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Induction of Labour

Induction of labour means starting a labour artificially rather than allowing it to naturally start on its own. Most labours start on their own between 37 weeks and 41 weeks and 5 days (term +12). If the labour does not start on its own, your midwife or doctor will talk to you about being induced. Sometimes, because of your health or that of your baby, your doctor may discuss inducing the labour rather than waiting for it to start on its own. Some examples of this include Diabetes, high blood pressure or concerns about the baby's size or growth on the scan.

Most women will be asked to come into the antenatal ward, Ward 65, for the midwife to start the induction. Some inductions of labour are carried out on the Delivery Unit. Induction of Labour is undertaken in single rooms. You should expect to be an in-patient on Ward 65 for several days before you are ready to be transferred to the Delivery Unit for the next stage of the induction process. During this time it is usually best to keep vaginal examinations to the minimum.

The induction process uses different methods. Your induction may use one or more of these methods, depending on individual circumstances:

 

  • Prostaglandin

Prostaglandins are substances that prepare the neck of the womb (cervix) for labour by making it soften, shorten or open. They are given into the vagina as either a gel (Prostin) or a pessary (Propess). The gel takes 6 hours to work, after which you may need at least 1 or 2 more doses. The pessary is given once and is left in place for 24 hours. In some women, the prostaglandin makes the labour start on its own, but for most women, it opens the neck of the womb enough to enable the waters to be broken. For some women, prostaglandin is not necessary as the neck of the womb is open enough to begin with.

 

  • Cervical ripening balloon

Your doctor may suggest the use of a cervical ripening balloon rather than the use of prostaglandin to soften and open the cervix enough to break the waters. For example, this might be because you have had a Caesarean section before. This small balloon is gently pushed through the neck of the womb by the doctor and is inserted using a speculum. This is a bit like having a cervical smear taken. The balloon is left in place for 12 hours after which it is removed. The physical pressure on the neck of the womb leads to the natural release of prostaglandins. At this stage, the neck of the womb should be open enough to enable the waters to be broken.

 

  • Artificially rupturing the membranes (breaking the waters)

Breaking the waters, or artificial rupture of the membranes, is done when the neck of the womb has opened up slightly. You may hear doctors or midwives refer to this as an 'ARM' which is short for Artificial Rupture of the Membranes. During a vaginal examination the waters are broken in front of the baby's head. This helps to stimulate the contractions to start. This is performed on the Delivery Unit.

 

  • Oxytocin Drip (Syntocinon)

After the waters are broken, the midwife will put a drip into your vein containing a drug called oxytocin. This is a synthetic version of the hormone your own body produces to start the contractions. The contractions and your baby's heart rate will be closely monitored while this is happening.

 

Delays in the induction process

Due to the unpredictable nature of maternity care, there are occasions when there is a delay in the induction process. If the Delivery Unit is busy with emergencies, or if it is expected that your baby will need a cot on the Newborn Intensive Care Unit, it may be necessary for you to wait on the antenatal ward before being transferred to the Delivery Unit. Under these circumstances, transfers to the Delivery Unit occur in order of clinical priority. We will do our best to keep you informed about any delays, and how long we expect this to take but this can be difficult and unpredictable.

You can read more about the processes of induction here:

http://www.nhs.uk/conditions/pregnancy-and-baby/pages/induction-labour.aspx#close

 

Available leaflet:

A patient's guide to induction of labour