An induced labour is one that is started artificially with drugs and/or breaking your waters. Every year, one in five labours are induced in the UK.
- 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
- There are concerns about your or your baby’s health e.g. gestational diabetes, pre-eclampsia or your baby is smaller than expected (this list is not exhaustive)
Your midwife or doctor will perform a vaginal examination. They will try to place 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. The aim is to stimulate a natural hormone (prostaglandin) to be released which gives an increased change of your labour starting naturally over the next 48 hours and reduces the need for other methods of induction.
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 attempt the sweep again in a few days with your consent.
Using prostaglandin (Propess/ Prostin)
Prostaglandins are drugs, which are inserted into the vagina to help induce labour by encouraging the cervix to soften and shorten or ‘ripen’. The aim of using prostaglandins is to allow the cervix to open enough to allow a midwife or doctor to break your waters (see artificial rupture of membranes below) and for contractions to start, although your waters may break on their own.
The process of using prostaglandins to induce labour can vary greatly between women as some may be more or less sensitive to the synthetic hormone. Therefore it is impossible to gauge how long an induction might take to get labour started. It can be anything from a few to 48 hours before labour starts. Although uncommon, in some cases the use of prostaglandins will not get the labour started at all and the only other option is caesarean birth.
This Trust uses two different forms of prostaglandin: Propess and Prostin. Your midwife or doctor will talk to you about which drug is more appropriate for you.
Propess ‘Out-patient induction’
Propess is used in straightforward pregnancies that have gone overdue by 7-12 days. The propess is inserted into the vagina by a midwife in the hospital. Your baby will be monitored for around 20 minutes before and after the procedure and if all is well you will be able to go home to await events and return to the hospital when your labour starts.
Prostin ‘In-patient induction’
Prostin is used if your labour is induced because your waters have been broken for 24 hours without labour starting, there are concerns about the health of you or your baby or you are less than 7 days or more than 12 days over your due date. Prostin is used on ‘in-patients’ only.
If your labour is being induced because your waters have been broken for over 24 hours without labour starting you will be given one dose of prostin only.
For all other prostin inductions you can have up to 4 doses of prostin before labour starts. Doses are given at least 6 hours apart, with no more than 2 doses in 24 hours (up to 2 doses a day are given over 2 days). As prostin is a synthetic hormone different women react differently and some are more sensitive to the hormone than others, so it is difficult to predict how long it might take for your labour to start. You will need to stay in the hospital throughout your induction.
Artificial Rupture of Membranes (Breaking your waters for you)
When labours are induced artificially then rupturing the membranes (the bag of fluid around the baby) is part of this process as we are attempting to mimic nature’s processes. This involves waiting until the cervix is starting to open usually by using prostaglandin (as explained above) although sometimes your cervix may have already made these changes on its own. With your permission, the midwife or doctor will undertake a vaginal examination and use a small plastic hook to snag the membranes and make a hole to allow the fluid to come out. Some women find the procedure uncomfortable but it should not be painful. The aim of breaking the waters is that it will stimulate labour start. If the labour does not start after having your waters broken you may need an oxytocin drip (see below).
Oxytocin infusion (hormone drip)
An oxytocin infusion aims to replicate the same hormones that the body produces during spontaneous labour and encourages contractions. It can only be used once your waters have broken. Women requiring an oxytocin infusion have 1:1 care with a midwife. The hormone is given through a drip in the arm and is increased very gradually to achieve regular contractions. The baby’s heartbeat is continuously monitored to ensure that he or she is not becoming distressed. Women who require an oxytocin infusion are not able to use the birthing pool, however we would still encourage and support you to be mobile and active in labour.
Rarely, induction of labour is unsuccessful. In these cases you will need a caesarean section.
If you decline induction when you are more than 42 weeks pregnant you will be offered:
• 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 and even if the tests are normal your baby is still at a small increased risk of stillbirth, usually because the placenta becomes less efficient.
If you continue to decline induction of labour after 43 weeks of pregnancy you will be offered referral to an Obstetrician and/or Supervisor of Midwives for further discussion and care planning.
If you have been recommended induction for a reason other than being overdue an individualised management plan will need to be made with you and your consultant based on the individual risk factors for you and your baby. You may also be referred to a Supervisor of Midwives for further discussion and care planning.