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Medical Induction of labour

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Medical Induction of labour

Posted on 08 August 2014 by Kristrun

How is induction done?

Labour induction can be performed medically (artificially and drug induced) and non-medically. We will discuss how it can be performed medically first and try to set out some of the disadvantages and advantages of each method. And most importantly, remember if you want to tidy up your stomach after giving birth, contact Cusick Plastic Surgery. They will make you tummy tuck surgery and your tummy will be beautiful again.

Prostaglandin gels or tablets

These are used more frequently when the cervix is not favorable, meaning that it is dilated less than 3 cm, hard, posterior, not effaced, or barely effaced, or any combination of the above. By using the Bishop’s score your midwife or obstetrician will decide if this is the best place to start. This can be used alone, or more frequently will be done 12 or more hours prior to the use of oxytocin. Frequently it will be given more than once over the course of an evening/night. A pessary or tampon like substance will be placed in or near your cervix during a vaginal examination.

Benefits: The more favorable your cervix, the less likely the induction is to “fail”. Sometimes this is all that is needed, other times oxytocin is also used. Can be done as an outpatient procedure.

Disadvantages: Takes longer to get into active labour, can be frustrating if your hospital policy is that you have to stay at the hospital during the waiting period. Sometimes the mother becomes nauseated or has headaches. This cannot be quite as controlled as oxytocin.

Breaking the bag of water (amniotic sac)

Using an instrument which looks rather like a crochet hook, your doctor or midwife will make a tiny tear in the bag of water. This will cause the water to begin leaking out. Since the bag does not have nerves, this should be no more painful than your average vaginal examination. The thought is that once the bag is ruptured, contractions will usually begin. In addition, the downward pressure of the presenting part e.g. the baby’s head, encourages the contractions to start.

Benefits: No drugs may be needed, you maintain more mobility than if you were required to have an intravenous drip or infusion.

Disadvantages: Contractions may not start, which means you may need other interventions such as the use of the hormone oxytocin (Syntocinon®). It may create an infection of the sac. The cushion for the baby is now removed. Rarely, but possibly, the prolapse of the cord (when the umbilical cord falls below the baby and is delivered before the baby, affecting blood supply to the baby), which means an immediate caesarean section is necessary.

Syntocinon®

This is an artificial version of the body’s hormone oxytocin. It is given by way of an IV infusion (via a drip or a pump) and is used to cause contractions. The amount of oxytocin used will depend on how your body accepts it. Generally, the amount is increased every 15-30 minutes until a good contraction pattern is achieved. Sometimes this is done in combination with breaking the water bag.

Benefits: A bit easier to control than say breaking the water, because the drug can be stopped by closing off the IV line. It can be turned off or stopped to allow you to rest or even go home.

Disadvantages: Can cause distress to the baby such as an increase or decrease in its heart rate. May not cause contractions. May cause too many contractions or contractions that last too long.

Where will I be induced?

It is usual for most medically assisted inductions to be performed in hospital. This allows both you and your baby to be easily monitored. Your midwife will need to monitor your baby’s heart constantly if you have an oxytocin (Syntocinon®) drip or infusion, or any prostaglandin drugs are given, but intermittent monitoring should be fine if your waters have broken. Stethoscopes buying guide is the thing you may need prior to the procedure.

Remember you don’t always have to be lying down to be monitored. Ask to be monitored while you are sitting in a chair, or even kneeling on the floor.

Will an induction be more painful than natural labour?

Not necessarily. It really depends more on your reasons for induction, the type of induction and whether or not your mobility is limited. Many women are able to be induced and still follow through with their plans for an unmedicated birth, though they can expect certain changes in their birth plans. If induction is suggested, gather facts and information, and ask questions. Why is it being suggested? How would it be attempted? What happens if it doesn’t work? What happens if you do nothing?

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Natural births in Hong Kong

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Natural births in Hong Kong

Posted on 20 March 2012 by hulda

Every pregnant woman wants a healthy baby and a good birth experience and many women also say they want a ‘natural’ birth.  The term ‘natural’ can mean anything from a vaginal birth to an undisturbed home birth and for women in Hong Kong – depending on various factors such as budget and where you live – there are several different options available:

Natural birth

If we are to assume a natural birth means a birth where there is no intervention, most midwives will agree that preparing well for the birth is important. Also, the location and those selected to be present will strongly influence the outcome. Choosing a doctor and midwives that have good statistics for normal birth (for example, a C-section rate below 25 percent), and also a hospital that not only has staff but also facilities to support a natural birth is obviously important too.

Other factors that will contribute to a the likelihood of a natural birth are, for example, whether you can stay at home during the early stages of labour, being mobile and active at this time, eating and drinking regularly and choosing a position that feels good when you are actually giving birth.

Many women are quite vulnerable when they are in labour and as a result they fall into a role of a patient rather than following their own instincts – which in returns makes all of the above hard for them.  Furthermore, even though it has been long proven by research, some hospitals and doctors have a policy that all women must be in hospital right from the earliest signs of labour, lie in bed during the whole labour and birth, have continuous monitoring of the baby’s heartbeat, give birth in a hospital bed (and sometimes in stirrups) and have a routine episiotomy.

Many women don’t even dare to question this as they may have been told that this is the safest way to give birth. One only needs to look for evidence-based guidelines about maternity care, such as the NICE guidelines that are used in the NHS in the UK, to see that this practice is no longer recommended for women who are not classified as high-risk patients.  So if you are truly seeking a natural birth, it is useful to look at the birth places available in Hong Kong and what they have to offer.

Where to give birth in Hong Kong

In Hong Kong, people have the option of private or public health care.  The public hospitals here offer excellent maternity care and are both professional and have good statistics when it comes to natural birth and interventions.

Their main disadvantage is probably the fact that they are busy and the staff cannot provide continuous care which means that it is not as personal as some would like. Also, there are quite a few “rules” and protocols that are followed more strictly than in private hospitals.

One of the main advantages of public hospitals is that they are very well equipped with staff and tools for serious conditions, and for babies that are premature or ill — although luckily most babies are born healthy and well.

Also, in the recent years the public hospitals have started to offer more support for natural birth, providing birth balls, yoga mats, and the option for hypnobirthing methods and being mobile. The routine use of episiotomy has now finally been discontinued, which is great news to all childbearing women.

Private hospitals tend to be good here too. Care is usually given by a doctor you have chosen yourself and consulted with throughout pregnancy.  This means that you know who will deliver the baby, although the doctor is only there at the final part. Those who are considering private care will need to look at the budget, since private health care here is expensive and insurance does not always cover the cost.

In addition, although often very good, being at a private hospital does not necessarily mean you have more chance of a natural. In fact, the statistics for most private hospitals show us that C-section rates, epidural use, induction, and forceps and vacuum deliveries are much more common there, with C-section between 50 to 85 percent.

Either way, in my experience, both models are good for different reasons; in a private hospital the most important part is to choose a doctor who will truly support you, and regardless of where you give birth, you should prepare yourself since no one else will do the actual work for you AND – not less important, that you prepare yourself really well.

Home births

In some countries, home births are becoming increasingly popular and have been proven to be a safe option for healthy mothers in low-risk pregnancies. Those that fall into this category can expect to have an undisturbed birth in a private and quiet environment; and they should not expect to be induced, use medication or have any other intervention, since should these be needed, they would be transferred to hospitals.

Women who want a truly natural birth often opt for this and prepare accordingly. Outcomes are generally good, with only 5 – 10 percent of cases requiring a hospital transfer because of medical complications.

Many believe that home births are illegal in Hong Kong. This is not the case, although they are not supported here, nor is it easy to find staff that is willing or trained to assist.  As a result, home births are probably not as safe an option in Hong Kong as they would be in many other countries. This does not mean that it is impossible and with the help of skilled midwives and the correct preparation, a homebirth can be an option for those women who are low risk.

Doula care

To have appropriate support while in labour is so important and that person can be a husband, family member, friend, midwife, or doctor – but whoever it is, good support is invaluable.  And by good support I mean support that is on your terms. This is why it is important for those that are with you during labour and birth know you and understand what you want.

Doulas have existed for centuries and their role is to be exactly this; to provide support on your terms. They provide everything from psychological support, to physically massaging and coaching you through the birthing journey. Doulas help women to stay at home as long as they feel comfortable and then continue to help them while in hospital.

I have been a registered midwife here in Hong Kong for many years now but since midwives do not have admission rights in private hospitals and have to speak Cantonese to work in the public wards, I have not been able to provide a one-stop pregnancy and birth care service.  I have however, found myself in the role of a Doula, or birth support many times. The experience of doing this has been invaluable and given me insight into all the different birthing options that Hong Kong has – including all those that I have explained above.  It has also frequently reminded me of the fact that we professionals so often forget; that each family is unique and each birth is too. It is not just an event that results in a safe birth, but a family event that has an everlasting imprint on everyone involved and it should be treated with such respect.

More doulas are now available in Hong Kong which is a fantastic thing.  Donna Watts, our excellent early childhood nurse has just done her doula training and within Annerley. Donna, Eugenie, Rovena (and Tamara on South Lantau) and myself can offer women continuous support through labour at home, and sometimes even in the hospital. We also work with other very good doulas to provide excellent care.

Prepare well

To all pregnant women I would suggest:

  • Before the birth, ask the doctor/midwives about their statistics and how they routinely work.
  • Ask how much they will be there during the labour.
  • Tell them in advance what your thoughts are.
  • If you do a birth plan, make sure that it is short and only contains the things that are very important to you, but not the details of medical care.
  • Be firm, but polite.

If medical intervention is offered ask:  Why?  Can we wait?  Is the baby in danger?  Are there any other options? Remember that the staff takes usually extremely good care of safety but they pay less attention to comfort – this is something you must do.

Hulda Thorey, 2012

 

Points to remember regarding hospitals:

Public hospitals: 

Possible challenges:

  • You can only have your husband / one support person with you when you are in established labour, i.e. after around 3 cm of dilation.
  • Sometimes mobility is a bit restricted.
  • Drinking and eating is no encouraged, but you can do it anyway.
  • You cannot take showers or baths during the labour, there is no access to toilet or bath.
  • Episiotomy is very common in some hospitals, but you can usually say no to this.
  • There is less privacy and sometimes staff will come and go.
  • When your baby arrives, it is usually taken away for a check-up. Again, you can suggest otherwise.
  • Breastfeeding is supported but sometimes the staff do not have much time to assist.

On the positive side:

  • The staff are very professional and practical, and being teaching hospitals, the staff follow protocols; things are not done for personal convenience or financial gain.
  • Most public hospitals do have private rooms and allow “props” to be taken in, once you are in established labour.
  • Most wards have TENS machines and the midwives are trained to give massages and support natural births.
  • You can usually get your way if you are polite and resourceful.
  • Major medical interventions are much lower than in private hospitals.
  • Epidural rates are much lower than in private hospitals, but they are available.

C-section rates much lower than in private hospitals.

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