Induction of labour is a process used to encourage labour to start artificially.
In order for a baby to be born the neck of the womb (cervix) has to shorten, soften and open. There must also be contractions. In most pregnancies labour starts on its own (spontaneously) between 37 – 42 weeks.
Induction of labour is advised when it is agreed that you and/or baby will benefit from it. So you can make an informed decision, you should expect the reasons for induction to be explained in detail to you.
Examples of common reasons for induction of labour:
- Pregnancy that has continued past 41 weeks
- If your waters break after 37 weeks but labour does not start on its own.
- Concerns that the placenta is not working well, for example if there has been a slowing of your baby’s growth
- Concerns about high blood pressure or protein in your urine (pre-eclampsia)
- Other concerns about you or your baby’s health, such as diabetes
Membrane sweep
Before an induction of labour you may be offered a ‘membrane sweep’. If you would like a membrane sweep, it is usually performed around 40 weeks. It only takes a few minutes and can increase your chances of going into labour on your own.
A membrane sweep is an internal vaginal examination. Your midwife or doctor will use their fingers to feel for the neck of your womb (cervix). If the neck of your womb has begun to open slightly, the midwife or doctor will ‘sweep’ their fingers around this area. This can release hormones which help to start labour.
A membrane sweep can be performed in a clinic or at home. If you are at home please provide your midwife with hand washing facilities and a private environment for yourself. If you have other children it is helpful if someone else can care for them during this visit.
The membrane sweep can feel uncomfortable. Following a membrane sweep you may experience some ‘spotting’ of blood, followed by cramp-like pains, a little like period pains. This is normal. If you experience any heavier vaginal bleeding, have concerns about your baby’s movements or think your waters might have broken after a membrane sweep, contact the maternity assessment unit on 0191 282 5748.
Induction of labour – what to expect
You should receive a phone call the night before your induction letting you know what time to come to hospital. Please bring your hand held notes with you when you attend for induction.
On arrival to the RVI, the maternity reception staff (Level 4, Leazes Wing) will direct you to the Induction Suite. The induction suite consists of six beds in two shared bays on Delivery Suite. There is a shared toilet and bathroom. The induction area should be permanently staffed by one or two midwives and a maternity support worker. The induction team’s job is to provide care and support to you during this part of the process. Your midwife will explain the procedure and answer any further questions you have about induction. You may also need to speak to a doctor before the induction starts.
Initial assessment
A midwife will perform an assessment of yourself and your baby’s wellbeing before starting the induction. This will involve checking your pulse, blood pressure and temperature, and testing a sample of your urine.
The midwife will check the position of your baby by feeling your bump. They will perform a quick scan to make sure baby is ‘head down’. A recording of the baby’s heartrate will be taken to ensure your baby is doing well and it is safe to go ahead with induction.
Providing everything is well, your midwife will offer you an internal vaginal examination. This is to check the neck of your womb (cervix). This helps the midwife to decide the next steps of the induction process.
Prostaglandin (Hormone) Gel
If the neck of your womb is closed or if this is your first baby, then you will be advised to have a medication called Prostin. This will be inserted into your vagina by a midwife. At the RVI, this medication is in the form of a gel. The medication is similar to the natural hormones that help to start labour. It can soften and open the neck of your womb.
We will monitor your baby’s heartbeat for an hour after we have given you the Prostin medication. After this you can walk around if you wish. We also can give you a birth ball to aid relaxation and comfort. If it is night time you may like to try to get some rest and sleep if you are able to.
You will be offered an internal vaginal examination 6 hours after the Prostin medication to see if there has been any change to the neck of your womb. If there has been little change, you may be given some more of the medication. You can have up to three doses of Prostin.
Some people go into labour after the use of Prostin. However, it is more common that the Prostin will have helped your cervix soften and open enough for it to be possible to ‘break your waters’.
Some people will not need any Prostin as the neck of their womb will be soft and open enough for a midwife to offer to break their waters.
Breaking Your Waters (Artificial Rupture of Membranes – ARM)
Once your cervix has softened and opened enough, your midwife will offer you a further internal vaginal examination to break your waters. This is to allow your baby’s head to apply more pressure to the neck of your womb, to hopefully start contractions.
Once your waters are broken your baby’s heart rate will be monitored for around 20 minutes. You will be helped to get clean and move around. You will also be provided with some maternity pads as the waters will continue to come away until your baby is born.
It is recommended that you try and stay mobile after your waters have been broken to see if labour can start on its own.
Hormone Drip (Syntocinon)
You will be offered a private birthing room at this stage. You may also meet a new midwife who will care for you until your baby is born.
Your labour may start on its own after your waters have been broken. If this happens there will be no need for any further induction measures. If you have not begun to labour on your own 2 hours after your waters have been broken, you will be offered a hormone drip in your hand to help with contractions.
This medication we give through the drip is called Syntocinon and it is a man-made version of the hormone that causes contractions in a natural labour (Oxytocin). The medication is given through the drip in your hand very slowly and in measured amounts until you are having strong and regular contractions. If you receive the hormone drip during labour, this drip will continue for 4hrs post birth as per guidelines. We will continuously monitor your baby’s heartbeat during labour.
Augmentation of labour
If your waters have broken after 37 weeks, we will ask you to come in to see us so that we can confirm this has happened and make sure that you and your baby are well. As long as everything is as expected with you and your baby, you will be advised to go home and wait for labour to start.
You will be given a time to come back to the RVI for an ‘augmentation of labour’, just in case labour does not happen on its own. You will be invited to come back around 18 hours after your waters have broken. An augmentation of labour is similar to an induction but we do not need to break your waters because they have already broken on their own.
If this is your first baby or the neck of your womb is closed, you will be advised to have one dose of the Prostin gel and wait 6 hours before starting the hormone drip.
If you have had a baby before, you may not need a Prostin and so will be offered Augmentation of Labour using the hormone drip (Syntocinon).
Frequently asked questions
Who can accompany me?
One birthing partner is welcome to attend your induction with you and stay for all of your labour care. A second birthing partner can join you when you are moved to your delivery room.
When would I expect my baby to be born?
If this is your first baby, the average time from admission to birth is 25 hours. The labour itself usually lasts about 12 hours. If you have had a baby before then the average time from admission to birth is 18 hours. The labour itself usually lasts about 8-10 hours. However, this can vary greatly from person to person.
What pain relief is available to me during induction of labour?
Whilst you are in the induction suite we can help with comfort measures such as supplying heat-packs if you are experiencing back ache. Some people choose to bring a TENS machine and use this during induction and early labour. We can also supply you with simple oral pain relief such as paracetamol and dihydrocodeine if required.
Once you are in labour and transferred to your own room then all the usual forms of pain relief are available to you.
What if the induction is unsuccessful?
Sometimes it is not possible to break your waters after up to three Prostins have been given. If so then one of the doctors on delivery suite will discuss your options with you. Options may include the a caesarean section or resting without further Prostin for one or more days, before starting the induction process again.
Further information regarding inductions can be found here.
