| Q: |
What is happening to my baby after 40 weeks?
| | A: |
In many pregnancies, there are no changes to your baby's
activities after 40 weeks and their movement patterns will be the same,
although your baby's head will probably move lower into your pelvis as
it gets ready for labor, resulting in a lighter feeling under your ribs
and a heavier feeling down in the pelvic area. In other pregnancies,
mothers may notice a slowing down of movements as the pregnancy
progresses. The placenta, which feeds the baby, operates on a lower
efficiency after about 38 weeks, and certainly after 41–42 weeks. This
means that your baby's growth tends to slow down the further your
pregnancy goes. Since it is not possible to accurately predict whether
or not the placenta will continue to function well, most hospitals have
an induction policy to avoid the risk of distress to the baby, which
increases the longer the pregnancy continues.
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| Q: |
What happens if you go over your due date?
| | A: |
This varies slightly from site to site, however you would
normally be offered an induction of labor between 41 and 42 weeks of
pregnancy, which means that your labor will be started artificially (see
Types of induction).
Different hospitals have their own criteria for how long past your due
date they will wait before suggesting an induction of labor, but this is
usually between 7 and 10 days after your expected date of delivery
(EDD).
If an induction
is considered, your doctor or midwife should discuss all your options
with you before any decision is reached. Although you are within your
rights to decline induction, you should make sure that you are fully
aware of the reasons why it has been suggested so that you can make an
informed decision.
|
| Q: |
I have a long menstrual cycle. I don't think I'm as overdue as they say. Can nature take its course?
| | A: |
The best time to agree on dating is at the initial visit when
memory is fresh and the size of the uterus reflects a better picture of
gestational age. If there is any discrepancy between size and dates, an
ultrasound can be performed early enough to be very accurate at
estimating a due date. When a menstrual history is collected, if a
mother has a consistently long cycle, days can be added to the EDD
(estimated date of delivery). Ultrasound usually confirms this if done
by early in the second trimester. You can always decline an induction of
labor however, antepartal testing of fetal well-being will always be
initiated if there is any chance you are 41 weeks or greater.
|
| Q: |
What is a “membrane sweep” and could I have this instead of being induced?
| | A: |
Prior to an induction of labor, at 41-plus weeks of pregnancy,
your midwife or doctor may offer to “sweep” or “strip” the membranes. A
membrane sweep involves your midwife or doctor placing a finger just
inside your cervix and making a circular, sweeping movement to separate
the membranes from the cervix. The aim of this is to stimulate the
release of hormones that may start labor contractions. Although this is
likely to be an uncomfortable procedure, it should not cause you actual
pain; you may also experience a mucus/bloodstained “show”—like a discharge—following this, which is quite normal
.
Membrane sweeps have
been shown to increase the chance of labor starting naturally within the
next 48 hours and therefore reduce the need for other methods of
induction.
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| Q: |
I don't like the sound of the amniotic hook. What exactly is this?
| | A: |
An amniotic hook is a long, thin piece of plastic with a hook
shape at one end. This is used to make a hole in the membranes
surrounding your baby to release the amniotic fluid in an attempt to
kickstart labor. The procedure, known as “breaking the water,”
amniotomy, or AROM (artificial rupture of the membranes), is as
uncomfortable as an internal examination, and isn't usually painful. An
amniotomy is carried out by the midwife or doctor, who will carefully
guide the hooked end of the instrument into the vaginal canal with his
or her fingers. He or she will then press the end of the instrument
against the membranes to pierce them, which can help to stimulate
contractions and in turn start labor or make the contractions stronger.
In some cases,
contractions become established quite quickly after this procedure is
carried out. However, if this is not the case, then you will need to
remain in the hospital and be induced with an oxytocin IV.
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| Q: |
Can an amniotic hook harm my baby?
| | A: |
An amniotic hook, which is somewhat like a long crochet hook used
to tear a little hole in the amniotic membrane surrounding the baby and
the amniotic fluid, is actually fairly blunt and shouldn't come into
contact with your baby at all, so there isn't really any risk that he
could be harmed.
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| Q: |
Why do I need to be induced?
| | A: |
The main reason for induction of labor is when your pregnancy
continues past your EDD, or estimated delivery date, as after this stage
the efficiency of your placenta can decline, which can put the baby at
risk.
|
| Q: |
Can I refuse an induction of labor?
| | A: |
You have a right to say no to any intervention and when induction
is considered, your doctor or midwife should discuss all your options
before any decision is reached. However, if you want to delay induction
beyond 42 weeks, then it may be suggested that you attend the maternity
unit for regular monitoring to check on your baby's and your own health,
which may include a Doppler ultrasound to check the blood flow in the
placenta. You will also be offered an ultrasound scan to check on the
amount of water surrounding your baby, since this can be a good
indicator of how efficiently the placenta is working and the overall
well-being of your baby.
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| Q: |
I 'm scared about sudden hard contractions after induction. Will it be more painful?
| | A: |
Some women do report that an induced labor is more painful than a
spontaneous labor. This may be because induced labors can be longer,
although this is not always the case. In a spontaneous labor, the body
responds to the gradual onset of contractions with the release of
natural painkillers called endorphins. In the case of induction, where
the onset may be more sudden, the body has less of a chance to do this.
However, some women do still get a gradual build up of contractions
after induction.
It is quite natural
to be scared of pain, but you may find it a help to be prepared mentally
and physically by planning which pain relief options you are going to
consider and ensuring that your birthing partner knows your plans so
that he or she can give you plenty of support. Many women opt for
“low-tech” forms of pain relief, such as TENS,
massage, being active and changing position, and aromatherapy, in early
labor, and these are all options with an induced labor. If you find
these are not enough, you can try medication, such as narcotics, and
even consider an epidural. If you know in advance how you may want to
cope, then you will be better able to deal with the pain.
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| Q: |
Will I need to be monitored continuously throughout labor if I'm induced?
| | A: |
If an oxytocin (hormone) IV is used to stimulate the contractions
then, yes, continuous monitoring of your baby's heart rate is
recommended. This is so the midwife and doctor can ensure that the
contractions are not too close together and that your baby is coping
with the contractions and not becoming distressed. As long as oxytocin
is running you will need external ultrasound scans. Many units now have
“wireless” monitors, which means that you are not physically attached to
the machine and can still move around during labor.
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| Q: |
Can my partner be present throughout?
| | A: |
Yes, your partner can be with you throughout your induction and
labor, and his continued support is likely to have a positive impact on
your well-being and help your ability to cope with the pain and stress
of labor. Ensure that your partner is aware of your birth plan
too
so he can support you in any decisions you need to make. A lot of
units allow more than one birthing partner, which can be a good idea if
things are going to be long and drawn out.
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| Q: |
What will happen if I don't go into labor after I've been induced?
| | A: |
Very rarely, women will experience an unsuccessful induction,
especially if their cervix is unfavorable, meaning that it has failed to
soften and dilate. This may ultimately result in a cesarean section
being performed. As always, discuss the options with your midwife or
doctor so that you are fully informed about the procedures being
offered.
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