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Induction of labour

What is induction of labour?

In most pregnancies labour starts naturally between 37 weeks and 42 weeks, leading to the birth of the baby. Induction of labour is a process designed to start labour artificially.

Inducing labour without a good reason is not recommended. Your labour may be less straight forward, more painful and take longer to start. Induction of labour has been shown to increase the likelihood of a caesarean section, ventouse (suction cap) or forceps delivery, compared to those who go into labour naturally.

The reasons for induction of labour should be fully discussed with you. If you are not clear about anything then please ask your doctor or midwife before you decide to go ahead.

Induction of labour does not send you into labour. We aim to get your cervix open enough to be able to break your waters.
The whole process of induction of labour can take several days. The date you are given for induction may not be the day you have your baby. Please be aware that it may be necessary due to unforeseen circumstances to change your given date at short notice.

Before induction can be started, there is a crucial process to be followed which includes ensuring that Delivery Suite (D/S) has capacity to receive you there should transfer be required; this may be urgent in nature or simply as a progression of your labour. In some instances, due to D/S being exceptionally busy, it is deemed unsafe to induce a labour and therefore inductions are fully cancelled.

How is labour induced?

Membrane sweeping (can be performed by your community midwife as part of your normal antenatal check; in a consultant clinic or on the ward)

Research has shown that a membrane sweep can be a more natural way of starting labour than using medication; and this will be offered to all women whose pregnancies are overdue before other methods of induction are arranged.

A membrane sweep is usually done by your midwife at around 41 weeks. While internally examining the vagina she will simply sweep a finger around the neck of your womb (cervix). The aim is to separate the membranes around your baby from your cervix; this releases hormones called Prostaglandins. More than one ‘sweep’ may be necessary.

If the membrane sweep is successful, labour may start within the next few days. It has a higher chance of working if the neck of your womb is already softening and preparing for labour.

Membrane sweeping – are there any risks or complications?

In uncomplicated pregnancies it will not cause any harm to either you or your baby. It can be uncomfortable as the neck of the womb is often difficult to reach before labour begins. There may be some slight ‘spotting’ of blood immediately afterwards. This is normal.

Propess (Dinoprostone) pessary (this can be given on the ward)

If your cervix is not ready to go into labour, and not open enough to break your waters, we will help it to open by using Propess® (Dinoprostone). This is done by the midwife performing a vaginal examination. The pessary, which is inserted into the vagina, looks like a very small tampon. It contains Prostaglandins which are released slowly over 24 hours to ripen your cervix. The midwife will perform regular checks on you and your baby during this time. It is normal for you to feel that not much is happening, however there will be changes happening to your cervix that you cannot see or feel.

Please tell the midwife if you experience regular pain, if your waters break, if you experience bleeding or if you are worried. If labour does not start the pessary will be removed after 24 hours. If there is no or little change in your cervix after this 24hours then Prostin Gel may be used.

Prostin Gel (this can be given on the ward)

This is inserted via applicator by the midwife at a vaginal examination. Once given, it will be at least six hours before the midwife will examine you again, unless you go into labour. A further dose can be administered after six hours if necessary. The midwife will perform regular checks upon you and your baby throughout the induction process.

Breaking of your waters (rupturing of membranes: also called artificial rupture of membranes, or ARM). This is only performed on delivery suite

Once the cervix is open enough it will be possible to break your waters. This is done by another vaginal examination using a special instrument; it can be an uncomfortable procedure. You will be allowed an agreed length of time to move around to encourage your contractions to start once your membranes have been broken. . If your contractions do not start you will need to have a hormone drip to make you have contractions called syntocinon. (Sometimes there may be a delay in transferring you to the delivery suite if a high number of women have attended already in labour as we are committed to providing one to one care during your labour)

Syntocinon (hormone drip). This is only performed on delivery suite

This will be started to stimulate contractions. It is given under strict supervision by your midwife, who will monitor both you and your baby closely. The drip will be increased gradually until you are having contractions every couple of minutes. It can be turned down if needed and even stopped, but only with good reason and discussion with the doctor.

It is beneficial for you to remain as upright and mobile as possible once contractions begin, and this can be achieved even if you have drips and monitors attached. Syntocinon will only be commenced when it is safe to do so.

Any combination of these methods we use for induction may be necessary for you. The decision of what combination will be decided by the doctor.

When do I come to the hospital?

You will be given a date and a time to come to the Antenatal Ward. If it is your first baby, you will be asked to come in the morning, and if it is not your first baby, you will be asked to come in the evening.

Can my birth partner stay with me?

Your birth partner will be welcome to stay on the ward with you if this is what you wish. There is a policy and a code of conduct agreement for your birth partner to read and sign; you just need to ask the midwife when you are admitted to hospital.

It is important to consider the following points for your birth partner:

  • We are unable to provide beds to sleep in or bedding/pillows. You are welcome to bring a roll up mattress/sleeping bag/duvet etc.
  • We are unable to provide any food or drink for your birth partner other than drinking water. There are facilities available in the hospital where both may be purchased. Hot drinks can be made on the ward from the facilities in the lounge area; a donation would be appreciated for these.

We are unable to provide any medical assistance to your birth partner; this includes headache medication. Should they become unwell, they will be asked to attend the A&E Department.

The whole process of induction of labour can take several days, and it may be better for your birth partner to sleep in their own bed overnight. They will then be able to provide support to you once you are in labour. We will contact your birth partner at any time day or night should you wish.

What should I bring into hospital with me?

You need to bring with you everything for a few days away from home, including toiletries and towels. There is no need to bring your baby bag and car seat into the Antenatal Ward. You will not need these until your baby arrives. Bring books, magazines and entertainment for yourself, as you may be with us for a couple of days. There is a television in your room, but there are no facilities for DVD players etc. A checklist is available to download here.

Visiting on the antenatal ward

Your birth partner is welcome at any time on the ward. Other visitors are asked to visit in the afternoon from 15.30 until 19.30.

You may wish to inform your relatives that the day you come to hospital may not be the day you have your baby. It is a good idea to have one relative whom you contact to let them know what is happening, and they can cascade the information to other relatives. Due to the Data Protection act and Confidentiality we are unable to give any information over the telephone.

We do not allow flowers in the hospital, and children who are not your own are unable to visit, this is to minimise the risk of infection to you and your baby.

We want your time on the Antenatal ward to be as pleasant as possible. The Midwives will be happy to answer any questions or queries you may have so don’t be afraid to ask. We operate an ‘open door during the day’ policy, and would ask that you adhere to this unless your door needs to be closed for a specific reason.

Throughout the Maternity Unit we greatly value your feed back and comments.A questionnaire is distributed on a weekly basis; however should you miss the distribution, please ask for one as your views are what we use to improve things which you feel we could do better.

This information is based on Maidstone and Tunbridge Wells NHS Trust practice and guidelines.