The subject we have been asked about most frequently is Induction.
Everyone has heard at least one horror story about the Induction that led to the 30-hour labour and then a Caesarean Section. Women and Doctors alike all want the safest, least painful and stressful labour achievable. You will always be advised according to your particular circumstances and with these aims in mind.
There seem to be two main concerns as far as Induction is concerned.
- Will Induction be successful if your cervix is unfavourable?
- Can you or should you refuse to be induced. And if so, at what stage does this become dangerous?
We will attempt to answer these issues as clearly as possible, but you should of course bear in mind that every woman faces different circumstances and you should take the advice of your caregiver very seriously.
The ease of induction is very much related to the favourability of your cervix. If it is long, hard, tightly closed and the baby’s head is high, this may make induction difficult. In certain cases 50% of inductions will be unsuccessful and will end in a Caesarean Section, but do remember that this means 50% will be successful and end in a Vaginal Birth. This is important to bear in mind as your outcome may have an impact on your future reproductive career. If you are expecting to have more than 2 babies it would be very good to try for a vaginal delivery rather than opting straight for a Caesarean Section.
The most common reason for the cervix being unfavourable is that the baby is in a back to back (OP) position. Often this will correct itself with useful contractions during labour. However, the induction process can tend to be long and drawn out and a bit stressful for you. It should not be stressful for the baby, his or her condition will be carefully monitored during the process.
How you will react to being induced depends on the whole picture of your pregnancy so you should be carefully advised by your Obstetrician. In very simple terms, if your cervix is unfavourable then you have 3 choices.
- To wait with extra monitoring of the baby by CTG and ultrasound and then to plan induction for a later date.
- To induce labour now and hope it goes well.
- Or to go for a planned Caesarean Section any time soon.
There is no absolute maximum for which you would allow a pregnancy to continue. The risk of unexpected adverse outcomes such as still births do increase gradually after 40 weeks and do reach a significant level at about 40 + 10 days and certainly by 40 +14 days. This increase however, is not dramatic and is only gradual. The risk will be affected by other features of your pregnancy such as your past medical history, age, weight, and whether you have had any significant events during your pregnancy.
Induction of labour is usually safe and easy and is done on medical grounds because of the increased chance of the placenta not working well after 42 weeks and a slightly increased chance of unexpected stillbirth. If you have had 3 or 4 babies already then induction can be a little more complicated and unpredictable and it needs an expert such as an Obstetrician to weigh up pros and cons for you carefully. If you decide not to be induced then a sweep may be a good alternative. It is very safe and non-invasive and may just trigger you to go into labour. If you fail to do so then you should be very carefully monitored with regular checks of baby’s heart rate and movement. Most people would agree to induction before 42 weeks and we hope you will listen carefully to the advice you are given.
The Doctor and Daughter’s Guide to Pregnancy