Induction: what is it like?

[Catherine4188]

Hello everyone,

So sorry to keep asking questions but I'm full of them and my midwife can't seem to give me a full picture as it's 'years' since she has been on an actual maternity ward. I also don't want to google too much and scare myself.

I have my induction date for Friday 15th December. This is my second baby but first with type 1 diabetes. With my first I had a natural birth in a birthing pool. I know this time will be very different. If you can provide any opinions, experiences or knowledge to my questions below I would hugely appreciate it.

How long did induction take to work for you?

How many attempts at the pessary do they allow before saying you need a C section?

Did anyone get to use water / bath a pain relief in the early stages?

What was your overall experience like?

How long were you and baby in hospital after birth?

If you have a C section do they allow you to breastfeed straight away or do you have to get all 'sorted' first?

Thanks again and I hope you understand my worries and questions.

 

[Diakat]

Hi @Catherine4188

Remember we are all different and all that matters is a healthy baby and you.

In my case they broke my waters but nothing happened, then the pessary and baby arrived 12 hrs later, ventusse delivery. So I can't answer any c-section questions.

We breastfed straight away and they gave her some neonate too just to be sure she had enough nutrition. We were in for a week.

Good luck.

 

[wiflib]

It's an utter disgrace that your Midwife cannot tell you your trusts protocol on IOL and the benefits/problems of it. I am a recently retired Midwife and this would trigger some updating for her, by her. At the very least, she should have referred you to someone who can discuss the process with you.
Call whichever team is caring for you and your pregnancy and ask them to contact you ASAP about what to expect. IOL has it's own set of risks, some of which are serious and you need to be given all the information in order for you to make that decision. They simply cannot do things to you without your permission or understanding as there are many things you can do to minimise those risks and improve the outcome.
On the plus side, this is not your first baby and you had a really good outcome last time so the likelihood is it will be more straightforward than if it were your first.

Have they talked about their policy on IOL and T1? Sliding scale? You will absolutely know more about your diabetes than the Midwives looking after you, they will simply follow some guidelines so don't allow anyone to take over your control, work with them.

One further point, it's not them that does the allowing, it's you. You tell them that you will be feeding your baby within the first hour of birth and that uninterrupted skin to skin will happen immediately following the birth, even if it's a CS. When you go home is entirely your decision, HCP's can only advise and support you they CANNOT tell you what to do.

Have they discussed with you the guidelines on the care of the baby following the birth? Some trusts insist on regular blood testing for the baby and will push artificial milk if they think it's easier. Find out if your hospital has a breastfeeding consultant.

Check out the Association for Improvements in Maternity Services and get asking on your mother forums if you are a member of one. Ignore all American info, it's utterly useless and they have the worst outcomes in the developed world.

 

[Dark Horse]

Here are a couple of sites with information about inductions:-
https://www.nhs.uk/conditions/pregnancy-and-baby/pages/induction-labour.aspx
https://www.babycentre.co.uk/a173/induced-labour

Here is some information about Caesareans:-
https://www.nhs.uk/conditions/caesarean-section/

Here is some info about breastfeeding after a Caesarean:-
https://www.babycentre.co.uk/a539020/recovery-after-a-caesarean-birth

Agree with @wiflib that you should have more information from your team. You shouldn't be expected to undergo any procedure without informed consent - the risks and benefits of having/not having the procedure should be explained to you so you have all the facts before making a decision.

Also agree that your need for insulin as someone with type 1 should be discussed/planned well in advance.

 

[wiflib]

I totally forgot the NICE guideines. Don't forget, guidelines are simply that, guides based on best available current evidence, they are not law.

I'm really sorry you have been forced on this path of steep learning without the support of the very people who should be.

 

[Catherine4188]

Thanks @witlib and @darkhorse.

I have to say I am not impressed with my care Since I switched hospitals. My first one was brilliant but couldn't offer the best birth or after care for me so I moved to a hospital which specialises in high risk pregnancies. However you get seen by an older hospital for your antenatal care. I have had scans which showed 10th centile growth when actually baby was 50th, told very little information about issues and concerns so that I ended up In a huge mess. I have been told vital information in waiting rooms. Then last week I was told that my babies growth has dropped from 50th to 25th centile over last 4 weeks, they said this was only a very small dip but I can't see how it is. So I have another scan on Friday this week to check. The only reason I'm not too worried is due to the mess they made last time and because they struggled to get a set of head measurements because he's so low down in my pelvis. However they did tell me that he has fluid on his testicles and no matter how much I asked for for information they said they were specialists on this and would fill out an emergency care plan for for once he is born to get the fetal medicine team at my new hospital to scan him. It's only through my own research that I've found this is a very common issue and it might rectify itself. All I was told was it would maybe need an operation, no timescale etc. So I came away thinking my tiny baby was going to need an op ASAP. They also forgot my 20 week fetal echo heart scan which had to be done at 29 weeks instead.

Anyway I will look at all the info you have give me. No o what's discussed risks with me at all and I don't know the policy of the hospital I am attending either. When you haven't been through it before you don't realise how little information they are giving you. I do have a birth plan which hardly says anything, she just said I would be on a drip from 4cm. Nothing about sliding scale but she did write down my current and pre pregnancy ratios. However she did argue that they were too low, even though I know that they are correct. She tried to get me to increase them for after birth but I had to tell her surely that would be silly as I Will be breastfeeding and my insulin needs will drop to begin with.

I'm lucky I have a sister in law who is a theatre nurse at the hospital I will attend so she has been able to quiz consultants about all my issues etc.

 

[Ellie_Wilko]

I was induced at 37 weeks. My hospitals protocol was pessary, wait 24 hours, another pessary, wait 24 hours, gel thing, wait 12 hours so by this time, I had been in hospital 3 days with absolutely no change what so ever. After the gel, they were able to break my waters (just about) and I was then taken to the delivery suite and put on the drip which definitely started contractions! However, 10 hours later I was only 3cm and babies heart rate was dropping so decision was made to go for an emergency csection.

After I had been stitched up and got back into the delivery room, they let me try breast feeding immediately but baby didn’t take to it.

I am pregnant again now and think I’m going to go straight for an elective csection this time to save 4 days in hospital twiddling my thumbs!

Good luck with what ever happens xxx

 

[wiflib]

I was induced at 37 weeks. My hospitals protocol was pessary, wait 24 hours, another pessary, wait 24 hours, gel thing, wait 12 hours so by this time, I had been in hospital 3 days with absolutely no change what so ever. After the gel, they were able to break my waters (just about) and I was then taken to the delivery suite and put on the drip which definitely started contractions! However, 10 hours later I was only 3cm and babies heart rate was dropping so decision was made to go for an emergency csection.

After I had been stitched up and got back into the delivery room, they let me try breast feeding immediately but baby didn’t take to it.

I am pregnant again now and think I’m going to go straight for an elective csection this time to save 4 days in hospital twiddling my thumbs!

Good luck with what ever happens xxx

That's a classic story of cascade of intervention cause by IOL which is why all the pros and cons of all routes of care need to be examined.

 

[Catherine4188]

It's an utter disgrace that your Midwife cannot tell you your trusts protocol on IOL and the benefits/problems of it. I am a recently retired Midwife and this would trigger some updating for her, by her. At the very least, she should have referred you to someone who can discuss the process with you.
Call whichever team is caring for you and your pregnancy and ask them to contact you ASAP about what to expect. IOL has it's own set of risks, some of which are serious and you need to be given all the information in order for you to make that decision. They simply cannot do things to you without your permission or understanding as there are many things you can do to minimise those risks and improve the outcome.
On the plus side, this is not your first baby and you had a really good outcome last time so the likelihood is it will be more straightforward than if it were your first.

Have they talked about their policy on IOL and T1? Sliding scale? You will absolutely know more about your diabetes than the Midwives looking after you, they will simply follow some guidelines so don't allow anyone to take over your control, work with them.

One further point, it's not them that does the allowing, it's you. You tell them that you will be feeding your baby within the first hour of birth and that uninterrupted skin to skin will happen immediately following the birth, even if it's a CS. When you go home is entirely your decision, HCP's can only advise and support you they CANNOT tell you what to do.

Have they discussed with you the guidelines on the care of the baby following the birth? Some trusts insist on regular blood testing for the baby and will push artificial milk if they think it's easier. Find out if your hospital has a breastfeeding consultant.

Check out the Association for Improvements in Maternity Services and get asking on your mother forums if you are a member of one. Ignore all American info, it's utterly useless and they have the worst outcomes in the developed world.

Hello,

After your advice I've been reading up of this sliding scale drip I'll be given. It sounds like it restricts your movements during labour from what people say. Is this true? If so what alternatives are there? Can I monitor my levels and inject/eat myself. As I say I had a great water birth last time and i do not want to be unable to move from a bed, I was quite active in the pool and it helped.

Thanks again.

 

[wiflib]

Hello,

After your advice I've been reading up of this sliding scale drip I'll be given. It sounds like it restricts your movements during labour from what people say. Is this true? If so what alternatives are there? Can I monitor my levels and inject/eat myself. As I say I had a great water birth last time and i do not want to be unable to move from a bed, I was quite active in the pool and it helped.

Thanks again.

You need to talk to your team about this. They will also advise continuous fetal monitoring (CTG) and that ties you down too. Find out if they have a remote CTG as that enables you to wander round without having wires to trip over. Get them to sort that now as they can be fiddly and sometimes the transducers get lost.
Call the hospital and ask for the head of Midwifery to call you and explain that you would like to see a senior Midwife to discuss the process in full.
They really need to explain to you the pros and cons of waiting for labour as a woman with T1 and the pros and cons of IOL.
I'd also recommend taking a good supply of food with you and arranging for others to bring some in. You will likely to be offered white bread sandwiches, crisps, cereal, biscuits and fruit or a hot meal of poor quality.
Don't be quick to put on nightwear, stick to normal comfy clothes as this will keep you empowered. You don't have to stay on the labour ward all the time.
Take food for your birth partner/husband/partner too and a fresh top to wear as they keep those places very hot.
Don't take a load of stuff with you, leave the car seat in the car, anything extra you need you can get afterwards.

I've gone on a bit and I'm really sorry, I detest seeing women getting railroaded and disempowered, it's one of the reasons I took early retirement. You are welcome to ask me anything and I'll do my best to help.

 

[Ellie_Wilko]

Hello,

After your advice I've been reading up of this sliding scale drip I'll be given. It sounds like it restricts your movements during labour from what people say. Is this true? If so what alternatives are there? Can I monitor my levels and inject/eat myself. As I say I had a great water birth last time and i do not want to be unable to move from a bed, I was quite active in the pool and it helped.

Thanks again.

I wasn’t put on a sliding scale as was able to manage my sugars well myself during labour.

However, as I was being induced and on the induction drip, I had to stay on the monitor the WHOLE time and was therefore restricted to the bed for the whole labour. I wasn’t even allowed to the toilet so had to use a bed pan!

 

[Catherine4188]

I wasn’t put on a sliding scale as was able to manage my sugars well myself during labour.

However, as I was being induced and on the induction drip, I had to stay on the monitor the WHOLE time and was therefore restricted to the bed for the whole labour. I wasn’t even allowed to the toilet so had to use a bed pan!

That's not good. I'm going to call the hospital today and get someone to explain it all to me. I feel quite anxious now.

 

[Catherine4188]

I wasn’t put on a sliding scale as was able to manage my sugars well myself during labour.

However, as I was being induced and on the induction drip, I had to stay on the monitor the WHOLE time and was therefore restricted to the bed for the whole labour. I wasn’t even allowed to the toilet so had to use a bed pan!

My hospital have advised me that they don't have wireless monitors and my drip will restrict me pretty much to the bed or just beside it. Not looking forward to this labour now... but if baby gets here safely that's what matters. Don't think I can use Tens machine either due to monitoring as it disrupts the signal.

Did you have any pain relief? What was your experience of them like? Last time I used a birthing pool and gas and air so not sure what the pain relief options are like. I heard pethidine can make you forgot things...

 

[jade88]

I was induced at 38 weeks and was very lucky that I responded quickly to the first pessary given! I had my little boy 24 hrs after being induced! I went on sliding scale and I’m glad I did because I could concentrate fully on labour without having to worry about working out how much insulin to take! Its definitely a more restrictive birth but is for babies safety so understandable!
I was able to use a tens machine despite being attached to monitor! I had gas and air only but was offered pethidine and epidural during labour. My son was 9lbs at 38 weeks 1 day which they underestimated on growth scan so glad I was induced when I was! I think the other main reason for
Inducing is the risk of plancenta failing increases and the risk of still birth. My son was completely healthy apart from low blood sugar so he spent 24 hrs in neonatal being fed through a tube.

 

[Ellie_Wilko]

My hospital have advised me that they don't have wireless monitors and my drip will restrict me pretty much to the bed or just beside it. Not looking forward to this labour now... but if baby gets here safely that's what matters. Don't think I can use Tens machine either due to monitoring as it disrupts the signal.

Did you have any pain relief? What was your experience of them like? Last time I used a birthing pool and gas and air so not sure what the pain relief options are like. I heard pethidine can make you forgot things...

To be honest, the first hour was probably the worst as wasn’t in unbearable pain and wanted to try and preserve some dignity! Once full blown contractions started, I didn’t care about anything and the day went in a flash...

I had gas and air until the pain was to much and then had an epidural but it unfortunately only partially worked on 1 side. I think it was only a couple of hours after I had it that they took my to theatre and because of the dodgy epidural, had to have a spinal for the c section rather than using the epidural.

It really wasn’t that bad once things got going and the day went so quickly that I can’t even really remember much - maybe that was the gas and air though

 

[myarnton1]

Hi there,
I’m sorry it sounds like you are being kept in the dark with the procedure i was actually induced on the 15th of December last year! I was induced at 36 weeks due to unexplainable low blood sugars, which in diabetic women can be a sign of placenta failure. My hospital has the same strategy as what @Ellie_Wilko was explaining earlier on in the comments.
I reacted very quickly to the first pessary I was given with regards to contractions but was not dilating much. I was taken up to the delivery suite and had my waters broke and put on the drip to help me dilate. I was nearly fully dilated but baby’s heart rate was very high so it ended in an emergency CS. I had the sliding scale which I did not like the thought of when I was pregnant, but it did make things a lot easier, I didn’t have to worry about bolusing and testing as the nurses then did it for me.
I had gas and air, pethidine and then the epidural which I desperately wanted as the contractions were very intense. Pethidine made me very sleepy, I wouldn’t have that again, I struggled to stay awake during labour because of it which I hated as I like to feel somewhat in control. However, everyone reacts to it differently.
Hope you get the answers you want to make you less anxious about the induction process. Ask questions, but try not to worry too much and go with the flow.
Good luck xx

 

[kitty55]

You need to talk to your team about this. They will also advise continuous fetal monitoring (CTG) and that ties you down too. Find out if they have a remote CTG as that enables you to wander round without having wires to trip over. Get them to sort that now as they can be fiddly and sometimes the transducers get lost.
Call the hospital and ask for the head of Midwifery to call you and explain that you would like to see a senior Midwife to discuss the process in full.
They really need to explain to you the pros and cons of waiting for labour as a woman with T1 and the pros and cons of IOL.
I'd also recommend taking a good supply of food with you and arranging for others to bring some in. You will likely to be offered white bread sandwiches, crisps, cereal, biscuits and fruit or a hot meal of poor quality.
Don't be quick to put on nightwear, stick to normal comfy clothes as this will keep you empowered. You don't have to stay on the labour ward all the time.
Take food for your birth partner/husband/partner too and a fresh top to wear as they keep those places very hot.
Don't take a load of stuff with you, leave the car seat in the car, anything extra you need you can get afterwards.

I've gone on a bit and I'm really sorry, I detest seeing women getting railroaded and disempowered, it's one of the reasons I took early retirement. You are welcome to ask me anything and I'll do my best to help.

OMG I so totally agree with everything you said. I was 48hrs in labour but well informed about every single thing and working with the team looking after me and deciding stuff on my own. I didn't have a sliding scale either as I wasn't keen on someone with not much knowledge controlling my diabetes and to be fair it was pretty much perfect during that time. In the end we had to have an emergency section under GA as baby's bloods were off and he had to get out asap but that was no one's fault and just bad luck. And I wasn't induced either but went to 40+4 when baby finally made a move himself