I previously wrote about what happens when your bump measures too small for dates, and now I’m going to fill you in on what to expect when you and your baby are facing failure to thrive and an early pessary induction.
What is a Pessary Induction?
A pessary induction is when you’re given a vaginal pessary loaded with hormones to artificially ripen your cervix and – hopefully – bring on labour.
This may be for one of several reasons, including:
- Being overdue;
- Your or your baby’s health is at risk;
- Your waters have broken but labour has not started after 24 hours.
Usually you will receive one tablet, followed by another at a predetermined interval. Depending on your individual circumstances it’s common to have two tablets six hours apart before considering different options.
The entire process of induction is complex, starting with the most gentle efforts to bring on labour, and becoming progressively more medicalised if your body does not respond.
You’ll usually be offered a membrane sweep in the first instance, followed by a pessary induction, and if necessary you’ll receive a hormone drip. If all of these methods fail to induce labour and it becomes unsafe to wait any longer for your baby to arrive, you’ll be taken for a caesarean section.
Preparing for Induction With a Membrane Sweep
Prior to an artificial pessary induction, in efforts to start labour more naturally, you’ll be offered a membrane sweep. A membrane sweep involves your doctor or midwife ‘sweeping’ the membranes of the amniotic sac in your uterus and, whilst it may be a little uncomfortable, it shouldn’t be painful.
Having a sweep may dislodge the mucus plug in the cervix, causing a bloody show. This is nothing to worry about, though it can be disconcerting if you’ve not been warned!
If neither you nor your baby are at any medical risk then you may be offered several membrane sweeps over a period of a couple of weeks once you’ve reached your due date.
How a Membrane Sweep Works
The sweep works by stimulating prostaglandins which are the compounds responsible for ripening the cervix and starting labour. Prostaglandin is also found in high concentration in sperm, which is why it’s thought sex may also initiate the process.
You may have heard the term ‘stretch and sweep’ in relation to the procedure, and that’s because the midwife performing the membrane sweep may also attempt to stretch the cervix, to encourage it to soften and dilate.
If a sweep fails to trigger labour but induction is medically necessary, the next step is using a pessary.
One side effect I discovered during my own induction can be an elevated heart rate for the baby. You will be closely monitored to ensure your and your baby’s health, and if necessary induction will be stopped. In our case the second tablet was given much later than usual for my daughter’s safety.
The Hormone Drip
If neither the membrane sweep nor the pessary induction stimulate labour, you’ll be offered the hormone drip. This amps up the process and in my experience is when the real pain begins.
You may be encouraged to accept an epidural and by this point you’ll likely be glad to do so!
Our Experience: Failure to Thrive and Early Induction
Following another scan to check my baby’s size, I was booked in to be induced at 8am the following morning. This in itself was quite terrifying: so very soon – why? I’d been having scans every few weeks and each time my mind was put at rest, so I wasn’t concerned this time. I’d even attended the appointment without my husband because I’d become so complacent.
So when I received a phone call from the hospital at 6.30am on the day of induction, asking me not to go in until 11am because they were busy, I panicked – was my baby at risk?
All I really knew was that the previous day’s scan had shown Pixie’s abdominal circumference was below what it should be compared to her other measurements – in other words she was failing to thrive. This is usually caused by the placenta prematurely failing, which is natural towards the end of gestation but can be incredibly dangerous if it happens early. And I was sickeningly aware of a friend of a friend who had just very recently lost their baby in the late stages of pregnancy for this very reason.
When we got to the maternity ward a few hours later I was in turmoil. A rather brash midwife again told us they were too busy to take me and turned us away until that evening. We had no choice but to go back home and by this point my anxiety was through the roof. We were eventually admitted at 6pm that evening.
Induction is notoriously horrific – but I’d not bothered to educate myself about something I didn’t think applied to me. No matter, I learned on the job:
Suffice to say it obliterated most of my wishes in terms of my labour.
The first pessary negatively affected Pixie’s heart rate to such a degree that the second was delayed by several hours. As our ambiguous fears solidified into reality, the guttural howling of the other women on the ward – initially terrifying – became irrelevant.
For a particularly harrowing half hour, my baby’s heartbeat disappeared with no fewer than three different staff unable to locate it. New machinery was brought in and still there was no joy; there were murmurings of an emergency section.
We’re not equipped to deal with the sheer terror and loss of control in such situations; as is often said to be the case during overwhelmingly intense despair, I felt myself watching the drama unfold, as though I’d left my body and was watching from another perspective.
Eventually, while my husband and I clung to each other desperately willing away our fears, I was scanned as a last resort – and there she was, curled up and hiding; distressed but holding on. I was monitored closely, and our relief was almost tangible as she stabilised.
I was urged to reconsider my position regarding an epidural. A midwife told me she’d personally insisted on having an epidural before the hormone drip when she was induced.
By the time my daughter was born, I wished I’d done the same.
The entire experience was unpleasant to say the least: I was high-risk; I was being so violently sick I was put on IV fluids; I relented and agreed to the epidural because my labour was so fast the pain was unbearable (it failed); I was catheterised; I was given an episiotomy and lost half a litre of blood.
In fact, the only things I (narrowly) avoided were a cesarean, and any form of assisted delivery (had I not worked so hard in the gym during my pregnancy, our daughter would have been born using ventouse). It’s fair to say I was traumatised by the ordeal.
But Then We Had Our Baby Girl
Labour lasted just 4.5 hours from the moment my waters were broken, and I dilated from 6 to 10cm in 45 minutes, delivering Pixie 11 minutes later. She arrived at 11.03pm, weighing a dinky 5lb 4oz, and she was perfect. I couldn’t quite believe after all the drama that she was here, and we were both okay.
Trying to put into words that surreal and magical time is like trying to describe a rainbow to the blind, the sound of the sea to the deaf.
Hand on heart, I don’t think I can say I even felt the immediate maternal outpouring of love we’re promised; in hindsight I expect I was in shock. We stayed in overnight and were discharged the following morning. Her blood sugar levels had been approved, I was successfully breastfeeding (I have never been more determined about anything in my life), and she was deemed fit to leave hospital. Hurrah!
Sadly, this was not the end of our story. You can catch up with the next drama here, or skip ahead for some better news about how a positive labour is possible after a traumatic delivery.