What is Induction of Labour?

“Induction of labour” is the process of artificially stimulating your womb to start labour.

Why do I need to be induced?

There are many different reasons, and everyone is an individual case.

Some common examples are:

• Your age –generally women over the age of 40 are offered induction at around 40 weeks as unexplained stillbirth rates in babies that have gone over their due date increases with maternal age.
• If your waters have broken but your labour hasn’t started naturally within 24 hours as the risk of you developing an infection increases after this time frame.
• If you are overdue (Different hospitals will operate different cut off points–between 41 and 42 weeks, considering local circumstances and your preference).

It’s important to understand the reasons behind why your Midwife/Doctor is offering you this procedure. It’s OK to ask questions, good ones to ask are:

• Why am I being offered induction?
• What are the benefits?
• What’s the risks (to me or my baby?)
• What happens if I choose not to be induced?
• When you feel that you have all the facts you can then come to a decision.
• What will happen if I’m induced?

1. When you attend the hospital for your induction your baby’s heart rate with be monitored for 20 minutes whilst you will have your observations taken (blood pressure, pulse, temperature, urine dipped etc.) This is check you and baby are fit & well before the procedure begins.

2. With your consent the Midwife will then undertake a vaginal examination and insert a pessary into the top of your vagina, at the back of the neck of your womb. The pessary is similar to a tampon because it has a tail on it to allow it to be easily removed. This procedure should not be painful but may well be uncomfortable – focus on relaxing your bottom half & breathing steadily.

3. Another 30 minutes of monitoring baby’s heart rate is done to ensure the baby is not having any reaction to the introduction of the pessary.

4. After this, depending on your circumstances and the policies of your hospital you may be allowed home, or you may need to stay on an Antenatal ward, Induction Suite or the Labour/Delivery suite in hospital.

5. If you remain in hospital you will have regular observations and monitoring of your baby’s heart rate, to check that you are both fit & well. Staff will be on hand if you need them, but you will generally be left to your own devices as you wait for labour to start. Some women find this first stage quite boring, so you might want to pack things to occupy you & your partner!

If you are at home, you will have regular contact with a Midwife from the hospital via the phone.

6. The pessary stays in place for 24 hours and during that time it releases an artificial version of the hormone prostaglandin which softens the neck of the womb. For some women the pessary can also start contractions but don’t worry if this doesn’t happen – we just like the pessary to open up the neck of the womb in order for us to move onto the next stage- anything extra to this is a bonus!

If you do become established in labour within the 24 hours the pessary will be removed, and you will be supported to labour with no further intervention unless required.

7. However, if you have not established in labour (and therefore had the pessary already removed) after 24 hours it will be time to go to the labour/delivery suite for the next stage of the induction process.

8. The pessary will be removed; your baby’s heart rate will be monitored again for 30 minutes and the Midwife will check your observations.

9. The Midwife (or Doctor depending on your circumstances) will then with your consent do another vaginal examination to assess what’s happening to your cervix and using something looking like a crochet hook, they will break your waters.

10. Depending on your circumstances and the hospital policy you may then be allowed to walk around for an hour to see if contractions will start naturally or some women will move straight onto the next stage.

11. The final part of the induction process is the “hormone drip”. Thirty minutes after the pessary has been removed and your waters have been broken (maybe a little longer if you have been allowed to walk around) a cannula will be inserted into the back of your hand and a drip will be connected. This fluid contains an artificial version of the oxytocin hormone (this is the hormone your body would normally produce in labour - it is responsible for your contractions). The hormone is given at a continuous measured dose starting low and then increasing every 30 minutes until you are experiencing 4-5 contractions in every 10 minutes.

12. Before you are connected to the hormone drip you will also have baby’s heart rate monitored – this will now be continuous monitoring until baby is born. So with cables attaching you to the heart rate monitor and the tubing from your hand to the drip stand it can become quite difficult to mobilise. It is still possible however to sit on a birthing ball at the side of the bed or adopt different positions such as all fours on the bed (although you can get tangled in all the wires!) But I’m afraid that a pool birth is definitely not an option by this stage.

13. Unfortunately I do have to let you know that induced labour is likely to be more painful than if you had started labour of your own accord. This is because the contractions build that much quicker and your body doesn’t have enough time to produce endorphins (natural painkillers) for each level before they increase again. So, think about the strategies you want to use to cope with this. (I’ll be writing lots of blogs on this soon!)

If it is suggested that you have an induction, make sure you understand the reason why. If you have any concerns and feel you would prefer not to have an induction you have the right to discuss this with your Midwife/Doctor.

Thanks for reading

Jane – The Midwife

For more blogs on pregnancy, birth and life as a new mum please visit www.naturalbirthingcompany.com/blogs/news

If you are unsure about anything or have any concerns whilst pregnant, please speak to your Midwife.