Induction of labour

Induction of labour (IOL) is the process of artificially starting labour and is offered when it is felt that your baby’s health or your health will benefit. This process takes place in hospital.

There are different reasons why you may be recommended to have your labour induced. The 3 main reasons are:

Prolonged pregnancy -There is a slight increase to your baby’s wellbeing once your pregnancy exceeds 41 weeks, therefore we offer a postdates appointment in the Antenatal Day unit to assess your pregnancy and offer IOL routinely between 10-13 days over your due date.
Pre-labour rupture of membranes = Sometimes the membranes around the baby break (waters breaking) and labour does not start. Over time, this can lead to a small increase in the risk of infection to your baby.
Medical reasons – You may have existing medical condition or problems can develop during pregnancy that affect you or your baby’s wellbeing (such as very high blood pressure, bleeding, or concerns regarding the baby’s growth) where it may be safer to start labour and deliver your baby earlier than expected.

There are various ways that labour can be started, and it is dependent on your individual circumstances. You may not require all procedures to induce your labour and your progress will be evaluated at frequent intervals and discussed with you.

Membrane Sweep

This is not a formal method of induction, but it can help start labour naturally in some cases and is worth considering. Membrane sweeps can be undertaken by your midwife.

To carry out a membrane sweep, your midwife or doctor sweeps their finger around your cervix (entrance to your womb) during an internal examination. This action should separate the membranes of the amniotic sac (sac of waters) surrounding your baby from your cervix. This separation releases hormones (prostaglandins), which may start your labour. It is not possible to perform a membrane sweep if the cervix is closed, and a membrane sweep is not always successful at starting labour.

Prostaglandin Pessary (Propess or Prostin tablets)

To have a prostagladin pessary, you will be admitted to the hospital and stay until after your baby is born.

A vaginal examination (VE) is performed to assess your cervix (entrance to your womb) and a small tampon or pessary is placed at the back of the cervix which slowly releases a hormone to soften and open up your cervix. Sometimes you may need the hormone re-siting or further dosages. Your midwife will keep you informed of your progress. It is normal to get cramping and backache during this process and you can help by staying active, using a birthing ball, bath or TENS machine. If you need stronger pain relief please ask the midwife caring for you.

Artificial Rupture of Membranes (ARM)

This is always undertaken on our central labour suite and is only required if your waters are intact.

A vaginal examination will be performed, and a small implement called a amnihook is used to make a hole in the membranes (sac of waters) that surround your baby. This allows the water to drain slowly and can help contractions start. It is no more uncomfortable than having a vaginal examination, but you will continue to slowly leak water until your baby is born. Sometimes this is done before starting a drip which contains a hormone called Oxytocin.

Oxytocin

This is given in the form of an intravenous infusion (drip) through a cannula in your hand, wrist, or arm). It is a synthetic hormone that causes your uterus (womb) to contract and open up your cervix (entrance to your womb). It is usually started slowly and increased until you have stronger, regular contractions. During this time, your baby’s heart rate will be monitored closely with a cardiotocography (CTG) machine to ensure there are no concerns. This part of the induction process is always undertaken in a labour room on Central Labour Suite (CLS) and works best if your waters are broken.

The IOL process can be unpredictable in terms of individual needs, process required and length of time to deliver. It is not possible to say when your baby will be born and occasionally there can be unforeseen delays due to high activity on labour ward. We aim to proceed with each step of the induction of labour process as soon as is safe to continue. If you have any concerns about this please speak to your midwife.

Before your induction of labour

You and your partner will be asked to attend for Covid 19 swabs around 3 days before your admission to hospital and this is done either in the Antenatal Day Unit or on the Central Labour Suite assessment area. A throat and nose swab will be taken, and this will be repeated on admission.

You will then be informed of the time of your induction and where to attend.

At the start of your induction of labour

On the day of your induction of labour, please attend maternity reception at your designated time and they will direct you to the department where the induction will take place. We aim to perform the induction process in a single room and your partner can be present throughout (on Ward 32, we have camping beds available if you wish for your partner to stay overnight with you). If the induction process is started in Antenatal Day Unit, you will be transferred to ward 32 after the prostaglandin medication is administered. If the induction process is started on ward 32 or Central Labour Suite (CLS) assessment area, you will remain there until it’s time to transfer to a CLS labour room.

The midwife caring for you will introduce herself and offer to check your temperature, pulse, blood pressure and palpate your abdomen (tummy) to feel the position of your baby. Your baby’s heartrate will then be monitored prior to examination. This is to ensure your baby’s safety prior to the induction process starting, is performed before and after prostaglandin administration, and throughout labour if you require the oxytocin infusion (drip). We have wireless monitors if you prefer to be mobile, please ask the midwife if you would like to use these.

A vaginal examination is then performed and based on these findings the midwife will decide which process you require and commence the induction.

If you need to be transferred to labour ward your midwife will liaise with the midwife in charge and organise your transfer as soon as possible.

You are welcome to bring extra pillows, snacks, music and things to help you relax during your IOL. We encourage you to be as mobile as possible and use the ball or bath to aid relaxation. Pain relief is also available, please discuss this with your midwife if you feel you require support, as there are different options available depending on the stage you are at.

It is normal to have questions or be uncertain if IOL is the right decision for you. You will be involved in the decision making. If you have any concerns, please do not hesitate to discuss these with your midwife or doctor.