What is an induction and why have I been offered one?
An induction is when we attempt to start labour artificially. Nationally, just over 30 out of 100 women will be induced. While we prefer labour to start on its own, induction will be offered when there is a clear medical indication and when the expected benefits to you and your baby outweigh the potential risk of the pregnancy continuing.
Remember, you are in the driving seat when it comes to decisions about your care so it is important that you ask questions and take time to come to a fully informed decision about your induction.
Induction in lower risk pregnancies by 41 weeks and 5 days
Pregnancy and labour past your due date are usually safe and straightforward but occasionally problems can develop. Women with uncomplicated pregnancies will be offered an induction by 41 weeks and 5 days. There is evidence to suggest that the risk of stillbirth increases at a faster rate after 42 weeks: at 42 weeks it is between 1-2 in 1000 births and up to 44 weeks the risk increases to 3 in 1000. Your community midwife will discuss induction of labour with you at your 38- week appointment and offer you a membrane sweep after your due date.
How will my labour be induced?
For labour to start the cervix needs to be ripe (soft, stretchy, thin and have moved forward) and open enough to be able to break the waters that surround your baby. Once your waters have been broken and your baby’s head comes down onto the cervix, you may start to feel some period-type cramps that increase in intensity, which will become the contractions that continue until your baby arrives. There are a few ways that we can induce labour, which depend on a variety of factors; however, for most women an induction is usually a three-part process:
Getting your cervix ready
Membrane sweep
Before your induction date your midwife or obstetrician should offer you a membrane sweep or a ‘stretch and sweep’ in an attempt to stimulate contractions.
There is some evidence to suggest that a sweep may increase the chances of labour starting within 48 hours. A stretch and sweep involves a midwife or obstetrician placing a finger inside your cervix, making circular stretching and sweeping movements to separate the membranes from the cervix. It may cause some light bleeding, discomfort and irregular tightenings that may make it difficult for you to rest and sleep.
Foleys balloon catheter induction
In a hospital setting, a midwife or obstetrician will perform a vaginal examination and insert a catheter (a flexible tube) into your cervix and with a small amount of sterile water, inflate the catheter like a balloon. The pressure placed on your cervix by the balloon should soften and open your cervix enough to either start labour contractions or allow for your waters to be broken (usually after 24 hours). Please refer to the ‘Foley Balloon Catheter Induction of Labour’ leaflet for more information.
Using prostaglandins
A hormone pessary (Propess) or gel (Prostin) containing a drug called prostaglandin is placed close to the cervix, which mimics your natural hormones and should help your cervix to ripen and start to open. The pessary is a small tab attached to a long piece of string. The medication in the tab slowly and continuously release the hormone over 30 hours. Some women may require more than one 30-hour cycle of the pessary. The gel is placed close to your cervix and remains in place for 6 hours. When your cervix is ready, arrangements will be made for you to move to the labour ward for the next part of the induction.
Breaking your waters
Although your waters may break during the earlier part of the induction most women will require a midwife or obstetrician to break their waters. This will take place on the labour ward and is called an artificial rupture of membranes (ARM). In order for this to occur the cervix needs to have made changes and be open enough that, during a vaginal examination, a small plastic instrument (an amnihook) can pass through to make a small hole in the bag of water around your baby.
Your waters, or amniotic fluid, will continue to drain through this hole until your baby is born.
Helping your contractions to start
Some women may begin to experience period-type pain or contractions after their waters break; if this does not happen you may require a drip called Syntocinon. Syntocinon is a synthetic hormone that helps to start, increase and maintain contractions throughout labour until your baby is born. The drip is given through a cannula in a vein in your hand and goes directly into the bloodstream. The flow of Syntocinon can be adjusted in response to how your labour is progressing.
What are the risks of an induction of labour?
An induction is not risk-free and can be very different from labour starting naturally. Studies looking at induction compared to waiting for labour to start on its own in lower-risk pregnancies, show that induction does not significantly alter how your baby is born. There is some evidence suggesting a slightly lower emergency caesarean rate, with a small increased chance of a further intervention, including epidural or an instrumental delivery (ventouse or forceps). There is a chance that your induction may be unsuccessful, or that your uterus may contract too much, which can directly affect your baby. We therefore recommend monitoring your baby’s heartrate frequently during the earlier stages of induction and continuously if you require the hormone drip.
If your midwife or obstetrician are concerned about how frequently your uterus is contracting they may suggest removing the pessary or try turning the hormone drip down or off completely. You may also be given an injection of medication to help reduce contractions.
How long does an induction take?
Unfortunately, we are unable to tell you exactly how long your induction will take as it is different for every woman. Your labour may start within 24 hours or (as with most cases) it could take more than 2 days before you are ready to have your waters broken and hormone drip started on the labour ward. Please factor this in when planning your hospital stay, ensuring you have sufficient childcare if you have other children.
Preparing for your induction
When attending your induction please ensure you bring your maternity handheld notes, birth plan and any medications you take regularly. You will be provided with hot drinks, water and three meals throughout the day, but feel free to bring snacks and sports drinks to keep you going. As the induction process can take some time, you are welcome to bring books, magazines or any electronic devices to keep you occupied during your stay.
Why might my induction be delayed?
Occasionally the maternity unit may be very busy, which can lead to delays with inductions. We appreciate this may be frustrating and upsetting for you; however, it is important to ensure that the maternity unit is providing safe care for everyone, including you and your baby. We endeavour to keep delays to a minimum and will keep you fully informed throughout. Very rarely we may need to change the day of your induction or ask you to attend another local unit in order for your induction to continue as planned.
What if I choose to not have my labour induced?
Whatever decision you make regarding an induction will be respected. We will offer you a consultation with a senior obstetrician to discuss alternative options while continuing with your pregnancy. To ensure we are looking after the health and wellbeing of you and your baby you may be offered additional monitoring, which may include regular checks of your baby’s heartbeat using a ‘CTG’ machine, or an ultrasound scan to look at the levels of amniotic fluid around your baby and the blood flow in the umbilical cord and placenta.
What will happen if my induction does not work?
Very occasionally we are unable to successfully induce labour. This can happen if the prostaglandins do not ripen and open the cervix sufficiently for your waters to be broken. Sometimes, once your waters have been broken, the hormone drip may not generate effective contractions to open your cervix. We understand that by this point you may have been in hospital for a long time and may be frustrated and upset. A consultant will discuss your options with you and your partner and together, come to a decision about how best to proceed. In most cases women will be offered a caesarean section to deliver their baby.
Who are the Willow Team?
The Willow Team are a passionate team of consultants and midwives who provide dedicated care to women who have their labour induced. The team discuss all inductions at least twice a week and arrange the optimal time for your induction.
Following the meeting, the Induction Midwife Co-ordinator for your area will contact you to offer you a date to attend for induction. Your Induction Midwife is available to answer questions, address concerns and help you create an individualised induction birth plan to ensure you feel empowered, supported, respected and informed throughout your induction of labour journey. Your induction of labour midwife will usually contact you within three days, if you have not heard anything after three days please contact the induction of labour midwife via phone or email. Please see below for details.
Contact details
The Willow Team meet at least twice a week and will be in contact with your induction of labour date. If you have not heard from a member of the team within three days please call your induction of labour midwife or send us an email and we will get back to you.
[email protected] upset. A consultant will discuss your options with you and your partner and together, come to a decision about how best to proceed. In most cases women will be offered a caesarean section to deliver their baby.
Emergency contact information
Lincoln County Hospital
Labour Ward: (01522) 573140
Antenatal Assessment Centre (24 Hours): (01522) 573138
Pilgrim Hospital Boston
Labour Ward: (01205) 445424
Antenatal Assessment Unit (08:45-16:45): (01205) 445144
Useful sources of information
NICE Guidance NG207 – Inducing Labour
NHS.uk Inducing Labour
Evidently Cochrane – Inducing Labour
Aromatherapy in Maternity Services Leaflet
Our during pregnancy page
References
If you require a full list of references for this leaflet please email [email protected]
United Lincolnshire Hospitals NHS Trust endeavours to ensure that the information given here is accurate and impartial.
If you require this information in another language, large print, audio (CD or tape) or braille, please email the Patient Information team at [email protected]