Still Pregnant?

So you’ve been waiting 40 weeks. 40 WEEKS and baby is a no show?! This is fairly common but doesn’t always make your due date any easier if it passes by without a trickle or baby to show for it. Especially as the well meaning but really flipping annoying texts start to roll in… “ No baby?”

Only 5% of babies are born on their due date, with the majority 65% born on day 40+10. Some women are now opting to use the idea of a “Due Month” to take the pressure off, but your midwife will be going off your due date, and it’s usually here or your 40 week appointment, that you will be offered some sort of medical induction to get things going. This is because some research shows that placenta function starts to decline post 40 + 14. It is worth noting that although the offer of a 40 week sweep seems to be standard practice, the World Health Organisation recommend no induction methods are given until 41 weeks gestation.

“In uncomplicated pregnancies, it is recommended to induce labour after 41 completed weeks of gestation. Available evidence does not support the policy of induction of labour before 41 weeks in uncomplicated pregnancies. Every possible precaution should be taken to obtain a reliable estimate of gestational age prior to induction of labour. Failure to do so can increase the risk of such adverse consequences as iatrogenic respiratory distress syndrome.”
— WHO

Induction can be quite a tricksy subject with some women being strongly anti intervention and others not giving it a second thought. As with all things it’s important to make sure you feel informed on your choice, and to remember it is a choice. 29.4% of labours were induced in 2016-2017 in the UK. Just because a labour is induced, it doesn’t mean it will be complication free or quick. In fact, world famous obstetrician Michel Odent says…

Any induction, natural or medical, is asking baby to come out before he or she is ready
— Michel Odent

If we apply this reasoning, it makes sense that the body needs a lot of encouragement to behave in a way it isn’t ready for, and that one intervention can lead to others. This is why with medical inductions, you are mostly required to stay in hospital - your body is doing something is wasn’t ready to do, therefore it needs constant monitoring incase any other intervention is needed. Below is the flow chart called the Cascade of Intervention. You can see below how one intervention can lead on to the next.

birth-flow-chart3.jpg

I used the term medical induction as many of us are already using non-medical methods to encourage baby along without considering them to be inductions. Food for thought 😉. So what might a non-medical, or natural induction method look like?

🌶 Hot & spicy curry? It’s not just an old wives tale, the Capsaicin in chilli peppers stimulates endorphins and can stimulate labour.

☕️Raspberry leaf tea. You can start gulping this down 8 weeks prior to your DD. It’s known to strengthen your Uterus and soften the cervix. Both pro’s for labour.

💆🏻Acupuncture, Massage, Reflexology. The body has certain points that can encourage labour and some practitioners are trained in labour induction methods. This is something you can work with from your due date onwards.

🍾Sex!! Not only does being intimate create Oxytocin which is the hormone our body produces during labour, but semen contains prostaglandin which stimulates the Cervix. Win win.

All of these methods you are in control of and don’t require you to be in hospital or with a medical professional to do, however in my opinion they won’t get you started unless your body is nearly there anyway. Medical induction methods are mostly sure start ways to get a labour party going. If you think of induction as a ladder, starting at the beginning & perhaps least intrusive, depending on how you look at it…

  • The Sweep - This is where your midwife will glove up and assess the softness of your cervix to see if it’s dilated (opened) at all. Fun Fact - If this is your first baby, your cervix will be a no access zone until your body is ready for labour so if it isn’t, there’s nothing the midwife can do. If you’ve given birth before your cervix will have stayed 1-2cm open since then, so there’s more chance of a sweep being possible. If you have dilated a little, the midwife will sweep his or her fingers in a circular motion inside the cervix to encourage it to open, stimulate the area and ideally trigger labour. There isn’t any proof that a sweep will work before 40 weeks, but there is 9.1% more chance of a sweep working if your waters have already ruptured. Sweeps can be given in the community if you’re home-birthing & in hospital.

  • A Pessary - Next on the ladder is the pessary. You might opt for this after you’ve had a sweep or decide against a sweep altogether and head straight for this. This is when the pessary, which looks a bit like a tampon, is inserted into the vagina to sit behind the cervix. The pessary contains the drug Dinoprostone which has the same effect as the naturally occurring hormone, Prostaglandin (hello semen) which is involved in starting labour. To receive the pessary you must go into hospital to have it inserted. Once it is, babies heart rate will be monitored for an hour or so and all being well you’ll be discharged to go home and wait for labour to start. If labour does start you will be requested to labour at hospital with the idea being that because there has been some medical intervention a home birth wouldn’t be advised. After 24 hours if nothing’s started you can go back into hospital to either receive a second pessary or jump to the next induction method. If you choose to have a second pessary, you will be kept in hospital for monitoring until labour starts or you try another method of induction.

It is worth noting if you decide to be induced, you do not have to try ALL methods of induction, nor do you have to work your way up the ladder, however you can’t go backwards! For example, once you’ve had a pessary you can’t then opt for a sweep and home birth. Or once you’ve had the drip you can’t have any other type of induction.

  • Breaking of Waters - If the cervix has opened a little either from a sweep or pessary, or just because… You may be offered to have your waters broken. This will only be offered in hospital, and you will be placed on the labour ward rather than the MLU. The ‘waters’ is the amniotic sac that the baby is in whilst in Utero. If you choose to have this, a small instrument (a bit like a plastic knitting needle!) is inserted into the vagina and cervix to make a small tear in the sac. With the release of fluid babies head can press down on the cervix which releases Oxytocin and create the positive feedback loop ending in Contractions! WHOOP. If this is successful, you’d expect to be in labour within 2-4 hours roughly. If after your waters are broken and you aren’t on the road to baby-land, you’re next stop is the Hormone Drip…

  • Hormone Drip - The hormone drip consists of a synthetic oxytocin hormone, called Syntocinon. With the drip you will again be in hospital on the labour ward, you & baby will be constantly monitored throughout even once you are in established labour ( 5CM + ). The drip is given via an IV (intravenous cannulation) into the hand and will be with you throughout labour. This is because having Syntocinon in your system will stop the bodies ability to naturally produce oxytocin, therefore there’s a risk of labour slowing down or stopping altogether without either present. Syntocinon has the same affect as Oxytocin creating the Uterus to contract, pushing babies head down onto the cervix which in turn encourages it to dilate and thin - hopefully. If at this point, established labour isn’t happening the next step would be heading for C-Section, although this is rare it is worth noting.

It can be easy with induction to feel like your whole birthing plan or wishes are thrown out of the window, especially if you had your hopes set on an intervention free birth either at home or a MLU. But don’t fret, and come back to the idea of Form Vs Essence, which I mentioned here. There are elements of labour we absolutely can not control whether you’ve been induced or not, but there are elements which we can. Focus in on those. There are also times when induction is recommended prior to 40 weeks gestation for reasons such as Gestational Diabetes, Premature Rupture of Membranes, Intrauterine Growth Restriction (IUGR). Again when these unplanned complications arise - we go back to to form vs essence. I recently supported a woman who was induced at 38 weeks, and although she received a sweep, pessary, waters breaking & ultimately the drip, she did so whilst maintaining the essence of the birthing she had hoped for… she moved & breathed through each contraction, she had calming music & low lighting, she didn’t have any pain medication, instant skin to skin and delayed cord clamping. These might not be your preferences but it’s important to remember that however baby is brought into the world, you have tools that are available to ensure you feel empowered throughout the process.

Further Reading;

Sara Wickham - Induction before 42 weeks
Midwife Thinking - Induction of Labour
NHS - Induction of Labour
NICE - Induction of Labour in specific circumstances
Royal College of Midwives - Intervention of Normal Labour and Birth
Birth Issues - Induction Truths