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Induction

An induced labour is one that is started artificially with drugs and/or breaking your waters.

It is your choice whether you have your labour induced. We will explain your risk factors to you, so you understand why induction is being recommended.

You might be induced if:

  • Your labour has gone overdue by more than 7 days (41 weeks)
  • Your waters have been broken for longer than 24 hours without labour starting
  • We are worried about your or your baby’s health e.g., gestational diabetes, pre-eclampsia or your baby is smaller than expected.

What to expect

There are several ways to induce labour. What you are offered and when will depend on your circumstances and how labour progresses.

Membrane sweeping (cervical sweep)

This aims to stimulate the release of a natural hormone (prostaglandin) to increase the chance of your labour starting naturally over the next 48 hours. It may reduce the need for other methods of induction.  

Your midwife or doctor will do a vaginal examination. They will try to put a finger inside your cervix (neck of the womb) and make a circular sweeping movement to separate the membranes surrounding your baby from the cervix.  

Membrane sweeping can cause some discomfort and slight bleeding but will not cause any harm to your baby.  

Sometimes the midwife or doctor may be unable to reach your cervix as it may be very far back in the vagina and closed. This is normal, but they may ask to try the sweep again in a few days with your consent.  

Using synthetic prostaglandin (Propess/ Prostin)

The aim of using synthetic prostaglandins is to encourage the cervix to open enough to allow a midwife or doctor to break your waters and for contractions to start.  

The drug will be inserted into your vagina to help induce labour by encouraging the cervix to soften and shorten or ‘ripen’.  

The effectiveness of using prostaglandins to induce labour varies depending on how sensitive you are to the synthetic hormone. It can be anything from a few hours to 48 hours before labour starts. In rare cases the use of prostaglandins will not get the labour started at all and the only other option is caesarean birth.  

We use two different forms of prostaglandin: Propess and Prostin. Your midwife or doctor will talk to you about which drug is right for you.  

Generally, prostaglandins are not recommended if you have had a Caesarean in the past. Your consultant will discuss the risks and benefits with you and make an individual plan for your care during induction.

Balloon cervical ripening 

This is a drug-free method to open the cervix so that the midwife or doctor can break your waters to get labour started. The aim of the balloon is to put gentle pressure on your cervix. The pressure should soften and open your cervix enough so we can break the waters.  

We will insert a very thin silicon catheter into your cervix during a vaginal examination. The catheter has two balloons at the tip and when it is in place, we inflate the balloons with sterile fluid.  

The catheter will stay in place for at least 12 hours up to a maximum of 24 hours. his doesn’t hurt you or the baby.  

Removing it is simple and painless. The balloons are deflated by the midwife and the catheter slips out, leaving the cervix slightly open and ready for your waters to be broken. Sometimes as the cervix opens the balloon will slip out on its own.

Artificial rupture of membranes (breaking your waters for you)

The aim of breaking the waters (the bag of fluid around the baby) is that it will stimulate labour start.  

We wait until the cervix is starting to open, usually by using prostaglandin or the balloon method if your cervix has not changed on its own. Your midwife or doctor will do a vaginal examination and use a small plastic hook to snag the membranes and make a hole for the fluid to come out. This doesn’t harm you or the baby, but you will feel a warm, wet sensation as the water drains and will need to wear a pad. You may find the procedure uncomfortable, but it shouldn’t be painful.  

If labour does not start after having your waters broken, you may need an oxytocin drip.

Oxytocin infusion (hormone drip)

An oxytocin infusion copies the same hormones that your body makes during spontaneous labour and encourages contractions. It can only be used once your waters have broken.  

If you need an oxytocin infusion you will have 1:1 care with a midwife. The hormone is given through a drip in the arm and is increased very gradually so you get regular contractions. Your baby’s heartbeat will be continuously monitored to make sure they aren’t getting distressed.  

People who need an oxytocin infusion are not able to use the birthing pool, but we’ll still encourage and support you to be mobile and active in labour.  

If, despite attempts to soften and dilate the cervix, we are unable to break your waters and help get you into labour, the obstetrician will talk to you about options including having a rest period and trying again in a few days. Ultimately, your doctor may offer Caesarean section to birth your baby if the induction of labour process isn’t effective for you.

Declining induction after 42 weeks 

If you decline induction when you are more than 42 weeks pregnant we will offer you:

  • Twice weekly monitoring of your baby’s heartbeat using cardiotocograph (CTG)
  • An ultrasound scan to check the amount of amniotic fluid (‘waters’) surrounding your baby.

These tests cannot detect all problems. Even if the tests are normal your baby is still at a small increased risk of stillbirth.

If you still decline induction of labour after 43 weeks of pregnancy we will offer referral to an Obstetrician and/or Supervisor of Midwives for further discussion and care planning.

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