Induction of Labour
What is ‘induction of labour’?
Most women go into labour between 37-42 weeks of pregnancy. Sometimes labour needs to be started artificially for the safety of women and/or that of their babies; this is called induction of labour.
Why am I being induced?
The most common reasons for induction of labour are:
If your baby is overdue
If there are concerns about your health or that of your baby
If your waters have broken but contractions have not yet started.
What does it involve?
Firstly, if induction is being considered you will be offered a vaginal examination to assess your cervix (neck of the womb). As part of this examination you may be offered a cervical sweep. This is whereby the midwife/doctor use his/her fingers to gently separate the membranes away from the cervix. This may help start labour spontaneously.
However, if your labour does not start spontaneously you may need to be induced artificially. Inducing your labour takes time, sometimes a couple of days.
Three methods are used to induce labour;
Vaginal medications such as Propess pessary and/or Prostin gel can be used to soften (or ripen) your cervix
Amniotomy (breaking the waters)
Intravenous hormone drip (syntocinon) which is a synthetic form of oxytocin, which causes contractions and labour to start. Some women will require all three methods, but others may only require one.
1. Propess and/or Prostin
You will be given a date & time to come to hospital.
Your midwife will carry out a detailed assessment of you and your baby’s well-being. Depending on if it is your first baby / you have had previous babies, a decision is made as to which medication is best suited. With your consent, the doctor/midwife will insert the chosen medication into your vagina, and place it behind your cervix.
Propess pessary (like a small tampon) remains in place for 24 hours, slowly releasing the medication with the aim of softening your cervix. The string of the pessary will be placed at the opening of the vagina.
Unlike Propess, Prostin is a medication of ‘gel like’ consistency, absorbed, with the aim of softening your cervix.
After the medication has been inserted, you will be asked to remain in bed and lie on your side for 30-60 minutes
A call bell will be provided to you so you can alert your midwife if you experience any pain, contractions, bleeding or rupture of membranes
Following this you are encouraged to mobilise and eat and drink as normal
Your midwife will monitor you and your baby’s well- being while you are waiting to go into labour
If labour starts within 24 hours of Propess being inserted?
If there are signs of labour, i.e. strong, regular contractions and/or your membranes rupture your midwife will assess you. If you are deemed to be in labour, the Propess pessary will be removed. You will be transferred to the Labour Ward as soon as a space becomes available.
If labour does not start within 24 hours of Propess being inserted?
If labour has not started within 24 hours you will be reviewed by the doctor. The doctor will examine you to assess if your cervix has ripened and if you are suitable for amniotomy.
If you are not suitable for amniotomy, a decision may be made to administer Prostin gel, to further assist successful induction. Your midwife will continue to monitor you and your baby’s well-being. You will be reassessed vaginally 6 hours later.
If Prostin gel is the initial medication of choice, similar to Prospess you and your baby are monitored. If labour starts, you will be transferred to the Labour Ward as soon as a space becomes available. If after six hours, there are no signs of labour, you will be examined by the doctor and a further dose of Prostin medication maybe inserted, with the aim of softening the cervix.
2. Amniotomy/Artificial Rupture of the membranes
When your cervix is ripe, your waters can then be broken. This is known as artificial rupture of the membranes (ARM) and is carried out on the Labour Ward. The midwife/doctor will perform a vaginal examination and break the waters using a small plastic instrument, shaped somewhat like a crochet hook.
3. Syntocinon drip
Oxytocin is a hormone that is released naturally by your body when you start labour. It causes contractions, which open your cervix and help you to give birth to your baby. For labour to establish it is usually necessary to administer a synthetic (man-made) form of oxytocin known as syntocinon. It is given intravenously (into a vein) as a drip in your arm, administered via a pump. Your baby will need to be monitored by cardiotocograph machine (CTG) during labour/birth to ensure that your baby is tolerating the syntocinon drip.
Can my partner stay with me?
If you are being induced with Propess and/or Prostin, your partner will be able to stay with you on the antenatal ward during regular visiting hours.
However, once you are transferred to the Labour Ward your partner can stay with you at all times.
Are there any risks with induction?
There are some risks, in that not all babies tolerate medications used to induce labour. For this reason, you and your baby will be monitored carefully. There is also the chance that induction will not work. If this is the case, a caesarean section may be necessary.
You can find more information about the induction of labour by visiting the National Institute for Health andCare Excellence website: https://www.nice.org.uk/guidance/