Waiting patiently for grandchild no 8.....

The art of patience I think is disappearing, we are always in a rush for things to happen or to be done, we want everything yesterday...sadly this is a reflection of the times.

Pregnancy traditionally is anywhere from 37 - 42 weeks, which is nine months and one week. More than 90% of babies do not arrive by the predicted date. So it is not unusual for a mother not to go into spontaneous labour just because its her due date. Technically you are not overdue until 42 weeks, but alas you see women are being offered inductions of labour (IOL) from 37 weeks.

Some mums battle with health professionals consistently about this issue..why is it that once you get to about 38/39 weeks you are offered and IOL, it seems like we are trying to change the boundaries of normal gestation times: Fair enough if there is a medical reason for an induction: as in the fetus (baby) is at risk or the mother, but not because you look uncomfortable or because we can.... IOL can lead to a cascade of intervention and we all know where that ends up. We need to let nature take its course, it stands to reason if you have reached 40-42 weeks and you have not gone into labour your body is clearly not ready....and you have to wonder have we got the dates right? This can already be disheartening for the mother who is eagerly awaiting her new arrival and can sometimes be annoying after so much of anticipation and excitement and pressure from family and friends.

Sadly it is not just health professionals that put pressure on mums, it is society that is friends, family, acquaintances, all saying when is this baby coming.... why don't you just get induced and have it over and done with....it seems everyone is in a hurry....sometimes too this is born out of fear, fear that something may go wrong and we as midwives need to be constantly reassuring about the normal processes of birth.

Then off course comes the advice about how to be induced naturally...and believe me everyone has a story about this one.... (some women have tried it all and none of it worked, like wise some women have tried one or two and it has worked....you never know your luck until you try)
Some of the traditional ways are:
Walking, housework, spicy food (curry) raspberry leaf tea, nipple stimulation and if you are really game clitoral stimulation; intercourse (love making) which releases the hormone Oxytocin which is called the love hormone... this then gets the contractions started; essential oils such as lavender and clary sage; membrane sweep; acupressure and most importantly be calm and think positively..... but like anything it is practice that makes perfect.... doing it just once or twice is not going to make it happen... it is something that you are going to consistently do over a few days or so...ensuring that everyone is safe and you can feel the fetus moving...

Formal Induction of labour: starts with prostin gel or Foley Catheter; artificial rupture of membranes, Syntocinon drip.....epidural? however this needs to be a blog all on its own....

We are waiting for contractions to begin....passing of a mucous plug, waters breaking.... all signs of the beginning.....the deadline is looming...

Clinical question for you?

A client presents: 37+3: G2 P1: Group strep B positive for IV antibiotics in labour..... history of Spontaneous rupture of membranes (SROM)at 0200hrs.... presented to hospital at 12noon, fetal movements felt and clear liquor noted...team decision for IOL...dept busy so client to walk around until staff available to commence IOL, the woman may go into labour on her own...still no contractions... now 1300 hrs staff available.. CTG for 20mins reactive no contractions, clear liquor noted..... IV syntoncion commenced as per regime.....Would you do a baseline vaginal examination at this point or would you wait until the woman commenced contracting? is there a need to do this vaginal examination at this point? What do you think?

Allowing women to make their own decisions......

Here is the follow up to the Empowering women - not as easy as you think scenario

....the woman is GBS positive with query ruptured membranes....she has commenced IV antibiotics, the advice given to her by the doctor is to be induced immediately 1700hrs....as the doctor feels she will not go into labour on her own...she is currently contracting 1:10 mildly. After being given all her options by the midwife....

The woman chooses not to be induced until the morning and goes against the medical advice given (this is all clearly documented).... she does choose to stay in hospital and wait until the morning.... her hope is to go into normal labour.... the outcome of this scenario is that the woman continued to walk around, eat, drink and no monitoring, until in established labour.... she progressed into normal labour and birthed at 0739hrs that morning....an assisted birth....

This was a good outcome by a woman who knew what she wanted and was willing to standby that decision despite the advice given by the doctor....she determined the risks and made her mind up with the information given... together with what she had anticipated for her birth (her birth plan was a natural normal birth) and an induction of labour was not in that plan (as it meant, restrictive movement, monitoring) however she made the best compromise she knew how..... to achieve what she wanted..... well done... congratulations......

CTG - Case study what would you do?

A gravida 2 para 1, 22 years old, uneventful pregnancy however in the last week developed high blood pressure: today not feeling well, visual disturbances and 1+protein in her urine, PE bloods taken, waiting results:
For Induction of Labour (IOL)@ 40 weeks.
Last baby spontaneous vaginal birth after an 8 hour labour, perineum intact.

admitted to ward at 1400hrs pre prostin CTG, normal reactive trace.

CTG recommenced post prostin 2mg @ 1600 hours..... describe the CTG and what action would you take...... what are your options and the womans options?