The mother-to-be arrives at the maternity ward either the night before or early in the morning of induction of childbirth. You settle into a room and a midwife makes the final preparations. She checks that you have had a consultation with an anesthetist and that all the necessary examinations have been performed. We also place a monitoring to listen to the heart rate of the baby and check the possible existence of uterine contractions.
Meeting in the pre-work room
The next day, you are taken to the pre-work room. The doctor or midwife will do a vaginal examination to assess the condition of the cervix : softened, closed, open, consistent … This is called the “Bishop score”. There too, a monitoring is connected.
All these elements obtained will make it possible to know what type of triggering must be set up: prostaglandins or an infusion of oxytocins.
The induction of childbirth with prostaglandins
In the case where your cervix is not favorable (toned and closed), the midwife or the doctor applies you, first of all, to the level of the vagina, a gel containing prostaglandins. This substance has a direct action on cervical maturation and on the uterine muscle.
A few hours later, he or she asks you an intravenous infusion of oxytocin, substance present when childbirth is spontaneous. The dose can be adjusted during labor and dilation, until you get intense and regular contractions.
When the cervix is fully open, we proceed to the rupture of the water pocket. The baby’s head then presses firmly on the collar and infiltrates to come out. But the expansion phase is often very long. An epidural is placed to better support the duration of childbirth.
Namely: the Cytotec(misoprostol) is one of the prostaglandins most used by maternity hospitals, although it does not have a marketing authorization (AMM) – it is an anti-ulcer drug – in this indication. It will be withdrawn from the market in March 2018, due to serious adverse effects it can cause in mother or child. Medication Propess, (dinoprostone), which has Marketing Authorization in this indication, remains marketed. Marketing Authorization has been issued for another drug Angusta, but it will take several months before this product is available in France.
Induction of childbirth by infusion of oxytocins
Yes the cervix is favorable (partially open), the future mother goes directly to the delivery room. The midwife must re-examine it and report any doubts to the initiating doctor.
The fetal membranes from the cervix are removed manually. It is a little painful and there may be a little bleeding, but don’t worry, this is normal. This technique is associated with the establishment of a oxytocin infusion.
The water bag is then pierced to activate the contractions. Work is faster and the epidural asked very early.
Expulsion and deliverance after initiation
When giving birth, what changes compared to spontaneous childbirth is the dilation phase. The expulsion phase and the release phase are normal.
Uterine contractions allow the baby to pass through the cervix and reveal his head. You are probably very tired, but you will be asked to push. It will be thanks to your efforts that your baby will be born. Inhale, block, push and relax between each contraction to regain strength. The midwife takes care of guiding the baby’s head to prevent a tear.
As for the delivery, it takes place 20 minutes after birth. This is to help uterine contractions still present to expel the placenta by exerting pressure on the uterine fundus. This step is very important: if pieces remain inside, there is a risk of bleeding.
In case of triggering with unfavorable local conditions, it should be known that the risk of cesarean section is increased.