All those months of fretting with nervous anticipation are nearly over, but there is nothing more frustrating than going overdue. We all imagine that we'll get to our due dates and hey presto - our babies will arrive. But especially for first time mothers, going overdue is completely normal
Most women will have an antenatal appointment close to their due date so that the midwife can assess them. For some women, their bumps will have dropped, indicating that their babies are coming soon, they may have even had 'a show'.
For some women, absolutely nothing will have happened to indicate that labour is close and this can feel very frustrating when you can't wait to meet you baby. Babies go overdue all the time especially for first time mums. Current research shows that first time mothers gave birth on average five days after their due dates and second time mothers gave birth on average two days after their due dates. The reason that inductions happen is that there is an increase in problems for babies that go beyond 42 weeks. This is because there is a very small percentage of babies who die or who are stillborn when the pregnancy exceeds 42 weeks. Doctors don’t know why this happens but feel that it is safer for the mother and the baby to induce labour before 42 weeks. In most pregnancies labour will start somewhere between 37 and 42 weeks and if you go over your due date you will be monitored very closely and will probably need to have weekly antenatal check-ups.
When and why might I need an induction?
An induction is usually recommended when it is felt your baby is better off outside of the womb than in. This may occur if your pregnancy is over 41 weeks, your waters break but labour does not start (your baby is at risk of infection once the waters break), or if you are suffering from a pregnancy related problem such as Pre-Eclampsia where the only cure for mum and baby is immediate delivery. Other reasons include poor growth of your baby or unexplained bleeding at term.
What happens in an induction?
When labour starts naturally your body makes a hormone called oxytocin which is released into the bloodstream and hormonal changes in the body start the process of labour. Nobody knows what the trigger is that starts labour spontaneously (or doesn’t start in some women) although lots of research has been dedicated to the subject. Inductions are when labour has to be started artificially and a synthetic form of oxytocin is administered to bring on labour.
Once it has been established that you need an induction, you will probably be offered a membrane sweep. A membrane sweep sounds worse than it actually is and involves a midwife inserting two fingers through the cervix and sweeping them around the inside. This releases prostaglandins from the cervix and can help to start contractions. Some women report that it is a little uncomfortable but no more so than a smear test. It is perfectly safe and can be an effective way to start contractions.
Your body naturally produces prostaglandin, which stimulates the uterus into contracting, but some women may need prosthetic prostaglandin to help get labour started. Synthetic prostaglandin can be administered by inserting a pessary or gel into the vagina, which softens the cervix. You may need more than one dose of prostaglandin to start contractions at somewhere like six hours later. Lots of prostaglandin doses are given at night so that you can have the second dose when you wake up (and you’ll have had a good night’s sleep before labour starts). The gel or pessary will have to be administered on the antenatal ward because you and your baby will need to be closely monitored.
Artificial rupture of membranes
Often known as AROM. One way of speeding up contractions is to artificially break the bag of membranes which surround your baby and this is known as your waters breaking. Once the bag bursts, the amniotic fluid leaks out and the amount of prostaglandin increases, which speeds labour up. It is done using a long plastic instrument with a hook at one end, during a vaginal examination. It should not be painful, just a little uncomfortable.
Syntocinon is a synthetic form of the hormone oxytocin, which makes the uterus contract and can be used once the cervix has softened. It is usually administered using an IV (intravenous line) so you won’t be able to move around as much. You may have to be attached to a foetal monitor, as Syntocinon can over-stimulate the uterus and result in your baby becoming distressed. You and your baby will need close monitoring. You are always given a small dose to start with and the dose will then be increased depending on your contractions and how effective they are. Because you are effectively forcing labour to start, contractions can come very quickly and can be much stronger. You probably won’t have had time to get used to contractions building up over time and this can make contractions feel more painful. Some women will decide to have an epidural with a Syntocinon drip as it can help with the pain.
Sometimes none of these methods will work and an emergency caesarean is required. Read our article about what happens in a caesarean so you are prepared if this has to happen.
Also read our feature on natural ways to start labour for some handy hints on trying to jump-start labour.
When shouldn't I have an induction?
If you are considering having a VBAC there is extensive evidence to suggest that induction can cause additional risks to the mother because of the effect they have on the scar tissue which can lead to uterine rupture. Routine inductions, especially with the use of prostaglandin gels should be avoided in mother's attempting a VBAC and other options will be dicussed with you if you want a VBAC but reach your due date and labour has not started.