As you head into pregnancy, birth and beyond these people will help you feel understood and supported. Now is a good time to reach out and make friends with those people; we all need a supportive community surrounding us and never more so than as we parent.

5. Information gives you the opportunity to live without guilt.

Being able to separate advice and opinions from information is a good skill to work on, especially when it comes to parenting. Information will allow you to understand why things happen and the results your choices may have. This helps you own your choices and feel confident in them. This confidence will help you reject the judgements and opinions of society and the media. Because, if we allow their opinions (which are always that parents are not doing well enough or getting anything right, whatever we do) to get into our thinking, they can turn into feelings of guilt and sadness that aren’t helpful or necessary. For example, when you’ve had the information you need to make the right decision for yourself about where and how your baby sleeps best then you can feel confident to answer the question "are they a good baby?" with the eye roll and “yes thanks they haven’t robbed any banks yet”. Which helps to avoid getting drawn into being given unsolicited advice about how things were “in my day”. If you’re looking for a good source of information on normal infant sleep do check out the BASIS Website.

Information is powerful, make friends with it and with those who will support you to use the information to make your own decisions and support you to assert your choices confidently.

Help Your Body Birth

Informed Birth Planning

Knowing how your body works can help you work with it and your baby to feel positive and confident in your birthing decisions and experiences.

There's no one type of positive birth. Neither is a positive birth only possible if all your hopes and plans come true exactly as you wish. A birth you can look back on and feel positive about means one where you knew you were supported by those around you and when you were given the chance to make the best fully informed decision for you whatever the circumstances on the day. You can have a positive home water birth, a positive planned c-section birth, a positive hospital labour ward active birth, a positive birth with an epidural, any kind of birth that feels like the right choice for you.

We're called Informed Pregnancy, Birth and Beyond because we want everyone to have access to the information they need to make their own decisions. We're there to support you to make your own decisions we're not interested in telling you what those decisions should be. Check out more about the reason for our name choice in our first blog here.

In our last post, we talked about shifting your focus from what is out of your control to what is in your control and how this may help you plan for a positive birth regardless of what's in the news or how hospital policies may change. Now it's time to get practical we've been collecting ideas from anyone who will talk to us about what practical activities and ideas can help to raise our positive birthing hormones and help us switch off our worry brains and let our bodies get with the work of labour and birth.

Help my body do what?

Quick biology of birth side note. What are we helping /letting our body do? In labour your body produces hormones (chemical messengers produced in one part of your body and sent to another where they cause an effect) one of the important ones for labour and birth is oxytocin, otherwise known of as the love hormone. Oxytocin is produced when you feel safe and loved and one effect it has is to cause the muscles in your uterus to contract (another which comes in handy later on is encouraging your breast milk let down.) These waves of contractions cause the muscle to pile up at the top of your uterus ready to push your baby out. They also pull your cervix open to make space for your baby to move through your birth canal and be born. So all of the ideas to practically help yourself are to allow your body to produce as much oxytocin as it needs (and alongside that the other hormones like the endorphins which are your own personal pain relief) and to move into the positions which allow your body to give your baby the space to be born.

Relax? Seriously it's a stressful time for everyone and waiting for my baby to arrive 'on time' isn't helping either!

There are so many outside pressures and waiting for your baby to arrive and being in labour (or maybe in labour wondering if this is it yet or not) is another potential stress This might seem a bit overwhelming even in a more normal time let alone during a pandemic.

Let's not be unrealistic we can't just tell ourselves not to worry just relax then click our fingers and it's done. But there are lots of ways we can help our bodies relax and give our brains other things to think about. The following list doesn't cover everything it's just some ideas that have come up during the last couple of weeks when we've been talking about this as a group.

• Follow the lead of other mammals. If you've ever had a pregnant pet you will know they don't overthink what's going on in the world, as they feel the time for their babies to be born is coming close they simply sneak away and hide somewhere dark and quiet where they won't be disturbed. You too can create a nest to birth in and you can snuggle up there in the last weeks of pregnancy and in the first weeks of your baby's life too. Make your own space with low lighting (bright lights can stop you producing oxytocin) where you feel safe and snuggled and where no one will ask you questions (having to answer questions makes the thinking part of your brain take over and you need to let your basic bodily functions part of your brain do the work of labour). Train your partner to know if you're snuggled in your birth nest you may or may not be about to have a baby but you definitely need to feel loved and not asked questions. So they can snuggle in and cuddle you and feel safe that if you need them to phone a midwife you will let them know without needing to be asked.

• If you're going into hospital you can take your nest with you by taking your own pillow, your headphones or earplugs or your own blanket to have over your head and your own smells with you.

• Keep nourished and hydrated. Your body is working hard it needs fuel to do so. Sip on a drink you like and nibble on things that give you energy. Eat lots of yummy meals while you're waiting for labour to start but once you're having regular contractions you might want to stick to lighter meals and snacking just in case you find yourself seeing your last meal again as labour progresses.

• Nice smells can help you feel relaxed. If you like to use an aromatherapy diffuser you may already have some favourite smells. Make sure you work with a professional aromatherapist or buy a specific labour blend to be sure you're using safe oils or stick to something basic like lavender, lemon, orange or mint.

• Lots of people like to use a hot water bottle or heated wheat bag on their bump in labour. You might have already felt the benefits of a heat pad or hot water bottle on your tummy if you've had bad period pain before. Another way of using water for warmth and relaxation is to take a bath or a shower. Heat pads are also very portable for taking with you if or when you go into hospital and showers are available in labour rooms even when birth pools are out of action for any reason.

• When we asked in our Facebook group what people found most useful in labour music was one of the most popular replies. So many of us find music is a great way to relax and unwind, we find music connects with us on a deep level, helps us celebrate when we're happy and feel comforted when we're sad. Lots of people chose to have traditionally relaxing music such as the track from their hypnobirthing class or a relaxing playlist on a music app. Other people love to have music on that has meant a lot to them through their lives, that they are used to relaxing to. Given that the ideal atmosphere for birthing babies is the same as the ideal atmosphere for making babies maybe your make-out music could be a good choice.

• Other popular portable accessories people had found useful were a comfortable floor mat for kneeling and all fours positions which can be very comfortable in labour or a birth ball to sit on. A sponge or washcloth can have many uses including to bite down on, to cool your brow or to support your perineum while pushing. Also with more than one mention, the humble loo seat can be very helpful in labour. The privacy and experience of letting go and relaxing our pelvic floor that we associate with using the toilet plus the comfortable position all help with the natural processes including birth.

• Acupressure can be very useful, there are some good guides on Debra Betts Website

• TENS machines which can be hired from most major chemists can really work well especially if you start to use them in early labour.

• Massage especially counter pressure (just a consistent firm pressure) on the low back can really help especially when you feel your contractions in your back. Changes of position can also be really helpful, check out the Spinning Babies website for more information about how and why some positions really help make room for your baby to be born.

• Hypnobirthing is really effective for many people at helping them to relax and turn off their thinking brain so their body can do the birthing work. There are several online courses available and some of our local teachers are teaching by Zoom at the moment.

• Last but very much not least the support of your birth partner through the whole of labour might be the only thing you really need. Your birth partner can provide physical support with getting in a comfortable position or massage for example. But even more importantly they provide you with connection and a feeling of safety that comes from knowing that one person is there just for you and completely believes in how wonderful you are. Many people worry about how it will feel to support their life partner through such a potentially overwhelming situation but one of the most important things you can do to prepare to be a great birth partner is to learn to relax and know that your connection and encouragement is all you need to bring with you. It's your job to just admire how amazing giving birth is and how amazing your partner is. And make sure you're prepared to look after yourself as a birth partner, pack your own stuff for labour, snacks, phone charger anything you might need. This is especially important with the current situation as if you're going into hospital you'll be there for the duration no popping out for coffee.