Many women I talk to about their induced labours say things like “I didn’t know xyz could happen” or “we weren’t prepared for abc” – generally the big ones are “I didn’t know it could take so long” closely followed by “I didn’t know it could be so quick”. Many of the negative aspects of their experience come down to the fact that they weren’t prepared and / or they were not informed about the process. This post isn’t about the actual risks or benefits of an induction of labour – there is heaps of information out there about that – but this is around logistically planning for an induced labour birth experience. Different things that are advised to help keep you feeling positive and prepared during what can be a stressful, frightening and exciting time. Obviously if your induction is more emergent and planned for tomorrow some of these things will not be able to be done and your medical situation could mean some things are not recommended. Which makes the first point, the most important.
Your first action should be to have a REALLY open conversation with your care provider about your hopes and goals for the birth and the reasons induction is recommended or wanted. Ask questions, gather information, go home and think about it all then ask more questions if necessary.
Do your research: BRAIN all the options – you can do this with your care provider and also with your doula if that helps you to get all your thoughts and options straight.
Put together an “induction plan” – like any birth plan it needs to be flexible and take into account the fact that things can change at any moment. The importance of a plan lies in the process of “planning” and exploring your options not the finished product. It also serves as a reminder that you, the mother, are still the decision maker. Ensure that you share and discuss the plan with your care provider and every single care provider you see over the lead up to the induction and during the induction process, amending the plan as needed.
Consider if you want to try “natural” induction techniques for a little while before you start the medical ones – talk to your care provider and doula about different options. If you choose this path I’d suggest starting 1 week before your booked induction date and only do the things you feel like doing – If you don’t feel like sex or hate the smell of clary sage then don’t force it, if going for a walk in the sunshine feels good then keep at it.
Cease natural induction techniques the day before you are booked in and REST instead. Labour is usually a very tiring endeavour and an induction can place additional stress on you. It is very important to be as rested as possible (yes, I know how hard it is to feel “rested” at the end of pregnancy!) before you go in. A lot of people assume that after they have the gel they will “rest” (because this is what the midwives will likely tell you) but please note that resting in hospital is not the same as resting at home. You will be on the maternity ward, possibly in a shared room. There will be babies crying, other visitors coming and going, meal carts clattering past your room, cleaners coming in and out and the midwife will be checking on you regularly. This is before you add on any potential early labour symptoms you may experience like cramping, vomiting or diarrhoea.
Be prepared for things to happen quickly. Generally if you are having gel you will be asked to come in in the evening to have the gel placed with the “plan” that nothing much will happen overnight and your waters will be broken in the morning. It will be suggested that your partner go home to rest and come back in the morning (in most public hospitals it will be mandatory that your partner leave after visiting hours are over). However it is entirely possible that you could be in labour within a matter of hours. Have a chat with your midwife about what support will be offered during early labour and at what point your partner will be allowed back. If you feel that you would like some additional support at any time tell the midwifery staff that you need your partner or doula and don’t take no for an answer – it is important for you to feel safe and supported. Ensure that your partner is prepared for the possibility that you will be calling him back in the middle of the night and that he has his bag ready, doesn’t drink and keeps his phone handy. Make sure your doula is kept up to date with what’s happening as well. She’ll need to be prepared for the possibility that she’ll be getting called out that night.
Be prepared for things to take a long time. I’m sure that every mother being induced hopes she will be one of those awesome stories where the gel is applied and bub arrives 6 hours later. And it can be very beneficial to visualise this happening. But it is entirely possible that things will take a lot more time and effort. And the longer you are in hospital the more exhausted you will get. If the first lot of gel doesn’t work your care provider will likely recommend more gel in the morning. I would then recommend spending the day alternating between actively trying to get labour going and restful activities. Walk. It can help get labour going, help with pain, stairs can help ensure bub is positioned well and fresh air and sunshine is good for everyone. Alternate walking with a “resting” activity. Meditate. Hypnobirthing Australia have some beautiful guided relaxation tracks that can help you to get deeply relaxed – they are great for any labour, but if you are planning an induction I HIGHLY recommend you purchase a couple of tracks. Pack a magazine or crossword puzzle book. Read a novel (you’re not likely to get another chance for a while!). Keep some clary sage handy and sniff regularly. Find a private place and do some nipple stimulation. Keep in touch with your doula for reassurance and distraction. And don’t get disheartened. By this stage you’ve likely had little effective rest for 24 hours and it can seem like your body is just not working and your baby is going to stay in there forever. If you are already aware of how long the process can take you are less likely to add being disheartened and despondent to your exhaustion. Remember that this is normal and many women go through this lengthy process and still have a positive vaginal birth – There’s no reason why you can’t too!
If the gel doesn’t put you into labour a couple of options are available to you. If your cervix is still hard and closed you may have the option to go home or remain in hospital but continue to wait. This can be a tough option for an exhausted mama to choose, but it is there. Or you may decide that a caesarean is a better option for you and your baby. Your care provider may offer the option of a mechanical dilation aid, such as a foley’s catheter, if appropriate. In any case it is important to again have a very open conversation with your care provider about the benefits, risks and alternatives of all your options as well as tuning into your own intuition and asking “what would happen next?” If they say that “our policy is…” ask them how this pertains to your own individual health circumstances. Ask questions, gather information, talk it over with your partner and doula and take all the time you need to make the best choice for you and your baby.
If your cervix is soft and open a bit your care provider will likely suggest breaking your waters (AROM) and starting the drip of syntocinon. As always ask questions. There may be options around leaving some time between AROM and starting the drip. For large numbers of women AROM and a good walk is all that is needed to get labour established so talk to your care provider about how much time they would be comfortable with you having. Also talk to your doula. If you are having your waters broken you will likely be needing her fairly soon afterwards so she’ll need to be prepared. If you end up having the syntocinon drip you will have one to one midwifery care throughout your labour as well as continuous electronic fetal monitoring. Have a really good chat to your midwife when she comes in so that she is aware of your hopes and goals for your birth and talk through how she will help you to achieve these. Let her know if you have a doula coming and what techniques you and your doula have previously discussed using.
Many women hold fear about the possibility of an induction and while it can increase risks to mum and bub, women have many reasons why they may consider it to be the best option for their birth. There are also a range of induction options and ways to mitigate some of the risks. As with any birth, being prepared, knowing your options, having a plan and having good support will help to ensure that you still have a beautiful, calm, safe and positive birth experience. Get prepared and get excited – You’re going to meet your beautiful, precious baby very soon!