Induction of Labour - Suffolk and North East Essex Maternity and Neonatal Services

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What is induction of Labour?

If you are offered an induction of labour, it’s important that you have enough information to help you decide if it’s the right decision for you.

Induction of labour is when labour is brought on artificially. It is offered when it is felt that it will benefit the health of either you, your baby or you both compared to waiting for a natural labour.

There are many reasons why this may be offered and different ways of making this happen.

Before an induction, your midwife or doctor may offer to perform a membrane sweep. This is an internal vaginal examination in which your midwife places a finger within your cervix (which is the entrance to the womb) and stretches it with a sweeping circular movement. This should stimulate the release of hormones called prostaglandins which may encourage your labour to start. This may be uncomfortable at the time and can sometimes cause light bleeding. It is up to you if you choose to accept this.

Why would I be offered induction?

There are a variety of reasons why induction is offered, including:

Prolonged pregnancy

Some risks increase as pregnancy goes past 41 weeks.

The risk of stillbirth rises from 0.04 percent at 41 weeks to 0.35 percent at 42 weeks. This will be discussed with you to help you decide if induction is the right path for you or to make a plan if you feel you would like to wait longer.

Waters breaking after 37 weeks

If labour doesn’t start spontaneously after your waters break, the risk of you developing an infection increases. The option of immediate induction, or to wait up to 24 hours for labour to happen on its own, will be discussed with you.

Complications occurring in pregnancy

Other reasons induction may be offered to you include diabetes in pregnancy, high blood pressure or pre-eclampsia, a small baby or a baby that is not growing well, and reduced movements from your baby.

All pregnancies and circumstances are different and your doctor or midwife will discuss this individually with you.

Preparation

There are two main parts to the induction process. The first focuses on the preparation and opening up of the cervix; the second is the breaking of the bag of water around the baby and getting your body into active labour.

An induction is artificially stimulating your body to labour, sometimes when it is not ready. Therefore, you can expect this to take time. Your cervix needs to respond to the process and we do not know how long it will take. It could be anything from 1-4 days. You may wish to discuss if the option of going home during the first part of the induction is appropriate for you.

If you are going to stay in hospital for the whole of your induction, you may want to think of things to take with you which will help you pass the time. Most units will allow your partner to stay with you, so they may need to pack some items for themselves like food, some toiletries and a change of clothes.

Methods of induction

There are different methods that can be used to induce labour. You can discuss the options offered locally with your midwife.

On arrival, the midwife will examine your tummy and confirm your baby’s position. Your baby’s heartbeat will be monitored for a short time to ensure your baby is well. This will be done using a CTG machine which will also monitor if you are having any contractions.

The midwife will offer other routine tests like checking your blood pressure, pulse, temperature and urine. You will then be offered a vaginal examination to assess the cervix to help you make a plan about which method of induction may work better for you.

You may hear your midwife or doctor refer to a “Bishop’s Score” as part of this assessment. A lower score will mean your cervix has not made many of the early changes in preparation for labour, whereas a higher score means some of these initial changes have begun.

Your options will be discussed with you, so you understand the plan and what that means for the next few hours until another review.

Questions you might like to ask your midwife

Why am I being offered an induction at this time?
Can we discuss the options for induction of labour in relation to my own pregnancy and circumstances?
Do you offer induction on the midwife-led unit?
Can I go home?
What methods of induction do you offer in this area?
How long will it take before labour starts?
If I have an induction, how will this affect my choice of place of birth?
If I have an induction how will my baby be monitored?
Will I need continuous monitoring of my baby’s heartbeat?
If I have an induction, can I stand up and move around during labour?
If I have an induction, will my partner and/or birth partner be able to stay with me at all times?
If I want to breastfeed will having an induction affect this?
If I have an induction, what impact might this have on my future pregnancies?
If I have an induction, what support is available during the whole process?
If I have an induction, what are my choices for pain management?
Can I use a pool during an induction?
What happens if I start the induction process, and then change my mind?

Prostaglandin Gel or Tablets

If your cervix is in the very early stages of changes, prostaglandin gel or tablets will be considered.

The gel or tablet is inserted into the vagina near your cervix to be absorbed. The midwife will want to monitor your baby and contractions for a short time after giving you the medication. You will then be encouraged to walk around when monitoring is finished.

A reassessment will be 6-8 hours after the first dose was given to you unless there is a reason to do it earlier.

Occasionally with this method, contractions come on too frequently. If this occurs, you may be offered another medication to bring the contractions back to a manageable level.

Prostaglandin Pessary

This will be offered when your cervix is in the early stages of change.

The pessary is inserted into the vagina near your cervix and slowly releases the hormone to be absorbed over 24 hours. It has a string like a tampon, so can be removed early if contractions become too regular.

The midwife will want to monitor your baby and contractions for a short time after giving you the medication. You will then be encouraged to walk about when monitoring is finished. You will be offered an assessment in 24 hours unless there is a reason to do so before.

If this method is used as an outpatient form of induction, the midwife will discuss with you all of the situations where you should either call or come back to be seen.

Mechanical Methods

Mechanical methods include using a small balloon or rods that are inserted into the cervix and work by stretching the cervix by gradually swelling up over 12 to 24 hours.

These methods require an internal examination (similar to a smear test) to be able to insert the small balloon or rods into the cervix. These may be more suitable if you have had a caesarean birth before as it is less likely to cause strain on your previous caesarean scar. This may also be used in an outpatient setting.

Next steps

Once your cervix is open enough, you can move to the labour ward where breaking your waters is the next step of the process. From this point of the induction process, you will require a dedicated midwife to provide one-to-one care. Sometimes there may be delays in transfer to the labour ward until a midwife is available to provide this care.

Sometimes breaking your waters is enough to bring on contractions to establish your labour. If this doesn’t occur, a drip containing a synthetic hormone called syntocinon is used to get your contractions started. This is a hormone produced in a laboratory, which is similar to the one naturally produced in the body.

The drip is gradually increased until you have three to four contractions every 10 minutes. It can take some time to get to this point and the drip may make labour more painful than natural labour. Your midwife will talk to you about the pain management options available to you.

During the second part of the induction process, continuous monitoring of your baby’s heartbeat using a CTG machine is required, to ensure that your baby is coping with the labour. This may restrict your ability to be mobile. There is a risk of bringing on too many contractions, ’ and this may cause distress to both mum and baby. There is some evidence to suggest that induced labours may slightly increase the risk of needing assistance at birth with forceps or ventouse.

Unsuccessful inductions

Sometimes induction is unsuccessful. If this happens your medical team will discuss a plan with you. This might include a rest period, further attempts to induce labour or a caesarean birth. This will be a conversation personalised to your circumstances, which considers how you and the baby are and your preferences.

Induction of labour may not be a path you expected and you will need time to process the information and choices. You can decide to proceed with, delay, decline or stop an induction and your decisions will be respected and supported.

BRAIN

A tool for improved communication

Whilst making the decision about induction of labour, you may find the BRAIN tool useful to help you ask the right questions during conversations with your midwife or doctor

Benefits

What are the benefits of an induction of labour for you and your baby?

Risks

What are the risks of an induction of labour? Are there any specific side effects that would be personal to you?

Alternatives

What are your alternatives to an induction of labour?

Intuition

How do you personally feel about the idea of an induction of labour?

Nothing

What if you do nothing? You don’t have to make a decision straight away; you can take some time to decide the best course of action for you.

Download BRAIN infographic as PDF

Links

Explanation point

Term	Description
Diabetes	A condition where your blood glucose level is too high.
High blood pressure	Also known as hypertension, is usually defined as having a sustained blood pressure of 140/90mmHg or above.
Pre-eclampsia	A complication of pregnancy that causes you to have high blood pressure and protein in your urine. It can make you unwell and can affect your baby’s growth and wellbeing.
Outpatient	A term that refers to a patient who does not need to stay in hospital overnight.
Contractions	A tightening sensation, which is the opening (dilating) of your cervix that in turn moves your baby down the birth canal so they can be born.
Drip	A method that enables you to have fluid or medicine straight into your veins rather than having to swallow it. A drip uses a cannula (narrow, bendy tube) that is put into a vein in the back of your hand or arm.
Forceps	Smooth metal instruments that look like large spoons or tongs. They're curved to fit around the baby's head. The forceps are carefully positioned around your baby's head and joined together at the handles. With a contraction and your pushing, an obstetrician gently pulls to help deliver your baby.
Ventouse	A plastic or metal vacuum cup which is attached to the baby's head by suction. During a contraction and with the help of your pushing, the obstetrician or midwife gently pulls to help deliver your baby.
CTG machine	Cardiotocography (CTG) is used during pregnancy to monitor the baby’s l heart rate and your contractions during labour.