What is Induction of Labour?
In most pregnancies labour starts naturally between 37–42 weeks and is called 'spontaneous labour'. Induction of labour (IOL) is a process used to encourage labour to start artificially. In order for a baby to be born the cervix (the neck or opening to the womb) has to shorten, soften and open. Your appointments in the IOL clinic aim to ripen your cervix in this way.
Induction of labour is offered for three main reasons:
Prolonged pregnancy– pregnancy that continues after 41 weeks as there is a slight increase in the risk of your baby developing health problems. Induction of labour is therefore recommended between 41 and 42 weeks. At Hull University Teaching Hospitals NHS Trust, we begin the IOL process at 13 days over your expected date of delivery (due date), which has been determined by your dating scan.
Medical reasons– If it is felt that your health or your baby’s health is at increased risk if the pregnancy continues beyond a certain date.
Pre-labour rupture of membranes– (the waters around the baby breaking). If spontaneous labour does not happen approximately 24 hours after the waters break there is a small risk of infection to the mother and / or the baby. We will try to induce labour by 24 hours following rupture of membranes, however this may not always be possible. If your induction is delayed, you may be admitted to Maple Ward so that your baby and you can be assessed and monitored.
Once you have reached your due date, you will be offered a membrane sweep, followed by another at 41 weeks. This procedure has been shown to increase the chances of labour starting naturally within 48 hours of the procedure and can reduce the need for other methods of induction of labour.
You may also be offered a membrane sweep earlier than your due date if induction of labour is being done for medical reasons. The timing will be advised by the doctor responsible for your care.
A stretch and sweep is a vaginal examination that can be carried out at an Antenatal Clinic in the hospital or community setting. The procedure involves the doctor or midwife putting two fingers inside your cervix and making a circular sweeping movement to separate the membranes from the cervix. This increases the production of hormones called prostaglandins which can encourage labour to start.
There may be some discomfort or bleeding but it will not cause any harm to you or your baby. It will not increase the chance of you or your baby getting an infection. Also, you can choose not to have a stretch and sweep.
All women come to the outpatient Induction of Labour Clinic on Maple Ward to have the procedure started.
Most women will be able to go home after their appointment but sometimes you will have to stay in hospital because of medical reasons or the method of induction being used. Please pack a birth bag and either bring it with you or have it available in your car. If your cervix is favourable to have the waters around your baby broken or the waters have already broken (pre-labour rupture of membranes) you will be induced on the Labour Ward. Please be aware that breaking the water around the baby can only be done on Labour Ward.
Admission to the Labour Ward will be managed according to individual needs and this may happen straight away or more likely you will be asked to wait at home with possible daily appointments in the IOL clinic until you are called to attend Labour Ward.
At busy times, the start of the induction process may be delayed. Very rarely it may be delayed for over 48 hours, however, the clinic midwife will discuss this with you at your appointment.
At the IOL clinic appointment, the midwife will discuss everything with you to make sure you understand the procedure. The midwife will do a full antenatal check on your baby and you and record your baby’s heartbeat with a cardiotograph (CTG) machine that gives a paper recording of the heartbeat.
You will have a vaginal examination to determine how favourable your cervix is to break your waters (Artificial Rupture of Membranes). If your cervix is not favourable then one of the methods below will be used to soften and open the cervix in order to be able to ‘break the waters’ around the baby. They may sometimes cause contractions to start.
Cervical Ripening Balloon Catheter
This is the only method used for outpatient induction of labour. This is because it has minimal side effects and does not need you to be monitored as closely as when using a medical method.
The procedure involves a catheter (a soft silicone tube) being inserted into your cervix. The balloon near its tip is then with sterile saline (salt water). The catheter stays in place for 24 hours, with the balloon putting gentle pressure on your cervix. The pressure should soften and open your cervix enough to start labour or to be able to break the waters around your baby.
The balloon catheter may fall out by itself or will be removed by a midwife the following day. You will be sent home with advice about what to do if you get contractions, bleeding , reduced baby movements or the waters around baby break by themselves.
Prostaglandin is a hormone that is naturally produced by the body. It is involved in starting labour. We use two methods to deliver an artificial version of prostaglandin.
- A pessary known as ‘Propess’® is inserted into the vagina. It releases the hormone slowly over 24 hours. It will be removed earlier if labour starts or there are any concerns about you or your baby’s health.
- A tablet called ‘Prostin’® is inserted into the vagina. You will be re-examined six hours after the first tablet; if the cervix is still not ready for the waters to be broken or you have not started in labour then a second Prostin® tablet will be inserted into the vagina.
You will have to stay in hospital if these methods are used, as your baby will need to be monitored every six to eight hours. It is important to be aware that the process of softening and opening the cervix can take up to five days and it may fail completely.
When the cervix is favourable to have the waters around the baby broken, known as an Artificial Rupture of Membranes (ARM), you may be able to go home and, unless you go into labour spontaneously, you will be contacted by the Labour Ward with a time for admission.
A bed may not be available on the Labour Ward for up to five days.
The consultant in charge of the Labour Ward will make a decision about when to admit you to the Labour Ward based on medical needs and at all times keeping in mind the safety of your baby and you. If you are being induced as an outpatient, this will NOT affect the decision about when you will be admitted to the Labour Ward. While you are waiting you may be offered daily assessment and monitoring of the baby.
Artificial rupture of the membranes(ARM)
When the cervix is soft, open to around two to three centimetres and the baby’s head has gone down into your pelvis, it should be possible to ‘break the waters’ around the baby.
This procedure is carried out by using a small plastic hook which releases the water and allows the pressure of the baby’s head to press on the cervix and stimulate contractions. It will not harm you or your baby. The procedure may be uncomfortable but it should not be painful.
You may be given some time to see if contractions start or we may use an artificial hormone called Syntocinon® straight away.
This is an artificial form of the hormone that causes your uterus (womb) to start having contractions, given through a tiny tube into a vein in your arm (drip). It can only be given when your waters have broken.
The drip is increased very slowly until your uterus is contracting regularly and strongly. During labour, your baby’s heart rate will be monitored continuously by a cardiotocography (CTG). Your ability to walk around will be limited by the drip and monitor, although you may choose to stand up or sit on a chair or birthing ball.
The Syntocinon® drip is the main form of induction when your waters have broken naturally and you do not go into labour.
In a small number of cases induction of labour is not successful following repeated attempts. Your management will then be discussed with your consultant obstetrician and a plan for birth put into place. It may be that a caesarean section is recommended.
We recommend making family, especially children and those caring for them aware that the procedure can take a long time (in some cases over a week) before the baby is born.
You may bring a book, magazines and games to keep you occupied due to the length of time the procedure may take.
There are television and telephone consoles by each bed and there is a secure mobile phone charging station on the ward. Mobile phones should NOT be charged by the bed.
Your birth partner may visit you either between 9am to 1pm, or 3pm to 7pm.
If you have any further questions, please contact Maple Ward on 01482 607779