VBAC (Vaginal birth after C section)
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Meg Wilson
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Consultant Obstetrician and Gynaecologist. ‘Labour Ward Lead’ at Whittington Health. Miss Wilson is passionately interested in women’s experience and safety through all stages of pregnancy. She also holds the position of Royal College Workplace Behaviour Champion.
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Birth and labour

Induction of labour

Induction of labour means that the onset of your labour is started with drugs or other medical techniques.  Your doctor or midwife should have discussed with you why you need to have your labour started this way.  Frequent reasons may be going past your due date, concerns about your baby’s growth or if your waters have broken for over 24 hours.
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In Short
You will be given some instructions about where the induction will take place. For some women this will be started on the maternity assessment unit and then you will be able to go home.  For other women, they will be asked to stay in the hospital on the antenatal or labour ward.  Where ever the induction is starting, the experience is often the same. 

The midwife will offer to monitor your baby for about half and hour on the CTG (heart rate monitor) before starting the process. They will check that you are well and answer any questions that you may have. An internal examination will be required, this is performed in a privacy and only with your consent. The midwife or doctor will feel the opening of your womb, ‘the cervix’ ,by inserting two fingers inside your vagina. The information they get about your cervix is important to consider the next process of the induction and sometimes it can give a bit of an idea about how long it may take.

There are different ways of starting the induction process, for most women a small pessary called ‘Propess’ is inserted into the vagina. ‘Propess’ contains a drug called ‘prostaglandin’ which causes the cervix to become soft. It can cause some tightenings of your womb and some women may wish to take some pain relief. There is a variation between the experience that women have at this stage, some fell very little whilst others have more painful contractions.

The alternatives to Propess is a gel called ‘Prostin’ which works in a very similar way and contains prostaglandins too. For other women, a different method is used which does not involve any drugs but uses a small soft balloon which stretches the cervix. This is called a ‘Cooks balloon’ and involves the insertion of a soft plastic tube into the cervix and then inflation of a balloon in the cervix and vagina. The balloon and tube are left for about 12-24 hours before being deflated and gently removed. Women having this method of induction may have some discomfort as the tube is inserted but are usually comfortable afterwards. The aim of both methods is to dilate your cervix to an opening of about 2 cm. This allows the induction process to proceed to the next step called ‘Artifical rupture of membranes’.

Waiting for these methods to work is sometimes quite a slow process and can be quite boring, especially if you are having your induction in the hospital. Most women go for a walk and visit the food hall. It is a good idea to bring in some entertainment such as a laptop, DVD player, books and magazines. The hospital has WiFi. Your partner can stay with you whilst you are in the hospital. We have reclining chairs by your bed that they can use to rest overnight if needed. Some women need another dose of the medication the following day which means this first stage of the induction can last up to 3 days.

The midwives will be available at all time to check you are ok and at set times will monitor you and your baby. For the women who are having their induction of labour at home, you will be given contact details to get in touch if your start to contract regularly or if you have any concerns.

For some women, there is no need for any of these methods to start labour as their cervix has already dilated naturally. If their cervix is open by approximately 2cm, they can move to the next part of the induction process called an ‘ARM’ or ‘Artificial Rupture of membranes’. This is when the ‘waters’ or ‘membranes’ around the baby are punctured with a small plastic stick inserted into the cervix. It is essentially like popping a water balloon and thankfully there are no nerve fibres in the membranes so it does not hurt you or your baby. Having the waters broken is usually performed in a room on the labour ward and pain relief options are discussed before it is done. Honestly, the experience is similar to the other vaginal examinations in labour and most women may just chose some gas and air.

After your waters are broken, we will offer to monitor your baby on the heart rate monitor (CTG) and then you will be free to walk around. Women are often encouraged to walk around for a couple of hours following an ARM as this in itself can stimulate contractions. After this time, the doctors and midwives will assess how regular and strong your contractions are occurring. They will then consider whether you need to have a drip called ‘Syntocinon’. This is a synthetic form of your natural hormone oxytocin which causes the womb to contract. It is given through a small plastic tube called a ‘cannula’ which is inserted into a vein in your hand or arm. Women often feel anxious that this drug will cause them a lot of pain, the reality is that it is started at a low dose and gradually built up every half an hour until your contractions are about every 2-3 minutes. It can easily be stopped or reduced. Some women wish to have stronger pain relief such as an epidural before Syntocinon is started, others wish to start and then consider pain relief later on if they need it.

After Syntocinon is started, we will watch the time closely. Most women will have vaginal examinations at 4 hourly intervals until they are found to have a cervix open to 10cm ‘full dilatation’. Whilst receiving Syntocinon, your baby’s heart beat will be continuously monitored on a CTG to check that the baby is not caused any distress by the strong contractions. A midwife will be staying with you in your labour room at all times.

Once you are fully dilated, it is usually about an hour before you are asked to try to push your baby out. This requires a lot of physical energy and therefore it is important that you have had opportunities to rest remain hydrated during your induction and labour so far.

If you have any more questions, please ask your midwife or doctor.

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DISCLAIMER
This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Essential Parent has used all reasonable care in compiling the information from leading experts and institutions but makes no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details click here.