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Induction of labour

Induction is the process of artificially starting labour and is offered when it is felt that your baby’s health or your health will benefit.   Induction of labour is not usually offered prior to 39 weeks gestation unless there are significant concerns about the health of the mother or baby.  For most women, awaiting spontaneous labour is preferable. Induction of labour may be offered for many reasons, including:

  • Concerns about how well your baby is growing
  • Underlying medical conditions that you may have before pregnancy
  • Current pregnancy complications
    (e.g. Pre eclampsia, obstetric cholestasis, gestational diabetes)
  • Pregnancies that are approaching 42 weeks.

For the majority of women induction of labour will be started on the antenatal ward. Some women who need their babies monitored more closely will be induced on the labour ward.

It is very important you understand why you are being offered an induction of labour, and that you are happy to go ahead with starting your labour artificially. If you have any specific questions relating to your care, please do discuss this with a midwife or doctor.

The cervix

During pregnancy the cervix stays closed, however during induction of labour the aim is for the cervix to start to open - but it isn’t all about dilatation! Before labour starts, the cervix is very far back (posterior). It is around 3-4cm long, feels firm, is closed and the baby’s head is normally just starting to engage into the pelvis. During induction, the aim is to bring the cervix forward, shorten it, make it softer, for it to start to open (dilate), and bring baby’s head down. Any change in the cervix is positive.  The ultimate aim is to ripen your cervix sufficiently so we are able to break your waters (artificial rupture of the membranes ARM).   Once your waters have broken, you will  usually need to have a hormone drip (oxytocin) in order to get your labour established.  The drip usually continues until the baby is born.  The induction process needs to happen gradually so it is common for induction of labour to take 2-3 days before established labour starts.  The process with induction of labour for twin pregnancy is very similar.

 

Monitoring your baby

During induction we recommend monitoring baby's every 6-8 hours. We monitor baby using a CTG machine – two pads are positioned on your bump and held in place using wide elastic bands. The pads are attached to a machine which records your baby's heart rate and your contractions then prints out the recording onto a long piece of paper. Midwives and doctors look at lots of different features to interpret these recordings and this gives them a good idea of how well your baby is coping. When we are not monitoring baby, we usually encourage women to be off the ward walking around, in the café or in the hospital gardens. We recommend having lots to keep you entertained, magazines, tablets etc Patience and a positive attitude is important as this stage may take quite a long time.

 

Examinations

The midwife will offer a vaginal examination to assess your cervix at a few points throughout the induction process. Examinations can be uncomfortable but shouldn’t be painful. The midwife will not examine you if you don’t want them to and will stop if you tell them to. If you find the examinations too uncomfortable, we can offer some gas and air to help you relax, and to help with any discomfort.

 

Induction Methods

There are a variety of methods used to induce labour, what you are offered depends on your individual circumstances. The aim of any method is to soften, shorten, and open the cervix, so it is possible to break the bag of waters around the baby. This process can take some time, and first babies can take a few days. 75% of women  give birth to their baby within 48 hours of coming into hospital.

Propess

is a fabric rectangle attached to a long string. The Propess is placed high in the vagina next to the cervix during  a vaginal examination, and the string is left on the outside of the vagina. After it’s placed we monitor the baby for 1 hour. The Propess stays in for up to 24 hours and should start mild contractions that may feel like period pain/backache. Everyone is different and some women may be more uncomfortable than others.

 

Prostin gel

comes in a long syringe. The gel is placed high in the vagina around the cervix during  a vaginal examination. After the gel is placed you need to lie down to let the gel absorb and to monitor baby for 1 hour. Once it has been absorbed you can do everything as normal: move around, bath etc. We offer a vaginal examination 6 hours after a gel to see if there has been any change to your cervix. Most women can be offered up to 3 gels.

 

Breaking the waters and the hormone drip

 

Your waters might break at any point in the induction. The waters surrounding the baby are contained by a membrane called the amniotic sac and are there to protect the baby during  pregnancy, and allow the baby to move around and grow. If they don’t break then part of the induction process is to release the waters by making a small hole in the amniotic sac with a long instrument. This should give you stronger contractions and should start to dilate the cervix. This procedure should not be any more uncomfortable than a normal vaginal examination.

If releasing the waters does not encourage strong contractions, it will usually be recommended to start the hormone drip. Oxytocin (often called the “love hormone”) is a hormone that is released by your body during labour which causes contractions. Oxytocin also comes in a synthetic form, which makes up the infusion (drip) that is used in induction. It is given through an IV cannula that is inserted into a vein in your hand/arm. The rate of the drip is adjusted until there are contractions every 2-3 minutes. Whilst you are receiving the oxytocin drip, it is important that your baby is continuously monitored on the CTG machine.

 

 

Further sources of information