Induction - Preparing For Birth Manual

Being overdue is very common, especially with your first baby, so relax and don’t worry. Only 5% of babies are born on their due date. Interestingly, world-famous obstetrician, Michel Odent says, “Any induction, natural or medical, is asking the baby to come out before he or she is ready.” However, under current medical practice, obstetricians like to start a medical induction at around 40 weeks and 10 days. This is because research shows placenta function starts to deteriorate from this point and there is increased risk by day 14 of it becoming less efficient and even failing.

Things to do to encourage labour naturally:

• Walking / circling - moving your pelvis to stimulate the baby moving down and connecting with your cervix.

• Raspberry Leaf Tea - up to 8 weeks prior to your due date - will strengthen the uterus and can soften the cervix. This herbal remedy may have contraindications for some women, e.g. if there has been a previous premature labour; low lying placenta; renal issues; VABC and more - thus it is recommended if this is something you are interested in trying, to seek best advise from a qualified herbalist practitioner.

• Have sex / make love! Semen contains a prostaglandin, which stimulates the cervix. It took oxytocin to make the baby – it takes the same hormone to birth them too.

• If things start to happen but not move forward very quickly and you (and your midwife) feel its time to encourage things along, try cuddling your partner and getting a bit intimate. The aim is to stimulate oxytocin to increase, and this happens when nipples are stimulated.

• Go quite, dim the lights, be still - let baby know all is well and safe - it is nature’s way of helping women give birth in safe environments. Relax!

• Water / bath / aromatherapy - all aid relaxation and calm.

• Eat hot, spicy food. Capsaicin in chilli peppers stimulates endorphins and chilies can stimulate labour.

• Acupuncture or reflexology can help, as can homeopathic remedies.

• Aromatherapy, such as jasmine promotes/makes contractions, among others such as Clary Sage and Rosemary, however it has been seen that women use ‘everything’ even when already contracting, or even when having a hormone pessary to artificially stimulate contractions - this may not really be great, as can lead to overstimulation. Best to discuss with your midwife, as many are being trained in the use of Aromatherapy to help women in labour.

• Pulsatilla 6c to progress labour and Caullpphyllum to start it - consult a qualified specialist.

NOTE: 60% of babies are born on or just after day 10, so might be worth encouraging discussion with the midwife on induction for day 11 or 12 instead (4% come on their due date!). This includes having sweeps.

Stages of Medical Induction:

There may be some circumstances which mean women are invited in for an induction earlier than full term - for example, if she has gestational diabetes, high blood pressure or obstetric cholestasis (OC) or is deemed at high risk for any other reason. Or inductions are offered when it is a thought that the baby has ‘gone overdue’ - and labour has not started spontaneously yet.

A medical induction can lead to a higher incidence of interventions and assisted births, however, there are births that proceed smoothly with little intervention and lead to vaginal deliveries as well, following induction. Offering or having inductions because of risks of having bigger babies or going overdue can be a contentious issue and is the topic of much debate in the profession. It is something each expectant mother needs to weigh up for themselves and discuss with their midwife and health-care team.

A medical induction involves the following steps:

• A woman may be offered a sweep - this is to assess the softness of the cervix and to see if it has dilated at all yet. If it has a little bit, then the midwife can sweep her fingers in a circle around the inside of the cervix. This is said to stimulate the area and can trigger labour. This can be offered up to three times and happens in your local midwife clinic in the community. If the cervix is not ready and has not softened or opened yet, then a sweep cannot be done. Patience can be encouraged - or you can move onto the next step.

• A pessary - can be offered. This is rather like a tampon with a hormone which releases and would be inserted into the vagina to sit next to the cervix. The hormones then stimulate the area and can trigger labour. This can be down twice, usually in the hospital. Once it’s in, in some areas of the country, mums can go home to rest and it is expected that spontaneous labour with begin within 24hours, upon which mum is requested to come back to hospital to give birth - the idea being that there has been some intervention so some monitoring may be required. This can put plans of a home birth out of the window. If labour does not begin, mum is invited back in.

• Breaking the waters - once the cervix has opened a little bit, then a women may be offer to have her waters broken. S small instrument is inserted into the vagina and through the cervix to make a small tear in the sac which contains the amniotic fluid. Releasing the fluid can stimulate labour as it can help the baby press down onto the cervix. This would only happen in the hospital and it would be expected that labour commences within 2-4 hours. If this does not happen we move to the next step.

• A hormone drip - this artificial (similar to oxytocin) hormone will stimulate contractions and begin labour - if this does not happen a caesarian will be needed.

At every stage your midwife will be on hand to discuss through your options and the next steps. Be sure to discuss any questions or concerns you have with her and perhaps use B.R.A.I.N to make your decisions.