Phindi Mashinini, a Johannesburg-based midwife in private practice, answers some of our questions about what an induction entails.
The most common reason for induction is if you are carrying post-date, but it can also be required due to an obstetric condition such as high blood pressure, pre-eclampsia or gestational diabetes. Induction will only ever be on recommendation from your OB/GYN or midwife. “For those moms who are really tired at the end of their pregnancies, sorry, there is no social induction possibility. You will only be induced if it is a medical necessity,” jokes Phindi.
Inductions are usually only done at 38 or 39 weeks because this is the optimal time for baby to be born without any complications. If there is a serious medical condition, induction may be done earlier, but, in this case, the birth is more likely to be via C-section so that there is less stress on the baby.
How do you induce labour?
There are several different ways of inducing labour:
- Stretch and sweep – This is a method of manually stretching the cervix and membranes slightly. During a vaginal examination, the midwife or doctor makes circular movements around your cervix with their finger intended to release a hormone called prostaglandins. The aim is to gently encourage nature to take its course.
- Gel/Oral Prostaglandin – Prostaglandin is introduced vaginally (using inserted gel (several doses, once every 6 to 8 hours), or a pessary and tape (like a tampon), which releases the hormone over 12 to 24 hours). Prostaglandin can also be taken orally, where the mom will drink diluted Mesoprostol every two hours until she has good contractions (3 in 10 minutes).
- Artificial rupture of membranes (‘breaking your waters’) – This is probably the method most often used, and one most of us are familiar with. With this method, the membrane is artificially ruptured using a small hooked instrument inserted vaginally. This method releases the amniotic fluid and prompts contractions. Breaking the water is most often done in conjunction with a drip containing a synthetic version of the hormone oxytocin, which induces contractions.
“Which method you use is dependent on a couple of factors. You need to consider where the cervix is positioned, anterior, central or posterior and whether it is soft and conditions are favourable for dilation. One also must consider the position of the baby’s head in the pelvis to understand how the birth will proceed,” explains Phindi.
How do you know it has been successful?
“Everyone’s body reacts differently to induction, so there are no hard and fast rules that will tell you that labour has started or how long your body will take to respond to the induction. It can take up to six hours for labour to begin, but it can also proceed within two hours. Obviously, once you are experiencing good, regular contractions, you will know that things are underway, but moms will dilate without feeling any contractions in some cases. This is why ongoing monitoring is essential and why any artificial process such as an induction must always take place in a hospital environment.”
In fact, moms are counselled before an induction about the potential for foetal distress, should labour unexpectedly progress too quickly. If there is any sign of distress, a quick decision to move to a C-Section might have to be made. Parents need to be prepared for that eventuality, especially if they have strong views about having a natural birth. “There is also a very slight possibility that the uterus might be ruptured during induction,” says Phindi. “But in my 38 years of practice, I have never seen that happen, so it is quite a rare occurrence and quite unlikely.”
Manage your mental health
All preggy moms, towards the end of their pregnancy, want the baby to hurry up and arrive, but it is important to manage their own mental health during this time. A good relationship with their caregiver, whether OB/GYN or midwife, is essential throughout the pregnancy but even more so at the end.
“It is vital that there is a good rapport between client and midwife or client and doctor,” says Phindi. “The patient should absolutely be able to trust that her caregiver has her best interests at heart and will do their best for both her and her baby. Peace of mind at the end will go a long way towards facilitating less stressful labour and a happy mom and baby at the end. Choose your caregiver carefully, and feel free to voice your concerns at any stage, so that the journey feels safe for you at every step. Induction should not feel like a scary prospect; your caregiver will be with you throughout and ensure that you receive the very best care. That’s what we are there for.”