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Obstetrician Dr Maggie Blott answers your questions on the induction of labour.
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Wendy Turner-Webster: All women hope for a straight forward birth as possible and after 9 months, they are uncomfortable and ready to give birth. I remember it so well, but babies can be as much as two weeks late, and may have to be induced. Now with me to talk about induction of labor is Dr. Maggie Blott, Consultant Obstetrician at the Royal Victoria Infirmary in New Castle. Welcome Dr. Blott.
Dr. Maggie Blott: Hello.
Wendy Turner-Webster: Just go through generally what Induction is?
Dr. Maggie Blott: Induction of labor is the process by which we artificially start off labor. It involves the need to give drugs, hospital giving them drugs and getting them into labor.
Wendy Turner-Webster: Now how far over the due date, would somebody have to go before, you said right this baby needs to be induced.
Dr. Maggie Blott: Generally we recognize that beyond 41 weeks or week past the due date, it's best to start inducing labor. Some women prefer to go bit longer than that, but most women are pretty ready to have their baby by the time they are 7-10 days past their due date.
Wendy Turner-Webster: Why wouldn't you say have a cesarean instead, what would make the decision as to one or other?
Dr. Maggie Blott: Well, cesarean should be done for, only for medical reasons and so simply being overdue is not an indication for cesarean. Of course the majority should do go overdue are perfectly normal, it is normal to go 7-10 days past your due date and not to have any complications. So we wouldn't do a cesarean section in that situation. We would start labor off, or recommend that labor would start it off.
Wendy Turner-Webster: Doesn't it make you wonder what they did in the old days, when you couldn't induce a baby?
Dr. Maggie Blott: No indeed you couldn't. In fact you wonder how our women ever managed to have a baby a 100 years ago, without all the hospitals and stuff that we have now, but actually majority of women whatever we do will be fine, which is why we don't rush to induce labor, but we recognize that when women get two weeks past their due date, there are risk involved it continuing with the pregnancy, risks not to the mother of course but risks to baby. Once the placenta starts to mature and age there's an increased risk of things like late stillbirth when babies unexpectedly die in the womb and therefore that reason we now recommend induction labor.
Wendy Turner-Webster: Okay. So, if Induction of labor is necessary, how do you physically go about getting the process started?
Dr. Maggie Blott: Well, there are two ways really. One is to give tablets, little Prostin tablet or hormone tablets which goes into the neck of womb and gets the neck of the womb ready for labor and in majority of cases will actually put woman into labor. If the neck of the womb is already open then we don't need to do that, we can just break the waters and breaking the waters itself can start contractions off. If contractions don't start by themselves, then we need to put a drip into the woman's arm with the drug called syntosin in it. That drug starts contractions, starts the process of labor of.
Wendy Turner-Webster: And would you automatically give pain relief, if you've got to induce a baby?
Dr. Maggie Blott: Yeah but one of the problems with induction is that, the labor starts very quickly, and spontaneously, unnaturally, but women start gradually going to labor. Sometimes, delivering the first baby the process of going into labor, can take 24 hours, with Induction of labor once the waters are broken and the Syntosinal drip has started the contractions start immediately and you don't get that gentle build up. So we offer pain relief as soon as a woman wants it, which can be simple pain relief like an injection or the gas and air that you breathe. Of course a lot of women who have their induced particularly with the first baby will opt for that epidural.
Wendy Turner-Webster: I had an induced labor on both my children. I elected to do so, but I remember the Obstetrician saying that it would barbaric to have an induced labor without some kind of pain relief because it so brought in so instantly.
Dr. Maggie Blott: Yeah it can be quite overwhelming to some women actually particularly if it's a first baby and they have got not experience with labor previously.
Wendy Turner-Webster: Yes, I'm sure, I'm sure. So what are the risks involved in an Induced labor to either mother and on child?
Dr. Maggie Blott: The biggest problem with induction of labor of course is a failure to get somebody into labor. So you start the process, you give them the hormone tablets and you can't break the waters later on because the neck of the womb doesn't open up or you start the drip and despite the contractions that the drip causes the neck of the womb doesn't dilute and you have what's called a failed induction and if that's the case, the only option is to do a cesarean section.
Wendy Turner-Webster: I see. So there's nothing you can do at that stage to get things extorted?
Dr. Maggie Blott: No. Not really, no. I mean some people do stop and restart a day or two later, but in the majority of cases, that's not ideal.
Wendy Turner-Webster: Oh! Really.
Dr. Maggie Blott: So you end up having to do a cesarean section and about 25% of women who are induced will end up with cesarean section for a failed induction.
Wendy Turner-Webster: Yes.
Dr. Maggie Blott: So that's the biggest complication if you like. And I think there's an increase incidences of things like fetal distress, babies who are having a lot of Syntocinon on drip, having a lot of Syntocinon in the drip, can find that quite stressful and so we have to monitor the fetal heart rate continuously in labor and there's quite a high instance of fetal distress. The baby gets distressed, the heart rate pattern changes and you have to do cesarean section.
Wendy Turner-Webster: To get the baby out quickly as possible.
Dr. Maggie Blott: To get the baby out quickly, as the result of the labor been induced really.
Wendy Turner-Webster: In what kind of cases, couldn't a woman have an induced birth?
Dr. Maggie Blott: We don't induce -- or we’re more cautious about inducing labor in a woman who has had a previous cesarean section. One of the reasons, one of the complications of giving birth normally after having the previous cesarean section is what's called, scar dehiscence when the scar on the womb opens during labor, and that's more likely to happen within a women who had a previous cesarean section, so we're cautious about inducing woman who have had previous cesarean sections.
Wendy Turner-Webster: Well, it sounds quite nasty, but is it dangerous?
Dr. Maggie Blott: It's dangerous.
Wendy Turner-Webster: Yes. It's dangerous.
Dr. Maggie Blott: So if you're going to induce a woman who's had a previous cesarean section, we need to look at very carefully why we're doing it, and ensure that we monitor her and to her baby very closely. We're also reluctant to induce women who have got a breech baby, the baby who's coming bottom first again because of the complications associated with that. And we're cautious about inducing women earlier in pregnancy, if we need to deliver them because of high blood pressure or because their baby is small, if they are early in pregnancy sometimes, we’re worried about inducing in that situation and we may opt to cesarean section in a high risk case.
Wendy Turner-Webster: I see! What about if somebody had planned for say, a water birth or something like that, can the two be combined or not really?
Dr. Maggie Blott: Not really. Having a water birth means, you've to be completely normal, really and the problem with induction or one of the side effects of induction if you like is that we have to monitor the baby continuously, because of the increase risk of fetal distress, and for that reason you can't get in the pool. So it does mean that women who are induced can't get in the pool, can't give birth in water, can't really mobilize as much as they might otherwise do have had spontaneous labor, so you're limiting women options when you induce their labor.
Wendy Turner-Webster: I actually with both my babies elected for an induced birth and in my experience was fantastic, because there was absolutely no pain at all, which I always think, well surely that can only be a good thing, and is that quite unusual for people to elect to have a induced labor.
Dr. Maggie Blott: No, I spent a lot of time in my antenatal clinic talking to women who want to be induced, want to have the labor induced.
Wendy Turner-Webster: Yes.
Dr. Maggie Blott: So I think the end of pregnancy is very hard work, back ache, tummy ache, not sleeping properly, worries about the baby. A lot of women worry that their baby is going to have a problem late in pregnancy.
Wendy Turner-Webster: And that you do get, when you are at the end of the nine months. I am so fed up of this. Get it out of me.
Dr. Maggie Blott: And the women have this -- when women first get pregnant, they have given this date and their whole pregnancy is focused on that due date and of course very few women actually give birth on their due date, and there is a range of normality a week or two before the due date, and as we have already said, a week or two after the due date, but it's completely normal. So you get to that due date. For nine months, you've been thinking about that date and then it comes and goes and you still haven't got your baby, and you're tired, and your back aches, and you haven’t been sleeping, and you want to have your baby delivered.
Wendy Turner-Webster: Yes and people will tell you, all kinds of about eat hot curries.
Dr. Maggie Blott: All sorts of natural remedies around for helping women to get their own labor started. And we’ve tried to encourage women to avoid induction of labor, unless it's absolutely necessary, because of the complications, because it increases the length of labor, because it's more painful, because your limit, your mobility and all the other things you might want to do. It's really better not to be induced unless you absolutely have to.
Wendy Turner-Webster: How do you mean limit mobility?
Dr. Maggie Blott: Well, in terms of you can get around the delivery room, you have to be on the bed because your baby needs to be monitored.
Wendy Turner-Webster: Oh! I see.
Dr. Maggie Blott: So you can't – some of the things you might want to do, might have planned to do in your childbirth classes, you can't actually do, because you're going to be induced, so it's generally better to avoid induction unless there is a medical indication for it.
Wendy Turner-Webster: Is there a particular reason why a baby, obviously we said, we would get to the due date, but then would get pass the due date and not come out, what's the medical reason why a baby is simply wouldn't want to come out?
Dr. Maggie Blott: Well, the honest answer, we don't really know, what triggers the process of labor. We don't know what triggers premature labor but we certainly don't know what triggers term pregnancy and we know it's normal. There is a range which is normal. So it's normal to go a week passed your date and not have a problem, but we also recognize that as your pregnancy goes two weeks post the due date, there is an increase risk of things like cesarean section, bigger babies and I suspect that some of the reason, some women go a long way passed their due dates because they're never going to able to deliver their baby normally, because the baby is too big, the head hasn't engaged into the pelvis, there is no pressure on the neck of the womb and labor doesn't start and in that group of women, who have got a big baby with a high head of 42 weeks, their chance of cesarean section and induced labor is very high indeed and that's because of the preexisting problem, baby is too big and that's why they don't go into labor.
Wendy Turner-Webster: Yes, so the longer -- is it right, that the longer the baby would stay in the womb, it is continually growing.
Dr. Maggie Blott: It is. It is. If you give birth at 38 weeks, certainly, where you give birth before the two weeks, that's four weeks difference and baby can grow an awful lot in four weeks, he can put on as much as two pounds in that four week period. So that can make a big difference.
Wendy Turner-Webster: Quite a lot. You said earlier, in antenatal classes, women were asking about induced birth and perhaps having a preference towards them, all people like yourself, all hospitals, I know you said, you are not keen to do, but are they more willing to say, alright then if that's what you really want you can have it or not?
Dr. Maggie Blott: No. I think we're not. Actually, there are guidelines now issued by the Royal College of Obstetricians, for example, is recommend that we do not induce labor before 41 weeks and that's because we’ve recognized the complications. So actually, I think the majority of obstetricians and indeed midwives would encourage women not to be induced, to let things happen naturally.
Your best chance of a normal birth and therefore a fewer complications is to have spontaneous on-set of labor. Now there are situations when we do need to induce labor, 42 -- prolong pregnancy, high blood pressure, baby that's not growing very well, there are situations where actually it’s medically indicated and of course in that situation, we do recommend induction of labor and we recognize that perhaps increase in cesarean section rate is a necessary part of that process, but if you’ve got a healthy normal pregnancy, the healthy baby, you're much better of, letting things happen naturally.
Wendy Turner-Webster: If you have an induced labor for the mother, is there any particular difference in the rate of recovery getting over the birth, then say, they had a natural birth or a cesarean.
Dr. Maggie Blott: Yeah. I mean it depends on the type of birth they have, given that if you have an induced labor, you're more likely to have interventions like an epidural, epidural leads to forceps delivery and cesarean section. You're going to have more complications from that and of course, all those things take longer to recover from and also if you induced labor, the length of labor is often much longer and so women are tired and they maybe in labor for 16-20 hours and they are exhausted and then they give birth, so the recovery time is prolonged. And if you labor is spontaneously, usually your labor is shorter and therefore you recover better from it.
Wendy Turner-Webster: So it always really comes down to the fact that the most natural way is the best, but cesarean or induction, I mean it's another option if really things are going wrong. As you said, well, we said at the start, how people had babies all those years ago, I don't know.
Dr. Maggie Blott: Yeah. Great!
Wendy Turner-Webster: Thank you very much for talking to us.