How is labour induced?
Around 30% of women are recommended an induction of labour for various reasons.
Depending on assessments done throughout your pregnancy, you may be offered an induction. To enable you to make a fully informed decision, your midwife or obstetrician will provide you with information regarding the risks and benefits of induction. They will discuss the different methods of induction and suggest which may be best based on your personal circumstances. Considering the different methods will enable you to advise your healthcare professional of your preference.
When you come into the maternity unit for your induction, a midwife will undertake a full assessment of you and your baby. This will include electronic monitoring (CTG) of your baby’s heartbeat and any contractions that you may be having. Your midwife will assess your cervix by undertaking a vaginal examination. You will have plenty of time to ask any questions, and your midwife will take you through your options and what to expect in detail.
Some people may need only one of the steps below, and others will need a combination to go into active labour (4cm dilated with strong, regular contractions). Induction may be a long process which can be frustrating, however the aim is to mimic the body’s natural process in the best way possible.
Step 1 – Preparing („ripening”) your cervix
Many find that their cervix is not quite ‘ready’ for labour yet. In that case, a step is necessary to ‘ripen’ your cervix to prepare it for labour. The aim of this step is not to start active labour, but to open your cervix enough to break your waters, ready for active labour to be induced. The different induction of labour options are listed below. Your hospital may only offer one method, or they may give you a choice. Depending on your circumstances, you may be able to go home for a period of time during your induction. Some people may not experience any changes during ripening and for others, it may be enough to start active labour. You may need more than one ‘round’ before your waters can be broken, in which case you may be offered more than one method one after the other. The order they are offered may vary between hospitals.Option 1 – Mechanical methods
There are two mechanical methods available, which do not contain any drugs (artificial hormone). They help to promote your body’s natural initiation of labour – they won’t start contractions artificially and side effects are less likely. Some hospitals may allow you to go home with these methods.Dilapan-S
This is a thin dilator that absorbs fluid from your cervix to gradually expand in diameter, helping to dilate your cervix and change its consistency for labour. The dilators remain in place for 12-24 hours and help your body release natural hormones associated with labour. Most people experience minimal pain during the process, and it doesn’t extend outside of the vagina, so you will be encouraged to relax or to go about your usual daily activities to help prepare your body. More information about: Dilapan-S.Balloon catheter
This is a small balloon which is inserted into the cervix and inflated with water. By putting pressure on the cervix, it encourages the release of your natural hormones and dilation. The balloon catheter remains in for 12-24 hours to stretch and soften the cervix in preparation for labour. The catheter tube will be taped to your leg during that time to keep it in place.Option 2– Medicinal Methods
Prostaglandins are medicines that use an artificial hormone to help ripen the cervix. There are two options available; a gel or a pessary that are inserted just behind your cervix. The gel works over 6 hours, while the pessary is released slowly over 24 hours. If you and your baby are responding well, some units may allow you to return home during this time, however, as with all medicines, side effects are possible, so your doctors may prefer to keep you in for continued monitoring. Cramps and pain can be common with prostaglandin methods, and your midwife will be able to discuss pain relief options with you.Step 2 – Breaking your waters
Amniotomy
Some people (particularly those who have had a baby before) may be told that their cervix is favourable for an amniotomy or ‘ARM’. This where your waters are broken artificially. A midwife will insert a small sterile hook into the vagina to make a hole in the bag of waters that surrounds your baby. After the waters are broken, labour may start on its own. Your waters will continue to drain from the vagina for the duration of your labour.Step 3 – Helping with your contractions
Oxytocin drip
A hormone called oxytocin may be offered to those who do not progress into active labour. Oxytocin is given continuously in small amounts until your baby is born. It is given directly into a vein through a cannula inserted into your hand or arm. The oxytocin aims to stimulate contractions and progress your labour. A midwife will be caring for you and your baby closely throughout your labour.
Understanding induction of labour – a video developed by clinicians, women and a local hospital charity in North West London.
