Your guide to induction of labour
Induction of labour (IOL) is the term used to describe the artificial onset of labour. Induction of labour is a relatively common procedure. About 1 in 20 of all deliveries in the UK is induced. There are various reasons for IOL and after discussion between you and your midwife / obstetrician you will be given date and time to attend your unit. However if you choose not to have your labour induced, your obstetrician will discuss your options with you.
Date ...... Time………………………..
Ward ………...... Telephone number………………
Before your IOL date you will be offered 2 membrane sweeps. The membrane sweep involves a vaginal examination (VE) to stimulate the cervix by separating the membranes from the cervix. This is usually performed in your own home by your community midwife but occasionally may be performed in the antenatal clinic by your obstetrician. Membrane sweeps have been shown to increase the chance of spontaneous labour.
There are 3 parts of the induction process:
1. Vaginal prostaglandins tablets / pessary - this will soften the cervix to become open.
2. Artificial rupture of membranes (ARM / amniotomy) / also known as breaking the waters.
3. Intravenous infusion (IV) of Oxytocin – artificial hormone to stimulate contractions.
Occasionally if your cervix is favourable, part 1 will not be required.
If your cervix is found to be open / favourable and your waters can be broken easily you will be given a provisional date and time for admission to Labour Ward. Please phone the ward at approximately 07.00 on the day of admission for bed availability.
If your cervix is closed or if you haven't been examined, you will be given a provisional date and time for admission. Occasionally when you are admitted the VE may show that the cervix has become more favourable. If this happens you will be able to go home and return the following morning to have your waters broken.
Labour ward can become very busy without warning and therefore in order to maintain safety for you and your baby, the induction of labour may be delayed or halted even at short notice.
On admission please bring with you your hand held antenatal notes and any current medication you are taking.
The midwife will perform an antenatal examination and a trace of the baby's heartbeat will be recorded by a CTG machine for approximately 30 minutes.
A VE will be performed and if it is not possible to break your waters easily a prostin pessary will be placed into the vagina behind the cervix. This is to soften and open the cervix to become favourable. The CTG will then be continued for a further 30 minutes. You may experience period type pain requiring some pain relief. You will be assessed again after 6 hours and may require further prostin. Sometimes more than 2 pessaries are required to make the cervix favourable and therefore you will be in hospital for a few days before labour commences. In this case your consultant and midwife will discuss further changes to the plan of care.
On labour ward the same admission procedure will be performed. Your birth plan and any preferences will be discussed. A CTG will be commenced and the midwife will perform a VE to break your waters. An IV containing an artificial hormone to stimulate contractions will be commenced. Throughout your labour your baby’s heart beat will be monitored continuously. Diet and fluids may be taken in the early stages of the induction process, however please check with the midwife who is looking after you. The IV will be continued for approximately one hour after delivery.
Visiting on Labour Ward
This is restricted to your birthing partner(s) only (maximum 2). No telephone information will be given to family and friends. There are no facilities for your partner to stay with you outside visiting times before your labour is established. The facilities provided in the room are for your use only, the restaurant and toilet facilities for your partner(s) are located within the hospital.
Are there risks to induction of labour?
Women undergoing induction of labour are more likely to require analgesia and assisted birth. Where labour is induced by drugs, about two-thirds of women will give birth without any further intervention, about 1 in 6 (15%) will have instrumental delivery (forceps or ventouse) and about 1 in 5 (22%) will have an emergency caesarean section.
Failed induction – this is when the prostin tablet does not work, and a further plan of care will be discussed with you
Cord Prolapse – rare occurrence when the cord slips past the baby into the vagina after ARM
Hyperstimulation – this is where the uterus (womb) contracts too frequently.
Uterine rupture – rare occurrence, where a tear develops in the uterus
Glossary
Cervix - the neck of the uterus/womb through which the baby passes during birth.
Prostin Pessary – Is the hormone tablet that is inserted next to the cervix to help make it favourable.
CTG - Is the machine used to monitor and record the baby's heartbeat and your contractions.
ARM – Artificial rupture of the membranes – breaking the waters in front of the baby’s head – the cervix needs to be open enough to do this.
Reference
Department of Health, Induction of labour, National Institute of Clinical Excellence (2008) Evidence update 2013
RCOG guidelines
Publication date: Sep 2017
Date of review: Sep 2020
Responsibility for review: Documentation Lead - Maternity
Leaflet reference number: PIL/CG/0277
Version: 3.0