Patient Information Leaflet

Inductionof Labour

Maternity Services

What is Induction of Labour?

This information leaflet explains the procedure for the induction of labour which is a process used to start labour artificially.

When is Induction recommended?

The doctor or midwife may offer or recommend an induction of labour if they feel it would benefit your health or the health of your baby.

On average around 1 in 5 labours are induced. Please feel free to ask any questions when discussing induction of labour with your doctor or midwife.

If you are healthy and have a trouble free pregnancy, induction of labour may be recommended if:

• Your pregnancy continues past 41 weeks or if you will be aged 40 or over at the time of delivery - you will then be offered induction of labour between 39 and 40 weeks.

• Your waters (fluid around the baby) break before labour starts (after 37 weeks).

Induction of labour may be offered at other times in pregnancy if there are concerns with your own wellbeing due to conditions such as; high blood pressure, diabetes or cholestasis, or there are concerns about your babies growth or movement pattern.

What happens when you reach your expected due date?

If this is your first baby and the midwife feels that the baby’s head is not engaged when you reach full term, she will refer you to the antenatal clinic to discuss a suitable plan of care for induction of labour.

If this is your first baby and the baby’s head is engaged, your midwife will offer a membrane sweep at 40 weeks.

All women will be given the opportunity for a membrane sweep at 41 weeks.

At Barnsley’s Maternity Unit, even if you have had a healthy trouble free pregnancy, you will be offered an admission date for induction of labour between 40 weeks plus 12 days and 42 weeks; from this gestation onwards the risks to the health of your baby will increase if not delivered. This is a national recommendation based on evidence which shows that after 42 weeks of pregnancy the risks to the health of your baby increases due to the reduced function of the placenta.

What if you choose not to be induced?

If you choose not to be induced at this stage then you may be seen by a consultant, who will agree a plan of care with you. This may

include daily checks of your baby’s heartbeat with an electronic fetal heart rate monitor (CTG) after 42 weeks gestation.

How is labour induced?

Membrane sweepThis involves your midwife or doctor performing a vaginal examination and placing a finger just inside your cervix (neck of womb) and making a circular, sweeping movement to separate the cervix from the membranes around your baby’s head. This procedure may cause some discomfort and slight bleeding (a show), but will not cause any harm to your baby and it will not increase the chance of you or your baby getting an infection. It can be carried out at home, at an outpatient appointment or in the hospital. The membrane sweep has been shown to increase the chances of labour starting naturally within the next 48 hours. Occasionally this may cause uterine tightenings or contractions. You may also experience period type pain. Following the membrane sweep your midwife will arrange your induction date.

Using ProstaglandinsProstaglandins are produced naturally by your body before and during labour. We can give you prostaglandins to help induce your labour by encouraging the cervix to soften and shorten (ripen). This allows the cervix to open and contractions to start. This will make it possible for us to break your waters and start you off in labour. The Prostaglandin may be all you need to start you off in labour yourself.

Prostaglandins are normally given as a tablet (Propess) that is inserted into the vagina. This is done in hospital, on the Antenatal Ward or the Birthing Centre. This tablet slowly releases Prostaglandins and will remain inserted for 12-24 hours. A further dose of prostaglandin may be given 6 hours after the first dose is removed if your cervix has not dilated enough to break your waters. Prostaglandins are not usually given during the night.

In most cases you will be advised to stay in hospital to allow assessment of you and your baby on a regular basis. However some women will fit the criteria for an outpatient induction of labour, for example if it is your first baby, you are low risk and being induced because you are past your due date. This means you will be allowed home after insertion of the Propess. You will be asked to return 12 hours later to check that you and your baby are OK. If all is well you will be allowed to go home again and return the next day to continue with your induction. Before giving Propess the midwife will monitor your baby’s heartbeat with an electronic fetal heart rate monitor (CTG). After being given Propess you will be advised to rest on the bed for 30 - 60 minutes to allow absorption of the Prostaglandins and monitoring of the fetal heart beat. Once it is established that everything is okay, the CTG will be discontinued and you will be able to move around, we encourage you to move around as this will help the induction process.

After approximately 12-24 hours you will be examined again to see if your cervix has softened and started opening. The midwife or doctor may then break your waters to facilitate the labour (this is called an amniotomy - see below). This will not cause any harm to your baby, but the examination may cause you some discomfort. Very occasionally Prostaglandins can cause the uterus to contract too much which may affect the pattern of your baby’s heartbeat. If this happens you will be asked to lie on your left side, the Propess will be removed and you may be given other medication to help relax your uterus (womb).

Breaking of the Waters (Amniotomy) Amniotomy is the name of the procedure used to break your waters. It can be used to start or speed up your labour. This is when your midwife or doctor performs a vaginal examination and using a small instrument which makes a hole in the membrane around the baby to release (break) the waters. This will not cause any harm to your baby, but may be uncomfortable.

Using OxytocinOxytocin is a drug that can be used to make your womb contract once your waters have been broken. It is given in the form of an infusion (drip) into your arm containing a drug called Syntocinon. The rate of the infusion is adjusted so that your contractions occur regularly until your baby is born.

If you have already had prostaglandins, oxytocin will not usually be given for at least 6 hours to avoid the risk of your womb contracting too much.

Your waters will need to have broken either naturally or by amniotomy before you can start an oxytocin infusion.

Your baby’s heart rate will be monitored continuously whilst you are having the Syntocinon infusion.

Very occasionallyOxytocin can cause your womb to contract too much which can affect the pattern of your baby’s heartbeat. If this happens you will be asked to lie on your left-hand side and the infusion will be turned down or off to lessen the contractions. Sometimes another drug will be given to counteract the oxytocin and lessen the contractions.

What happens if your waters break before labour starts?

Sometimes a woman’s waters break before labour starts. This happens in about 1 in 20 pregnancies and is known as pre-labour rupture of the membranes (PROM). If your waters break you will experience a sudden gush or trickle of fluid down below which unlike passing urine cannot be controlled. Please contact the Birthing Centre if you think your waters have broken. You will need to be seen to have this confirmed.

At this point a plan will be made based on your pregnancy history. Around 9 out of 10 women will go into labour naturally within 24 hours, so the option will be given for you to go home, await events and return 24 hours from when your waters broke.

What is the admission process?

On the date of induction you will be asked to attend the Antenatal/Postnatal ward (in the Women’s and Children’s Department) at the time pre-arranged by your Community Midwife (usually in the morning). Please bring your handheld notes and things you will need for admission, including yours and your baby’s bag.

The midwife will show you to the ward area. She will perform a routine antenatal check and monitor the baby. She will need to perform a vaginal examination to assess the most suitable method of induction. If your induction is for medical reasons or pregnancy complications you will be induced on the Birthing Centre.

At all times she will keep you informed of the situation. If there is anything you need or require further explanation about please do not hesitate to ask.

Our aim is to ensure the safety of all mums and babies in our care and we aim to provide one-to-one midwifery care on the Birthing Centre when you are in established labour. Occasionally induction of labour may be delayed because it is anticipated that this will

not be achieved due to lack of space or safe staffing on the Birthing Centre. In these circumstances we would not start the labour process by inducing you.

If the Maternity Unit is very busy when you arrive you will be reviewed by the midwife but your induction may need to be delayed. We will ensure the safety of you and your baby is kept as a priority but, following a thorough assessment, you may be asked to go home and return as soon as possible, sometimes later in the day or on the following day.

Your baby may not be born on the day of your induction; sometimes the induction process can take a couple of days so you and your supporters need to be prepared for this. You will be able to eat and drink as normal and your supporters are welcome to use the hospital restaurant.

We regret that we are unable to accommodate birthing partners on the antenatal ward overnight.

If you require further information or advice please contact:

Antenatal/Postnatal ward: 01226 432242 / 432241

Labour Ward: 01226 432249

Authors: B Godwin/G DunningReview date July 2016 Next review: July 2019BHNFTPL0006

If you need this information in an alternative format, please contact the Patient Advice and Complaints Team on 01226 432330.

Barnsley Hospital NHS Foundation TrustGawber Road, Barnsley S75 2EP

Tel: 01226 730000 Fax: 01226 202859

01226 432330

01226 432330

01226 432330

01226 432330