Posted on

Breaking your waters (amniotomy)

Breaking your waters (amniotomy)

Pregnant woman reclines on a hospital bed holding her bump Before, or during labour your waters will normally break at some point (although sometimes they don’t – and some babies are born in their amniotic sac). If your labour seems to have slowed down or there are concerns about your baby’s wellbeing, your midwife might recommend breaking your waters. This is done during a routine vaginal examination, it does not hurt your baby, and has been shown to sometimes reduce the length of labour. If you think your waters have broken it is important to call your maternity Triage/assessment unit straight away, particularly if you think you can see meconium, which is green or brown in colour. If you are less than 37 weeks pregnant this may be a sign of premature labour.
Posted on

Induction of labour: Frequently asked questions

Induction of labour: Frequently asked questions

Smiling pregnant woman holds her bump while talking to a midwife

Do I have to have an induction?

Your midwife/doctor will explain why induction has been recommended for you and your baby, including the risks and benefits of having it at the time advised, versus waiting. If you choose not to have the induction, or to postpone it, you may be offered additional monitoring to observe you and your baby’s wellbeing.

How long can induction take?

Induction can take anything from a few hours to a few days. Bring plenty of things to distract you, as there can be a lot of waiting whilst the medications start to work.

What if the induction does not work?

If the induction is unsuccessful your midwife and doctor will discuss your options with you. These options may include waiting, trying something else or a caesarean section.

Is induction painful?

Vaginal examinations may be uncomfortable but should not be painful. It is felt that induced labour (particularly with a oxytocin drip) can be more painful than natural labour. You can discuss your options for pain relief with your midwife at every stage of the induction process. National guidance includes offering an epidural for pain relief prior to commencing, oxytocin (the artificial hormone), to augment (increase) contractions.
Posted on

How is labour induced?

How is labour induced?

Close up of a medical drip 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.
Posted on

Why might I be offered an induction of labour?

Why might I be offered an induction of labour?

Pregnant woman in discussion with healthcare professional
  • you are overdue or post-dates, meaning that your baby has not been born yet and you are at least 10-13 days past your due date. This is the most common reason for induction
  • your medical history suggests an earlier birth would be safer for you or your baby
  • there are concerns with the wellbeing of your baby, meaning that it would be safer for them to born sooner than to wait for labour to start naturally
  • your waters have broken and labour has not started naturally.
Posted on

My team for birth and labour

My team for labour and birth

Midwife touches the control of a monitoring machine

Midwives

Midwives are your main carers in labour, whether you choose to have your baby at home, in a midwifery-led birth centre or on an obstetric labour ward. Women in established labour will normally receive one-to-one care in labour from a named midwife. Your midwife will support you during labour, ensuring you and your baby are well and safe.

Obstetricians

An obstetrician will be involved in your care if any complications or more complex needs arise during labour and/or birth. If an induction of labour is recommended for you, or if your labour and/or birth slow down it is likely that you will be seen by an obstetrician. If there are concerns with your health,  the health of your baby or if an assisted or caesarean birth is recommended you will also be seen by and cared for by an obstetrician who will work in partnership with your midwife.

Maternity support workers

These may work under the direct supervision of your midwife to provide you with support during labour.  They may also help you with feeding your baby immediately after birth.

Anaesthetist

If you have an epidural during labour, this will be put in by an anaesthetist. If you require a caesarean birth, you will also be cared for in theatre by an anaesthetist, in partnership with an obstetrician and your midwife. Anaesthetists may also become involved in your care if you have any complications or need a higher level of care due to medical conditions.

Theatre team

If you have a planned or emergency caesarean birth, there will be staff in the theatre to assist the anaesthetist, obstetrician and midwife who are caring for you. You may also be in theatre if an assisted birth is recommended, or if you have any complications after the birth that require more intensive care.

Student midwives/doctors

During labour and birth, there may be a student midwife or doctor working with your named midwife. Student midwives or doctors may provide you with care and support under direct or indirect supervision of the midwife, depending on their stage of training. Care will only be provided with your consent, and your midwife will discuss this with you.

Admin/clerical

The team of midwives and doctors in birth centres and labour wards are supported by a team of reception, clerical and administrative staff that you may meet. Please ensure you inform the clerical team if you have any changes to your contact number, address or GP to ensure that information is recorded correctly on key documentation.
Your team for labour and birth Midwife-led care in labour
Posted on

Epidural

Epidural

Heavily pregnant woman sits while an anaethetist injects anesthetic into her bare back Epidurals are the most effective pharmacological form of pain relief in labour. This method of pain relief can only be given on an obstetric unit (labour ward) by an anaesthetist. An epidural is a special type of anaesthetic that is given as an injection into the back, numbing the nerves that carry pain impulses to the brain. Once the first dose is given it takes around 20 minutes to work, then either you or your midwife will top-up the medication as needed to keep you pain-free. An epidural usually provides effective pain relief, however some women do not always find it works fully, and it may need to be adjusted or re-sited. If you have an epidural you will also need to have a drip in your hand and continuous electronic fetal monitoring. Lower back pressure is sometimes felt even with an effective working epidural. Some women are still able to move around after an epidural, whereas others find it more difficult due to their legs feeling heavy and unable to support their weight. If you want to walk with an epidural it is essential that a midwife first checks that your legs are strong enough, and somebody must always walk with you for support. Some women will find passing urine difficult, if this happens a catheter may be needed to empty your bladder. Depending on your stage of labour, this catheter may stay in until the day after birth. An epidural can affect your blood pressure, so this will also need to be monitored regularly. Having an epidural can make the second stage of labour longer, and may increase the likelihood of you needing an assisted birth. It can also cause itching or shivering. Other risks of epidurals include severe headaches or rarely nerve damage.
Frequently asked questions about epidurals Epidurals in labour