What to expect with an induction of labour

Short on time? Then the key things to know are:

• You may be offered an induction of labour if you have any health conditions, or if there are some concerns about the baby
• Most inductions are offered due to women being over their due date, at around 42 weeks
• There are two types: medical inductions and mechanical inductions
• The aim of an induction is to soften and dilate the cervix enough to allow the waters to be broken
• If the induction is not successful you may be offered a caesarean section
• You and your baby will be closely monitored throughout the induction process
• You may be offered an out-patient induction so you do not need to be in hospital for the whole induction process

 

What is induction of labour and why would I be offered one?

A pregnancy is considered to be full term between 37-42 weeks. Most pregnancies will end in a spontaneous, natural labour, however, it is sometimes necessary to induce labour; in other words, artificially start labour.

Reasons for induction of labour

Most hospital trusts throughout the UK would consider inducing labour if women go over 42 weeks of pregnancy. Postdates (over 42 weeks) is the most common reason to induce labour. It is thought that by 42 weeks the placenta can become inefficient and not work to its full potential.

Some women are offered an induction of labour before 42 weeks, if, for example, you have high blood pressure or for whatever reason the baby is not growing as well as can be expected. Women will not usually be offered an induction of labour before 36 weeks.

You may also be offered an induction before your due date, if your waters have broken and labour doesn’t start within 24 hours of them breaking. This is because once the waters have broken there is an increased risk of infection for you and your baby.

Labour induction process

An induction of labour often starts with a membrane sweep. This will be offered to you by your midwife or doctor.

What is a membrane sweep?

A membrane sweep is an internal examination, where the midwife or doctor attempts to insert a finger through the cervix, and tries to stir up the membrane sac in a sweeping motion.

This procedure can be a little uncomfortable and can often result in some bleeding. It can help to start labour or can cause you to feel some small contractions or irritations in the uterus.

What happens if a membrane sweep doesn’t do anything?

After a membrane sweep the next step would be to start a medical induction. This involves the insertion of a prostaglandin, often in the form of a pessary, gel or tablet. Some women are able to go home following the induction to await events, otherwise you will be kept on the maternity ward for close observation.

What is a balloon induction?

Some trusts are now offering a ‘mechanical’ induction rather than a medical induction. This process is seen to be safer than a medical induction as sometimes the pessaries or the gel have been known to over stimulate the uterus, which can cause complications.

It works by inserting a balloon catheter into the vagina, which puts constant pressure on the cervix, which in turn causes prostaglandins to be released and therefore helps the cervix to open up enough to be able to break the waters.

A medical induction can be left for 6-24 hours depending on the type of medication used and you would be checked at regular intervals. If at any time when you are at home you start to feel contractions or your waters break you should let the midwife know.

What happens if the induction doesn’t work?

An induction is not always effective. If it has not worked at all you may be offered another induction or a caesarean section depending on your circumstances.

Can I have my waters broken?

If the induction is successful and the cervix begins to dilate, you will be offered an amniotomy (a midwife or doctor tol artificially rupture the amniotic sac) and then a hormone drip infusion to help the contractions increase in frequency and intensity. The aim of an induction isn’t necessarily to get you into labour straight away, but simply to soften and dilate the cervix enough to allow the medical team to carry out this amniotomy.

It is possible that labour can start at any point during the induction process and it is possible that it won’t start at all. If labour does start, it should continue to progress normally, if it doesn’t start at all, even after the hormone drip then again you would be offered a caesarean section.

Your baby will be monitored regularly when undergoing an induction of labour and if at any point it becomes apparent that the baby is getting stressed, the induction process will be stopped or a caesarean section will be advised.

What are the risks of an induction of labour?

A medical induction is essentially trying to force the hand of nature and therefore is not always successful. It puts you in a higher risk category of having to have a caesarean section and also puts you at a higher risk of infection due to the increased amount of internal examinations and intervention.

Whilst it sounds like a daunting and risky procedure, it is sometimes worth bearing in mind why you are being offered an induction in the first place. It is important that you are aware of why this process is being offered and always ask plenty of questions, don’t always assume that this is the best path.

Do I have to be induced?

If you are being offered an induction for being post dates (overdue), it is completely reasonable to ask for extra monitoring and give yourself a few extra days grace to try and get into labour yourself.

How long does it take?

An induction of labour can be a lengthy process so be prepared to be hanging around for some time. The initial stages can take from 24-48 hours and if that hasn’t been successful you may be asked to rest for 24 hours and start again, if it is safe and practicable to do so.

Natural induction of labour methods

Whilst there is no medical research to confirm their effectiveness there are a few other things you could try in the lead up:

• Walking - especially up hills and sideways down stairs
• Try a spicy curry - this is more likely to upset your bowels, but as your bowels lie directly by the side of the uterus it is thought that an irritable bowel will irritate a uterus and therefore start uterine contractions
• Sitting on a birthing ball - like walking this helps to widen your pelvis and will encourage baby’s head to put more pressure onto the cervix
• Making love - this can work in two ways, semen contains prostaglandins, the hormone that we use during an induction, so if this is near the cervix it could encourage the cervix to soften - also when women orgasm they produce the hormone oxytocin, which is the hormone that we need to get contractions started

Looking for support with your birth? Book an appointment with one of our private midwives at a time that suits you to get specialist advice with any concerns.