Induction of labour is a process designed to start labour artificially. In most pregnancies, labour starts naturally between 37 and 42 weeks. All methods of induction aim to soften and open the cervix to enable the waters around the baby to be broken and stimulate uterine contractions.
Why You Might Be Offered Induction
The most common reason for induction is when your baby is overdue. Induction is usually recommended by 42 weeks gestation, as after this time the placenta may become less efficient and complications may be more likely. If your pregnancy has been normal, induction is offered between 10 and 14 days after your due date. Induction may also be offered for other reasons, such as raised blood pressure or if your baby is thought to be small. If it is felt that you or your baby’s health will benefit, induction may be recommended earlier. The specific reason for your induction will be discussed with you by your doctor or midwife.
Discussing Your Options
When induction is being considered, your team midwife or doctor will discuss your options before any decision is reached. This includes explaining the procedure, care involved, and any risks to you and your baby. If you choose not to go ahead, your care options will be discussed. If you decide to have your labour induced, a date will be arranged for admission to the antenatal/postnatal ward, depending on availability. Sometimes, if the ward or unit is busy, your induction may be delayed; you will be given a full explanation and may be asked to return later that day or the following day.
Where Will I Be Induced?
You will be given an appointment to go to Forth Valley Royal Hospital. Have breakfast before coming to the ward and eat and drink normally whilst on the ward. Your partner is welcome to stay during the day but will be asked to go home at 9pm if you are not in labour. If labour starts during the night, your partner can be called to be with you in the labour ward.
Why Might My Induction Be Postponed or Delayed?
Induction may be postponed if:
- There is no midwife available to care for you at the time.
- Midwives and doctors need to prioritise mothers and babies for induction, and another mother may have a greater need.
Priming the Cervix
- Pessary or gel prostaglandins: Drugs that act like natural hormones to “prime” the cervix, making it softer and shorter. Inserted into the vagina as a gel or pessary.
- Balloon catheter: A soft balloon inserted through the cervix to stimulate the release of your own hormones to prime the cervix.
How is Labour Induced?
The method chosen depends on your individual circumstances and how ‘favourable’ your cervix is. You may be offered one or all of these methods:
- Prostaglandin medicine (vaginal pessary or gel)
- Balloon catheter insertion
- Breaking the bag of waters (artificial rupture of membranes)
- Oxytocin drip
A midwife or doctor will perform an internal examination to assess the cervix and decide which method is best.
Prostaglandin Pessary
A slow-releasing pessary stays in place for 24 hours when the cervix is less favourable. If it falls out, alert a midwife for reassessment and reinsertion if necessary.
Prostaglandin Gel
Given when the cervix is more favourable. Sometimes one dose is enough, but more may be needed, with second or third doses given 6 hours apart. Further gel may be needed the next day. If labour has not started after the first day, you may need more prostaglandins or it may be possible to break your waters.
How Long Will It Take?
Some women go into labour with prostaglandins alone, but it is more common to move on to the next step. If labour has not started by the third day, a doctor will review you and your baby and discuss your care. Occasionally, induction may last up to 4–5 days.
Risks Associated with Prostaglandins
Prostaglandins are very safe; serious side effects are rare. Some women develop painful contractions or diarrhoea. Occasionally, prolonged contractions can affect the baby’s heartbeat, so monitoring is done before and after prostaglandin administration.
Balloon Induction
Used for women who have previously had a caesarean section and are aiming for a vaginal birth, or for low-risk women who wish to go home after insertion. It may also be used for women who have not responded to other methods.
- Foley catheter: Inserted through the neck of the womb and inflated with fluid.
- Cook’s® balloon catheter: Soft silicone tube with two balloons, inserted on either side of the cervix and inflated with saline.
The balloon catheter is kept in place for 12–24 hours, then drops out or is removed. The cervix is reassessed with the aim of breaking your waters.
How Does Balloon Induction Work?
The balloon encourages the cervix to dilate and helps start labour. It releases prostaglandin, causing the cervix to become shorter and softer. Sometimes, this is enough to trigger labour naturally.
Are There Any Risks or Complications?
Balloon catheters are considered a safe first-line choice for induction. There may be a very small risk of infection, but this is present with any vaginal procedure. Discomfort may be experienced during insertion, but it should not be painful.
What if the Balloon Doesn’t Work?
If the cervix is not dilated enough or the balloon doesn’t soften the cervix enough, prostaglandins may be offered or a caesarean section may be necessary. Your doctor will discuss all options with you.
Why Use the Cervical Balloon Instead of Prostaglandin Pessary or Gel?
Balloon catheters are mechanical, while prostaglandin pessaries are artificial hormones. Artificial hormones can cause the womb to over-contract, which may not be suitable for all women, especially those with a previous caesarean section. Women induced with prostaglandins require monitoring throughout the process, while those with a balloon catheter may be allowed home.
Information for Women Going Home with Cervical Balloon
You can do things as normal (showering, bathing, walking), but avoid sexual intercourse. Contact the hospital promptly if you experience:
- Vaginal bleeding
- Painful contractions
- Balloon catheter falls out
- Difficulty passing urine
- Concerns about baby’s movement
- Waters break
- Feeling unwell or feverish
What Might I Expect to Feel?
After gel/pessary/balloon insertion, you may experience crampy period pains, backache, burning sensation in the vagina, or discomfort at the top of your thighs (effacement pain). Discuss any concerns with your midwife.
What Can I Do to Help the Discomfort?
- Walking around may ease discomfort and help labour start.
- Use relaxation and breathing methods practised in parentcraft classes.
- Hot packs, massage, TENS machine, bath or shower, and pain relief tablets (e.g., Paracetamol) may help.
Breaking the Waters to Induce Labour
Performed by a midwife or doctor during an internal examination using a small instrument called an amnihook. This is called artificial rupture of membranes (ARM). If contractions do not start, a syntocinon (oxytocin) drip may be recommended.
Syntocinon (Oxytocin) Drip
Given through a drip to make the uterus contract. The rate is increased until regular strong contractions occur. The baby’s heart rate is continuously monitored. Waters need to be broken before oxytocin can be used.
When Will I Go to the Labour Ward?
- When labour establishes (regular, rhythmic painful contractions with shortening and dilation of the cervix)
- If waters can be broken, or break naturally during induction
- If there are concerns regarding you or your baby
If Induction Doesn’t Work
You may be offered another attempt at induction using a different method. If this still fails, a caesarean section may be offered. If labour does not progress after ARM and a syntocinon drip, caesarean section may also be offered.
