I'm overdue - what happens now?
If we could all choose our ideal
birth it would probably go like this: waters breaking on due date at 9am (and
not all over the bed, yay); labor pains for two hours; comfortable pain-free
journey to the hospital; partner calm and helpful; contractions bearable; 20
minutes of pushing; baby born with no problems whatsoever and no forceps, vacuum extraction cup, drugs or episiotomy anywhere in sight.
In reality, however, birth is
often very different – and it can all start with that due date. Fact is, your
baby is the one person who doesn’t know that date – and babies are late all the
time, especially for first time moms. Research suggests that most first-time
moms have their babies five days after their due dates, with second-timers
waiting an extra two days for the new arrival. For some moms-to-be, though, it
takes a little medical help in the form of induction to get things moving.
When and why might I need an induction?
Two weeks after your due date is
when you’ll officially be regarded as overdue – and when your OB-GYN might want
to discuss induction (where labor is started artificially) to get those
contractions started. This is because the 42-week mark is when your placenta
starts to deteriorate and may not provide your baby with enough oxygen (a very
small percentage of babies die or are stillborn when pregnancy exceeds 42 weeks). It’s also possible he could grow too large for you to
deliver vaginally.
Induction may also be
recommended before you reach full-term if your waters break but you don’t go
into labor (your baby is at risk of infection once your waters break), or if
you’re suffering from a pregnancy-related problem such as pre-eclampsia, where the safest course of action for both you and your
baby is to deliver him as soon as possible. Other reasons include poor growth
of your baby in late pregnancy or unexplained bleeding at term.
What happens in an induction?
Labor starts naturally when your
body produces a hormones that jumpstart your contractions. Induction is the
process of getting those contractions started artificially, and your OB-GYN has
several methods she may try:
Membrane sweep This involves your OB-GYN gently inserting two
gloved fingers in between your cervix (the neck of the uterus) and the
membranes (the amniotic sac that holds your baby) and sweeping them around to
detach the membranes from your cervix. Some women report it’s a tad
uncomfortable but don’t panic: it sounds worse than it feels, and it’s safe.
This method releases prostaglandins (labor hormones) from the cervix and can
help to start contractions but it can take a few days to work and may only be
effective if you’re pretty close to going into labor all by yourself anyway.
Prostaglandins If
a membrane sweep doesn’t work, or your OB-GYN reckons your cervix hasn’t yet
started to soften, she may admit you to hospital and try to start your labor by
inserting synthetic prostaglandin gel into your cervix. She’ll likely give it
at night so you can get some rest before contractions start, or a second dose
is given if needed. It can start the softening process and stimulate
contractions but it doesn’t work all the time.
Rupturing the membranes If your OB-GYN finds that your cervix is a
few centimeters dilated she may try rupturing the membrane sac that surrounds
your baby, using a small plastic instrument with a little hook at the end. It
shouldn’t cause much discomfort and if your cervix is soft enough the procedure
may start your labor. But if contractions don’t begin naturally you’ll need a
hormone drip to stimulate them, as your baby will need to be born within the
next 12-24 hours to prevent infections from reaching him.
Pitocin This is a
synthetic version of the natural labor hormone
oxytocin, which stimulates
contractions and makes the uterus contract. You’ll get it via IV if all else
fails.
Your induced labor
If you need to be induced you
and your baby will need close monitoring throughout your labor, since induction
can result in powerful contractions early on without the gradual build-up you
get if your labor starts naturally. Being attached to a fetal monitor will
restrict your movement, potentially making it difficult to cope without pain
relief, and many women opt for an epidural.
What if induction fails?
Sometimes none of these methods
of inducing labor works and an emergency cesarean is required. Read our article
about what happens in a cesarean so you’re prepared for this eventuality. Also read our
feature on natural ways to start labor for some handy hints on jumpstarting labor without your
OB-GYN’s help.
The information in this feature is intended for
educational purposes only. If you have any concerns about your health, the
health of your child or the health of someone you know, please consult with a
doctor or other healthcare professional.
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Last Modified: 18/06/2008
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