Medical Inducement?

[Leewoss]

Hi Ladies,
It seems my blood pressure is continuing to creep up and with the baby measuring larger and the possibility of pre-ecclampsia rising, I want to be prepared. DH and I are trying all sorts of natural induction methods but no results so far. If I do get pre-e and have to be induced, what is the best way? Is it the gel or the picotin or something else? I know I am a wimp but I am hoping to find the least risky, invasive, and painful way I can. Any advice or experience with medical inducement would be greatly appreciated. I feel like this is one area where there doesn't seem to be much info out there...

[ExuberantDaffodil]

I was induced with pitocin, followed by my water being broken. Personally, it made having a pain-med-free birth difficult (but not impossible!). I think that if I had to be induced again, I would go first with having the membranes stripped. If you are at all dilated and effaced, the gel won't be necessary. If you do have to go the pitocin route, I would suggest that you insist on being given the smallest dose possible, and have it increased only if you aren't responding to it, and as soon as you are in labor, having it reduced or turned off alltogether.

[baby.fatty]

My childbirth educator (Penny Simkin, who is kind of a celebrity doula and super awesome) suggested asking our caregivers about using a Foley catheter to mechanically induce labor rather than using cervix ripeners / pitocin to chemically induce labor. The Foley catheter is basically these two balloons which they place on either side of your cervix and then inflate.

And that is all the information I have! Sorry I can't be more specific, but maybe another mama knows more about it.

[jess5377]

baby.fatty,

I'm thinking we were totally in the same birthing class if you were in her last home birth/birth center course.

"It's a small world...."

Sorry to hijack the thread.

[mamatolevi]

find out your bishop's score. It's indicative of how ready you are to labor and that can help make a decision on how to proceed. the higher your number the more likely the induction will result in a vaginal birth. (That does not mean however that a low number will result in a c/s.)

Based on my two induction experiences (one for the reasons you're listing and the second for pushing 42w) I recommend the following:

I'd say hold off as long as possible on letting them do AROM. If you're not quite ready to labor, but need to be induced, the baby needs the room to maneuver to get into a good position and you need the cushion the fluid provides. Also, if baby is still riding high, you run the (small) risk of cord prolapse. Also, you're likely to be checked fairly often during your induction unless you refuse; frequent checks raise the risk of infection esp. if your water is broken. (My first indcution had AROM at 1cm; baby dropped quickly into apoor position and got stuck. Second, broken at 8cm and born vaginally 20 mins later.)

the other disadvantage to having your water broken is that it puts you on the clock - either 12 or 24 hrs depending on the hosp/dr.

I'd also say to start with gel if I was too far dilated to use the foley cath. (gel was useless in my first indcution, but wasn't in long enough; never tried foley but hear good things about it) Then go low dose/slow increase pit. (first induction dr cranked pit despite promising to do low dose; second was low dose/slow incr as it was a vba2c labor. worked like a charm,but I wen tin with a high bishop's score) Once labor's established, see if they'll turn off the pit. DO NOT ALLOW THEM TO CRANK THE PIT; it can lead to distress. Make them tell you every time they come to adjust the dose and question them. Is labor established? are you contracting o.k.? Is baby o.k. on the monitor? Have them show you the strip. If all is o.k. then why increase?

Low dose/slow increase pit has been shown to reduce the likelihood of c/s. I forget where I saw the studys (I think ICAN?) but maybe one of the folks here with some google-fu can find it. Also, lower dose/slow increase, IME, gives the body time to build up endorphins. (I never got an epidural for my second induction; had it by 3cm for my first. ...and the dr wondered why the baby got stuck. )

In the meantime, soaking in warm baths with epsom salts will help the swelling as will massage. rest rest rest.

Hugs and good luck!

[GoBecGo]

The magic of foley's cath is that if it doesn't work they can take it out and try again the next day. This isn't an option with any other induction methods apart from the gels, but i know a few women who were sent home after a failed foleys cath attempt - they will NEVER send you home after gels until the baby is born. Once you begin chemical induction you're there until the baby comes out.

I had high BP at the end, i insisted they check my liver function time and again and in fact i never was diagnosed with PE, i just had highish BP exacerbated by whitecoat from all the talk of PE all about me. If i'd been forced to have an induction i'd have asked for:

membrane sweeps daily if at all possible from whenever they began to insist induction needed to happen soon,

foley's catheter induction before i began any induction medication

pitocin only if labour stalled out after the foley balloon fell out (usually happens about 4cm)

AROM only once labour is well established and babe is well-down in the pelvis.

Hopefully of course, it won't come to any of this.

[Leewoss]

Ladies,
Thank you so much for all your wonderful advice! I am seeing the OB in an hour and this info helps me more than you can know

[shakenbake]

i can tell you in my experance that my pit labor was HORRID i did make it at 15 with no epi and no pain meds but OMG it was bad id say do everything you can b4 pit as it makes contractions very much harder longer and faster =-(