Induction of labour

• If you are overdue
• If your waters have broken before labour starts
• If you or your baby have a health problem

• When induction of labour is offered, it is largely when the benefits of your baby being born are greater than prolonging the pregnancy and awaiting labour to start naturally.
• Most babies will be born healthy, but there is always a small risk of stillbirth at any stage in pregnancy and this risk increases as you go further past your due date. Current National Institute for Health and Clinical Excellence (NICE 2021) guidance on Induction of Labour tells us that the average risk of stillbirth at 40 weeks is approximately 1 in 800 pregnancies and that this risk doubles by 42 weeks when the risk is around 1 in 400 pregnancies. This is because the placenta might not function as well, and this can reduce the oxygen and nutrients available to your baby.
• Induction of labour can be different to labour starting naturally. Induced labour may involve more vaginal examinations and a longer stay in hospital, this is because the process can take several days until your baby is born.
• Some women report induction of labour to be more painful than a labour that starts naturally. Whilst some women go into labour quickly, for other women it can take longer and increase the amount of intervention and pain relief required.
• Sometimes the hormones used during induction of labour (Prostaglandins) can cause the womb to contract too frequently and this can affect the pattern of your baby’s heartbeat.
• There is a small chance that the induction of labour process will not work. If this happens a doctor will discuss your options with you, and you will be able to decide how to proceed.
• There may be other risks to consider for some women. These will be discussed with you on an individual basis, considering your medical history, previous pregnancies, and current pregnancy.

The doctor or midwife will explain the risk versus benefit to you. If you choose not to have an induction of labour an individual plan of care will be made with you and your doctor or midwife. We often call this a wellbeing plan

A balloon catheter is a soft narrow tube with a balloon at the end which is normally inserted into the bladder to help drain urine. It can also be used to help dilate the cervix (neck of the womb) by inserting the catheter into the opening of the cervix and inflating the balloon. This is known as a mechanical method of induction of labour.

Prostaglandins

Prostaglandins are medicines that are similar to hormones naturally produced by your body. They are used to help your body get ready for labour and encourage contractions to start.

If you are having an induction of labour, your midwife or doctor will talk you through the process and explain which medicine is most suitable for you.

Prostaglandins can be given either vaginally or by mouth. This will be done in hospital, usually on the induction suite or labour ward, where you and your baby can be monitored and supported throughout.

Misoprostol

Misoprostol is a prostaglandin medicine that may be given as a liquid solution or as a tablet to swallow. It works in two main ways:

• It prepares your cervix: it gently softens and thins the cervix (the neck of the womb), helping it to open.
• It helps start contractions: it encourages your womb to contract, which can help start labour or help labour progress.

Often, you will need more than one dose for it to be effective; this could be every 2 hours and up to 8 doses.

Prostin (Dinoprostone)

Prostin is a prostaglandin gel that is inserted into the vagina, behind the cervix (the neck of the womb). It works over approximately 6 hours.

It works in two main ways:

• It prepares your cervix: it gently softens and thins the cervix, helping it to open.
• It helps start contractions: it encourages your womb to contract, which can help start labour or help labour progress.

You may need more than one dose for it to be effective.

Monitoring and support

Your midwife or doctor will explain which medication is most suitable for you and what to expect during the induction process. You and your baby will be monitored throughout the process to ensure that you are both well

If the waters in front of your baby’s head do not break on their own, a procedure called an ARM will be advised. This is when a midwife or doctor makes a hole in the bag of water surrounding your baby to release the fluid inside.

This procedure involves a vaginal examination using an amnihook. An amnihook resembles a crochet instrument with a small hook on the end. Sometimes breaking the waters is enough to encourage your labour to start. However, it is common that some individuals will also require an
oxytocin infusion.

Oxytocin is a hormone that causes contractions of your womb, and it can be used to start labour or speed up labour

A membrane sweep is performed during a vaginal examination. A midwife or doctor will use their fingers to gently “stretch” your cervix (opening to the womb). They will then “sweep” around the inside of your cervix to separate the membranes (baby’s water sac) away from the cervix. This encourages a natural hormone called prostaglandin to be released which can help labour to start and may reduce your need for an induction of labour. You will be offered this after 39 weeks but it may be offered from 37 weeks if there is a medical reason for you to have an earlier induction of labour. In some circumstances a stretch and sweep is not appropriate and the reasons for this will be discussed with you. Following a membrane sweep it is normal to experience some discomfort and experience a blood-stained vaginal loss that should be sticky or mucousy. If you experience any “runny” fresh, red bleeding or are concerned please contact the Maternity Assessment Centre (MAC) for advice.

The Induction of Labour Suite is located on ward M3 in the Women’s and New-born Unit. Access to the Women’s and New-born Unit is via Smith Lane, Gate 5.
You can call us on: 01274 383583 (24hrs)
You can find us at this postcode: BD9 6DA
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