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  1. #1
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    Question Tips for 1st induction

    Hi,

    Was just hoping someone might be able to give me a heads up on what to expect when you're being induced?

    Does it hurt twice as bad as normal? Do I need to ask for an epidural?

    My DR says they will break my water and put me on a drip if need be.

    Should I ask for anything in particular?

    Thanks in advance

  2. #2
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    I'm sorry you have to choose this but I understand you have compelling and genuine medical needs. Here are some hints on how to cope so as to avoid the worst outcomes which are sadly common with induction. Good move to try and minimise the damage! Studies show clearly that rupturing your membranes at the start, as part of induction, leads to poorer outcomes because babies need to cushion intact so tell your doc you'll be fine without until labour is established or maybe not at all.
    Refusing early rupture also reduces the risk of fetal distress from cord compression; the risk of infection, which avoids IV antibiotics and septic workups; and the rare but catastrophic risk of umbilical cord prolapse.
    Good luck with it!


    How can women considering elective induction minimize the risks?
    (adapted from The Thinking Woman’s Guide to a Better Birth © 1999 by Henci Goer)
    • Refuse induction if you have no prior births. Induction will increase the chances of cesarean by anywhere from 50% to 250%. (See Table.)
    • Refuse Cytotec (misoprostol, prostaglandin E1). As noted above, Cytotec has a propensity for precipitating women into short, violent labors and a potential for catastrophic complications. Cytotec was not formulated for use in inducing labor and has not been approved by the FDA for this purpose, although recently, lobbying by ACOG led the FDA to lift a ban. Besides being riskier than Prepidil and Cervidil (prostaglandin E2), Cytotec offers no compensating advantages—at least not for women. Cytotec produces virtually identical cesarean rates compared with inductions involving prostaglandin E2.22 The higher risks and equivalent effectiveness notwithstanding, hospitals like Cytotec because it costs mere pennies a dose compared with $75 to $100 dollars per dose of prostaglandin E2. Obstetricians like it because it allows them to practice “daylight obstetrics”—insert the pill in the morning, return later in the day for the delivery or the cesarean, be home in time for dinner.41
    • Refuse rupture of membranes before labor is well-established and progressing. Having intact membranes means you can back out if the induction doesn’t work. Refusing early rupture also reduces the risk of fetal distress from cord compression; the risk of infection, which avoids IV antibiotics and septic workups; and the rare but catastrophic risk of umbilical cord prolapse.
    • Consider refusing induction with an unready cervix and/or little or no dilation. These conditions greatly increase the probability of cesarean section regardless of the use of cervical ripening procedures.27,43-44
    • When cervical ripening is necessary, request Cervidil. Unlike Prepidil, it can be removed should uterine hyperstimulation occur.
    • Avoid mechanical dilators for cervical ripening. These materials gradually dilate the cervix by absorbing water. They are not as effective as prostaglandin E2 at either promoting successful labor induction or achieving vaginal birth, and they may increase the risk of infection.25,43 Again, lower cost is the single advantage.
    • Although this should be standard practice, make sure the IV fluid contains salts. Salt-free fluids, especially in combination with oxytocin, one of whose effects is fluid retention, can cause serious blood-chemistry imbalances.14
    • Have continuous electronic fetal monitoring. It reduces the risk of newborn seizures.26
    • Insist on a low-dose(physiologic) oxytocin regimen that allows at least 30 minutes between dose increases.14 The chance of developing adverse effects goes up with the total amount of oxytocin given and the peak dose. High-dose regimens greatly increase both.
    • Arrange to have the nurse try turning off the oxytocin once active, progressive labor is established:. When labor kicks in, it may continue on its own without the extra stimulus. This will be less painful for you and easier on the baby. A plain IV will be kept running, so oxytocin can easily be restarted if needed.
    • Low-dose, long-interval protocols increase the odds of being able to turn the oxytocin drip down or off in active labor.3
    • Avoid or at least hold off on an epidural. Because epidurals slow labor, they can substantially increase the risk of cesarean section, especially when given early in labor. Epidurals also cause fevers with prolonged use. A fever in labor indicates a possible infection in mother or baby and leads to a cascade of interventions.
    • Limit vaginal exams once membranes are ruptured. There is a clear relationship between length of time since rupture, the number of vaginal exams, and infection.38
    • Refuse internal contraction-pressure monitoring. It requires rupture of membranes, increases the odds of infection, introduces risks of its own, and doesn’t improve outcomes.6

  3. #3
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    Default my induction story...

    hi ryally,

    i was induced with my bub. i was a week over due and my blood pressure was starting to play up. my ob did a strip and stretch the day before and sent me home to see if i would go into labour naturally as i was about 2 cms dilated.
    unfortunately i didn't so the next morning they induced me. my ob broke my waters which wasn't too bad - felt a bit like period pain. I also had the drip with oxytocin (sp?). It probably took about 1/2 for labour to start (or when i started to feel the contractions).
    what i found is that you just go straight into full blown labour - there is no gradual lead up. i had intense contractions from the start and they were 1 minute long with a break of 1 minute so I didn't get much recovery time between contractions. it does make it difficult to "get on top" of the contractions and i found it hard to cope without pain relief as a result.

    of course it didn't help that there was only one midwife on duty and 4 labour rooms full. she came back maybe every couple of hours to check on me and adjust the drip. at one stage she did try to turn it off because i was really not coping with the pain but my contractions just stopped altogether so it had to be turned back on.

    i made it to 5cms then asked for pethidine which did nothing for me at all except make me dopey and about 1/2 hour after that I got an epidural.

    what i mainly found was that i just did not have the energy to push ds out at the end - partly because my epidural was put on full bore and when they turned it off for me to push, we waited for about 45 minutes and I still couldn't fell a thing. So it was really difficult for me to push effectively. Anyway, I ended up having forceps.

    My suggestions would be to keep your options open for pain relief. If you have the same type of induction as I did then you will be attached to a drip on a stand so you can move around etc. although you have to take the stand with you. I didn't have any restrictions on what I could do or where i could go in the room or positions i wanted to try. Oh, and don't be polite and not tell the midwife if your contractions are too fast etc. like i did. I will know better next time!

    Good luck and i bet you can't wait for your little boy!
    Last edited by talon; 14-09-2005 at 11:54.

  4. #4
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    Hi,
    My stories arn't all that bad. I was induced at 5 days over and 2 and a half hours later I had an 8pound 14 oz boy. I used some gas but no pethadine and there was no further intervention. (they only broke my water). Next one was induced at two weeks early so I needed my water broken and a drip to get things going. This labour was also under three hours and I used gas and nothing else. Also no other intervention. I believe all women should go in with some idea of what they may want but still be open minded as you just don't know. I have also had 2 labours that started on their own one was 26 hours and the other only five I used pethadine for both. I have also had 1 emergency ceasar so I have definatly had variety.
    I hope however yours turns out the end result is a beautiful healthy baby. Goos luck. It is not always a terribl experience.

  5. #5
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    wow caroline, you have had variety.

    i just wanted to add that i have heard some induction stories that were pretty straightforward with few complications. i reckon it varies a lot across the board.

    the other thing i have heard is that the labour is supposed to be quicker with an induction. is this true? i only ask because mine was about 10 - 12 hours and because ds is my first i have nothing to really compare it to - although i really don't consider this to be a "fast" labour.

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    Being induced isn't always the quick way. My sister was induced and didn't dilate properly until after she had an epidural. Everyone is so different and as everyone can see with mine every labour is different.

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    I was induced at 12 days over due and labour started within 40 mins, v.intense and I did ask for an epi early on as I couldnt stand the pain. Labour took about 6 hours from first contractions to end, my waters broke by themselves, I did tear and get cut and our DS was forcep delievery as I was exhausted (i know 6 hrs doesnt seem like along time but it was for me!) All in all I'm very happy with how labour went, I've heard worse stories, for instance the girl next to me at the hospital had to be induced four times over five days as the inducements didnt work!

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    Hi Ryally, I am not writing to say that this will happen to you, as every womans body is different but to give you my experience of an induction.

    I was ten days overdue with an unripe cervix. I was given a dose of gel at 8pm and was left to see how things would progress. The next morning I was examined and there had been no action so my OB administered another dose of the gel. Several hours passed with absolutely nothing happening
    My OB was concerned as to why there had been no progression into labour and I was terrified that he would break my waters and hook me up to the drip, this was something that I definitely didn't want!! He suggested a caesar, and as crazy as it might sound I was relieved I found this option less scary than the drip etc.

    But as I said this is just my experience. I wish you all the best with the upcoming birth.

    dee dee

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    My waters broke but contractions never started, so 16 hours later they put me on the drip. (Lucky, cos I was getting really bored walking around the hospital). Yes, contractions were pretty intense and came on within 10 minutes, but I coped OK. After a few hours I had some gas and later on some pethedine. I also had a shower and spent time sitting on the toilet.

    I had a great midwife who knew accupressure points that helped too. But then she finished her shift and I was left with a real bozo midwife.

    Showering with a drip was a little awkward, and dh had to cut my top off (it was getting too awkward to try and get it over the drip).

    Good luck with your induction, you'll forget about it all as soon as you see your precious little baby.

  10. #10
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    Hi Ryally

    I had heard some awful stories about being induced before I had my little bubba....which really did panic me....but my experience was very positive...now I look back and think that they were just rude little individuals trying to scare me!!

    I had to be induced one week early for health reasons related to the bub. The doctor broke my waters at 8am, which did not hurt any more than a pap smear, and hooked me up to an Oxytocin drip straight away. For the first two hours my contractions were nothing more than slight cramping even though they were quite close together. The third hour the contractions started to increase in intensity etc , which is when I asked for pain relief....they then gave my gas which freaked me out so I threw it across the room and asked for something stronger.

    The midwife then examined me and I was fully dilated so could not have peth or epi..... After 1 hour of pushing our beautiful baby boy arrived....so all up 4 hours and very positive experience.

    So try not to listen to the horror stories, they tend to freak you out and it may be for nothing!!

    Although I have heard that some people get an Epi at the same time the drip is put in given that labour can come on so quickly and intensely....might be something to chat about with your doctor??

    Cheers


 

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