Ladies, doctors do not prescribe induction to cause you undue pain

Every time I mention that a pregnant woman might require induction, I am met with a lot of resistance. Such was the case with Nasra* who was carrying her third baby. She had two little girls aged four and seven, and the whole family was excited that a boy would join the troop this time round.

Nasra was friendly, inquisitive and eager to learn. Despite coming from a cultural background that was not too keen on educating women, she held a master’s degree in finance and administration and ran a successful company with her husband. She was a modern elite mum.

MISINFORMED

After a check-up and assurances that all was well at 40 weeks of gestation, I broached the topic of possible induction of labour. She would hear none of it, even after I took my time to dispel the myths about induction of labour. She was adamant about waiting for labour to begin naturally.

At the next appointment, a week later, we needed to fix a date for induction. After an hour of explaining why it was necessary to induce labour, Nasra agreed to come to the hospital after three days for induction.
By 7pm on the material day, there had been no sign of Nasra, so I made a mental note to talk to her the next morning. Then I got a phone call at 2am. Nasra was in the ward in labour and had a bout of bad diarrhoea. She begged the midwives to do something to stop it. We made her comfortable, started her on intravenous fluids and continued to monitor the labour. The diarrhoea subsided and five hours later, Nasra held her son in her arms amidst tears of joy and relief.
Nasra had disregarded my advice and turned to old wives’ tales to avoid induction. She walked a lot, had sex, rubbed her nipples … and when all these failed, she resorted to good old castor oil. The oil led to intractable diarrhoea and eventual labour. Now that the worst was over, Nasra made fun of it and chided herself for opting for the longer, uncomfortable route to achieving the same results.
Nasra’s biggest fear was pain. She had been told that induction of labour was much more painful than natural onset labour. This misconception rings true for many women in Kenya.
The trigger for natural onset of labour is still poorly understood, but the role of prostaglandins in ripening the cervix and triggering labour is clear. This has allowed us to have safe, effective and affordable methods for inducing labour. Before the advent of prostaglandins, mechanical methods were used to open the cervix. For example, catheters were placed in the cervix and inflated to stretch it open and trigger labour in the process.

Sometimes labour sets in naturally, or through induction, but the contractions are not strong enough to ensure labour progresses at the desired pace. This calls for augmentation with the dreaded “drip”, as the oxytocin infusion is commonly referred to by mothers.
Augmentation is used to avoid prolonged labour that is both detrimental to the mother and the unborn baby. As the contractions gain strength and increase in frequency, the pains become more intense, hence the belief that the “drip” is painful. It is important to destigmatise the process of induction, because the goal is a healthy baby and mother, rather than to cause unnecessary pain!

WHAT YOU NEED TO KNOW ABOUT INDUCED LABOUR

Do I really need to be induced?
The most common reason for induction of labour is post-datism i.e. when you go beyond the expected date of delivery. A grace period of a week to maximum two weeks will be allowed depending on the doctor and the hospital protocols. Other reasons for induction include compromised well-being of the baby or mother and breaking of waters (rupture of membranes) before onset of labour in a term pregnancy.

How it is done?

Once the mother is admitted for induction and all the necessary reviews have been done to assure us of the safety of the baby and the mother and their capacity to handle labour, prostaglandin, in form of a vaginal pessary, is inserted high up the vagina and the mother is allowed to rest and await labour pains. Depending on the type of pessary used, repeat insertions may be done every twelve hours for the long-acting one, or every six hours for the short-acting ones. The general rule is that within 24 hours, labour should have commenced.

When is augmentation needed?

Once labour commences, it will proceed just like natural onset labour. The strength of contractions will determine whether augmentation is needed or not.
What if induction fails?

It is critical to note that just because labour was induced does not guarantee a vaginal birth. Complications may arise that may necessitate a Caesarian section.

The induction process itself may also fail, leaving us with the option of a Caesarian section.