Induction of Labour
‘ Starting labour to safely deliver your baby ‘
What is ‘Induction’?
Induction of labour occurs when your doctor uses medicine to start your labour for you
instead of waiting for it to begin on its own. Labour is induced when the risks of the
pregnancy continuing are greater than the risks of staying pregnant. These may be risks to
yourself or to your baby.
When is labour induced?
Being overdue: In most pregnancies, labour starts naturally between 37 and 41 weeks
leading to the birth of your baby. If your labour has not started by 41 weeks, induction of
labour is offered.
Waters breaking without contractions (after 37 weeks): In some women the membranes
and fluid around the baby breaks before the labour starts. Most women will go into labour
spontaneously within 24 hours of this happening. If they don’t then induction is offered, as
the risk of infection is slightly increased.
Other reasons your labour might be induced include:
Diabetes
High blood pressure
Infection
Bleeding
Concern for the baby, including growth problems
Your doctor will discuss your reasons for induction with you. It is important to know that if
you do not wish to be induced and would rather wait for your labour to start naturally then
it is up to you to decide about the risks and benefits. If you decide not to be induced, we will
need to keep a closer eye on the baby with scans and monitoring once you go 2 weeks past
your due date.
Ratified by W&CH Q&S Group
Date: March 2013
What happens?
At 41 weeks, all women are offered a membrane sweep by their midwife. This is an internal
examination to encourage labour to start. It may be uncomfortable but does not cause any
harm to you or your baby. If labour has not started 2 days later, another sweep will be
offered, and if you need another, a final one is offered around 40 weeks + 11 days.
After your sweeps, if the neck of your womb (called the
cervix) is not at all ready for labour then a drug called
prostaglandin can be used. Prostaglandin is a drug that
helps to start labour by causing the cervix to soften and
shorten. This allows the cervix to open and contractions
to start.
The two main forms of prostaglandin that are given are Propess pessary and Prostin.
Propess is like a bag attached to a ribbon that is inserted into the vagina. It slowly releases
prostaglandins over 24 hours. Prostins are tablets or gels that are also inserted into the
vagina, and they are given at least 6-8 hours apart. The choice depends on how your cervix
feels on internal examination.
More than one dose of prostaglandin is often needed to induce labour. During this process
the midwife will monitor your baby’s heartbeat prior to each insertion, and then at regular
intervals once you start to have contractions. Early labour is uncomfortable and you can
request pain relief at any time.
Occasionally a catheter is used to help the cervix to open up so that we can break your
water. If your cervix has already opened and the baby’s head is in the pelvis then your
doctor or midwife may decide to break your waters for you. This is called artificial rupture of
membranes or an amniotomy. Oxytocin may then be given by a drip. This is a drug that
starts your contractions, which can only be used after your membranes have ruptured.
Sometimes there may be a delay when people are ready to have their membranes ruptured
if labour ward is busy.
Ratified by W&CH Q&S Group
Date: March 2013
Frequently Asked Questions:
Q: Am I suitable for induction?
Anyone can be induced if there is a medical need. Your doctor or midwife will discuss if
there is a need, and then an internal examination will be carried out to decide what kind of
induction you are suitable for.
Q: How long does induction take?
It is important to remember that because induction is done when women are not fully
ready for labour, it takes time for the body to respond. Induction often takes considerably
longer than a labour which starts spontaneously.
Some women may respond to the pessary or
tablet or drip within hours, but many people will
need to carry on with one pessary / tablet after
another for up to 5-6 days.
“My labour was induced in May 2012. It
took 4 days but there were no major
problems, although I did need an epidural! I
would definitely be induced again if it was
needed.”
Mrs L, May 2012
Q: Which method of induction will I have?
There is a possibility that you may need several methods, one after the other, depending on
how you respond to each method.
Q: Is induction safe for my baby?
Induction is very commonly used in the UK and is very safe. Induction does have a small
increased risk, and for this reason we will monitor your baby closely to make sure they are
happy throughout your labour.
Q: Where will my induction take place?
If you have not gone into labour after your 3 membrane sweeps, you will be admitted to the
ward for induction. Once induction starts you will remain in hospital until your baby is
delivered. When your labour advances you will be transferred to the labour ward.
Once your baby is delivered you will be cared for exactly the same as other normal
deliveries, and will not need any additional check ups.
Q: How will Induction affect my labour?
When labour is being induced we need to monitor the baby using a CTG machine, meaning
you cannot move around as much. Usually this means you are not able to have a water
birth. The process may be long and tiring, and many women chose to have more pain relief,
such as an epidural. Women who have inductions have a slightly increased chance of
needing forceps, Ventouse or Caesarean section deliveries.
Ratified by W&CH Q&S Group
Date: March 2013
It is also important to mention that occasionally emergency cases will come into hospital
that may be seen before you, causing a delay to your induction. We will do our best to make
sure this does not happen, but please bear with us if it does.
Occasionally you may be offered to attend the other maternity unit in the Health board in
order to proceed with your induction if there are likely to be delays in the unit you have
booked into.
Q: What happens if it doesn’t work?
Some people do not respond well or at all to the Induction drugs . If IOL fails, further options
like caesarean section will be discussed with you.
Q: What may go wrong ?
Some women react too strongly to induction, meaning their uterus contracts too frequently
which is called hyperstimulation, and could distress both mother and baby. An injection can
be given to calm the uterus down.
Extra information
If you are concerned about your induction or have any questions, please feel free to speak
to any member of staff in the maternity team.
In addition, for more information please visit the Maternity Services page on the ABMU
Health Board Internet site: www.abm.wales.nhs.uk
You can also find more information on the NHS Direct website – www.nhsdirect.nhs.uk or
telephone NHS Direct on: 0845 4647.
Ratified by W&CH Q&S Group
Date: March 2013