Induction – What are the alternatives?

Overdue and bored of waiting? Our midwife explains the different methods of induction

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A stretch and sweep can help to bring on labour

A stretch and sweep

If you go over your due date, your midwife should offer you a stretch and sweep which can help to prevent the need for induction. It’s a vaginal examination where the midwife will slide a finger through your cervix (if it’s open) and sweep the finger around, separating the bag of waters from the cervix, which can sometimes trigger labour.

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It doesn’t happen instantly and can be repeated again after 48 hours if needed. It can feel uncomfortable and cause a small amount of bleeding, but it is known to reduce the chance of induction.

Do it yourself

There’s a shortage of evidence proving that sex, hot curries and acupuncture can trigger labour, but it’s not going to do any harm, and can be fun trying. You’ll find plenty of women who will swear that eating fresh pineapple or a pound of plums, or stimulating their nipples for hours on end, brought on their labour. Raspberry leaf tea from 34 weeks of pregnancy can help to prepare the cervix for labour, but it won’t actually give it a kick-start.

Patience

It’s worth remembering that the majority of mums-to-be will go into labour on their own by 42 weeks, so sometimes good old-fashioned patience and simply waiting it out usually works for the best.

Mum’s story

“I was booked in for an induction at 2.30pm on my eleventh day overdue. I’d been having contractions on and off and had three stretch and sweeps, but labour just wasn’t happening. The midwife decided to give me a pessary but then found I didn’t need it, as I was already 4cm dilated. However, as the hospital wasn’t fully staffed they couldn’t break my waters so the midwife gave me my fourth sweep.

The contractions came and went, but by the evening they’d stopped again. They finally broke my waters at 11.30am the next day and labour came on quickly. 

I was hooked up to the monitors and the hormone drip to make me contract, but I was soon hyper-contracting so they removed the drip. I had gas and air and gave in to an epidural at 2.30pm. After that I found I could cope much better, although the staff were becoming concerned that the baby was in distress.

At 5.10pm the doctor examined me and said I could start pushing but only for an hour then she would have to help as I hadn’t realised the baby was face up (back-to-back). After an hour, the doctor tried a ventouse, but it wouldn’t properly attach because the wrong part of his head was presenting. 

Eventually I had a local anaesthetic and an episiotomy, and they used forceps to help our baby out. At 6.30pm, seven hours from induction, Charlie was placed on my chest, weighing 8lb 8oz. It wasn’t the birth I’d hoped for (I’d planned a water birth with gas and air) but every time I look at our son I’m just overwhelmed with love for him and the rest fades away.”
Rachel Killoran, 25, from Weymouth, mum to Charlie, 11 weeks

The induction journey

1. The first stage of induction is kick-starting those contractions and getting the cervix to open.

2. A vaginal examination will confirm whether or not the cervix has started to dilate before the induction even begins.

3. If the cervix has opened the first stage of the induction is avoided. If not, prostaglandin hormone is put into the vagina, either as a tablet, gel, or pessary, which slowly releases the hormone over the next 24 hours.

4. In some areas, women can go home if they have the slow-release pessary. They return as soon as the contractions start. The dose of hormone aims to start to work by creating contractions, and thinning and dilating the cervix.

5. If the cervix has started to open but the contractions are still not strong and regular, the next stage is having your waters broken (the artificial rupture of membranes). For women who don’t need the vaginal hormone, or particularly women who have had children before (the cervix sometimes remains open a little), they can begin with this stage.

6. The midwife uses a plastic hook, a bit like a crochet needle, which she gently slides into your vagina and carefully through your cervix, to pop the waters around your baby, at which point you’ll feel a gush of warm fluid.

7. If this doesn’t work, you’ll be advised to have a continual drip of a hormone called syntocinon which goes into a vein in your hand. This should gradually increase the strength and length of contractions until your cervix is fully dilated.

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8. Syntocinon is a strong drug and your baby will need close monitoring of his heartbeat to make sure that he remains happy throughout labour.

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