Birth Induction

Not how you imagined it, but sometimes a necessity.

Sometimes you wait and wait… and the birth doesn’t want to start….
Sometimes the doctors at the hospital decide for safety reasons to induce birth.
In Germany you do this only in a hospital. Please do not try anything at home, as it could harm you and your baby.

Due date

A normal pregnancy lasts 38-42 weeks (average 40 weeks = 280d after last menstrual period = 9 months). When the due date has passed your OBGYN or the assigned hospital will check up on you every two days. You will be admitted to hospital after roughly 7 days to discuss options (inducement, waiting or c - section). In Germany it is quite normal to wait up to 1 - 2 weeks before acting.

Reasons for Induction

After the due date the placenta might not work as good as before. There is a risk that your baby is not adequately nourished anymore. Studies have shown that the complication rate is rising with every day after the due date.
Hence the close monitoring.

Other reasons for induction are 

• Infection mother or child,
• Rupture of the membrane without contractions after 24hours
• Preeklampsia
• Small baby/not growing
• Cholestasis
• Diabetes in pregnancy (especially when you take insuin)

Methods of Induction

There are different methods to stimulate contractions:  alternative methods, mechanical methods and medical methods.

Alternative Methods

Acupuncture & homeopathic globuli

Labour Cocktail

Some hospitals give a “labour cocktail” containing Rizinusöl (castor oil), apricot juice and Prosecco. The oil has a laxative effect and the prosecco helps you to relax. Just before delivery it is allowed in some hospitals to have alcohol in this cocktail. Your hospital will inform you about that and everybody must decide on her own if she takes it or not. Do not under any circumstances take this yourself at home.

Enema

Another possibility to start contractions is to give an enema. If it is not your first pregnancy or if your cervix is already a little bit open you can give an infusion with oxytocin.

Mechanical Methods

Ballon Dialatation

When this method a balloon is positioned in front of cervix causing a gentle pressure on the cervix and thereby promoting the body's own prostaglandin release. Prostaglandins are substances that trigger contractions and loosen the tissue at the cervix. This facilitates and supports the opening of the cervix.
At the moment there is a discussion if this could be done as an outpatient treatment.

Synthetic thread

Dilapan S is a synthetic thread made of patented hydrogel that absorbs the fluid from the cervical tissue.
The thin 4 mm thread can expand up to 15 mm over a period of 12-24 hours. This allows it to gradually dilate and soften the cervix.

Medical Inducement

This is done with Prostaglandin E1 and E2.
At first there is the possibility to get prostaglandin gel vaginally. With this the cervix opens. This is done by a gel, a tampon or a vaginal tablet.
You can also get Prostaglandine in form of an oral tablet. ( Angusta)
These two methods are the most common.

Inducement after a c-section

In this special situation you need to find a way together with the hospital and the doctors. . Angusta (tablet) is not allowed in that case, but the vaginal Prostaglandin and the balloon are an option.

Conclusion

In case of an inducement your hospital will assist you to find the best way for you and you decide what fits your needs and wishes.

The most important thing is that you and your partner are not overwhelmed but try to decide together. Try to stay calm and relaxed. Everybody wants the best for you and your baby and sometimes a birth does not start as you imagined it.

But it is still a birth – it is the birth of your baby – it is a special moment. Try to accept the situation and try to make the best of it. 
This result is the best you ever got: your sweet baby!

revised May 2022
Dr. Christine Krämer, M.D.
This blog post has been prepared with the greatest possible care and does not claim to be correct, complete or up-to-date.“

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