It is helpful to know what to expect in terms of how you prepare for your induction of labour.
This leaflet provides information regarding:
- What is Induction of Labour (IOL)
- How will I be induced?
- What are the risks to IOL?
- How long will it take?
- Pain relief options?
- On the day
- What if my IOL does not work?
- What if I choose not to be induced?
Section 1 – What is Induction of Labour (IOL)
IOL is when we attempt to start labour artificially. In the UK, approximately 20% (1 in 5) women will have their labour induced. There are many reasons why you may be offered an IOL. Some of these include:
Prolonged pregnancy. This is called a ‘post-dates’ induction where your pregnancy has gone beyond your due date by 10 – 14 days
- The pregnancy is affected by a medical condition such as high blood pressure, diabetes or obstetric cholestasis
- Multiple pregnancy e.g. twins or triplets
- Aged 40 or over
- When there are concerns about the growth or health of your baby
The reasons why are you are being offered an IOL will be discussed with you in full in order for you to decide if you wish to have IOL.
Section 2 – How will I be induced?
The method used to induce you will depend of different factors including your pregnancy, medical background as well as findings from your initial vaginal examination (this informs us how ready your cervix is for labour).
The main ways we use to induce your labour are discussed below. However, it is important to remember that your waters may break or your contractions may start at any time during your IOL procedure.
Membrane sweeping - This has been shown to increase the chances of labour starting naturally within 48hours of having this done and can reduce the need for other methods of IOL.
A membrane sweep is a vaginal examination during which your midwife or doctor places a finger just inside your cervix and makes a circular, sweeping movement to separate the membranes from the cervix. It can be carried out at home, at an outpatient appointment or in hospital. If it is your first baby this will be offered at both 40 and 41 weeks of pregnancy. If it is not your first baby it is recommended at 41 weeks of pregnancy.
You may feel some discomfort from the procedure and may notice a show of blood or a small amount of vaginal bleeding. As long as this is a small amount of blood and your baby is moving normally. This is nothing to worry about. Being mobile, well hydrated and active can also help encourage your body to start labour.
Prostaglandins - There are 2 types of prostaglandins that may be used. Which one and the reasons why will be discussed with you before use. Both options are designed to start to soften the cervix so breaking your waters (discussed overleaf) can be performed and encourage the start of labour.
Prostin pessary
It is inserted into the back of the vagina and works over a 6 hour period. You will be assessed after 6 hours and you may need more than one tablet inserted if the cervix is still not dilated enough.
Propess pessary
This is a tablet that is attached to a small ribbon which is placed inside your vagina. The hormone is slowly released over 24hours - you will not be assessed vaginally again until after the 24hours unless labour has started. After 24 hours the pessary is removed with the use of the small ribbon and you will be assessed to see if the cervix is dilated
Balloon catheter
A balloon catheter is used to stretch your cervix open, without using medication. A small catheter will be inserted into your cervix and a small balloon filled with water. This will be left inside for up to 24 hours and encourage your body to release natural labour hormones. During this time the catheter may fall out if the cervix has stretched open enough. Some women will be offered the opportunity to go home following the balloon catheter and this will be discussed with you at the time.
NB. For the cervix to dilate enough it can take quite a while and may require all above methods to be used.
ARM – Artificial Rupture of Membranes (breaking your waters)
A vaginal examination is performed and a small hole is made in the membranes with a slim sterile instrument. This may be uncomfortable for you but does not harm baby. You will feel a warm gush of fluids which will continue until the birth of your baby. In some cases, it may not be obvious if the ARM was successful and it may need to be repeated.
Intravenous hormone drip - Oxytocin
Depending on your circumstances or if labour does not start, we will use oxytocin to start the contractions or make them stronger and more frequent. This medication will be given through a drip in your arm. You can still be active in labour and move around. Your midwife will advise and support you with different positions.
You will remain on the hormone drip until your baby is born. Your baby’s heart rate and your contractions will be monitored continuously.
During your vaginal examinations if at any point your cervix is soft enough you will be offered an ARM (artificial rupture of membranes) / ‘breaking the waters’. Depending on your circumstances you may then be offered time for contractions to start naturally or you may be started on an intravenous hormone drip.
Section 3 – What are the risks to IOL?
As with anything in healthcare, there are risks associated both with having an induction of labour and not having an induction of labour. Not having an induction means that the pregnancy continues with clear discussion and understanding of the risks involved with this.
The current rate of induction of labour in North Cumbria is 39.7% of all pregnancies – this is within the parameters of regional and national statistics. In north Cumbria, around 1 in 5 women who attend for induction of labour will go on to have a caesarean section, either because we did not manage to get labour started or because there were concerns about the baby’s wellbeing before the cervix was fully dilated (and the baby was not low enough for vaginal birth).
One in 6 women will have an assisted birth either because the baby is not coping with pushing, which is tiring for babies as well as mums, or because pushing has not resulted in the baby being born meaning the risks of tears and bleeding begin to increase. If you have had a baby before, things are usually much more straightforward and we expect at least 4 in 5 women to have a normal birth.
With induction, we are nudging you into labour – your womb can sometimes contract quite frequently and babies don’t get a long enough break during contractions. We will monitor you and your baby continuously during labour after induction so that we get the right balance and ensure your baby is well. We aim to keep the focus on you and listen to you so that you have a positive and safe experience.
Women undergoing IOL have a slightly increased risk of a Post-Partum Haemorrhage (PPH) (bleeding).
Section 4 – How long will it take?
The induction process is different for every woman and depends how ready your cervix is for birth. Generally it can take between 2 -5 days from the start of induction to the birth of your baby.
Section 5 – Pain relief options
If you are being induced, you may want to consider your options for pain relief. Induction of labour can be more painful than going into labour naturally.
The use of prostaglandins and balloon catheter can cause early contractions and can last for quite a while, during this time you can request pain killers, use Entonox (gas and air) or consider a TENs machine to help you (the hospital does not provide a TENS machine). You also have alternative methods such as hypnobirthing and the use of water for pain relief. Women undergoing an IOL have a higher incidence of requiring an epidural for pain relief. We have a 24/7 epidural service in both hospitals.
Section 6 – On the day
On the day of your induction you will need to contact the labour ward where you are booked for IOL at 9am and we will advise you of what time to come in. See below for telephone numbers
On occasion the maternity unit can become very busy and in these circumstances we may need to ask you to call back later in the day. On rare occasions we may need to delay your IOL by 24-48 hours or offer you an induction date at an alternative hospital (either Carlisle or Whitehaven). We understand that delaying your induction can be very upsetting, however, our priority is ensuring that we are only starting the induction process when it is safe to do so.
At any point during your IOL, if you have any concerns or questions, please do not hesitate to speak to your midwife or Doctor.
The induction process can take a while so we recommend bringing in book/card games etc. to pass the time. We would also recommend bringing plenty of food and refreshments for the duration of your stay (in addition to regular hospital meals which are provided for women—unfortunately we are unable to provide meals for partners) and a few changes of clothes.
Whilst you are on labour ward you can have a birthing partner with you.
If you are on the antenatal ward (before labour) or the postnatal ward (following birth) your partner will not be able to stay overnight.
Section 7 – What if my IOL does not work?
If we are unable to get you in to labour the options will be discussed with you and your partner but can include:
- 24 hour rest and the induction process restarted
- Caesarean section
- Stop the IOL
Section 8 – What if I choose not to get induced?
If you choose not to be induced we will organise an appointment with an obstetrician to discuss an individual plan for your pregnancy. A plan will be put in place after discussion with you and with your agreement that will monitor you and your baby’s wellbeing.
Useful telephone numbers
Cumberland Infirmary, Carlisle
Triage: 01228 814269
Labour ward: 01228 814266
West Cumberland Hospital, Whitehaven
Maternity ward: 01946 523260
Labour ward: 01946 523242
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complaints@ncic.nhs.uk | 01228 936302