Patient Information

Induction of Labour

Induction of labour is the process we use to start labour artificially. We use different
methods, which are explained below, to help your cervix to soften and open out and your
uterus (womb) to start contracting. This leaflet is written to help you understand why labour
is sometimes induced and what happens during an induction.

Why is labour induced?

Induction of labour is usually advised only when it is agreed

mother and/ or baby will benefit from it.

The decision is usually made when there are thought to be

fewer risks to mother or baby with induction, than if the
pregnancy is left to continue.

Examples of common reasons for induction:

 When the pregnancy is 10 or more days overdue.
 Concerns about high blood pressure and/or protein in the
urine (pre-eclampsia).
 Other concerns about mother and baby’s health, for
example when the mother has diabetes.
 When there are concerns that the placenta not working
well, for example, if there is slowing of the baby’s growth.

You should expect that the reasons for induction will be

explained to you, if induction is offered.

How is Labour induced?

Stretch and Sweep

Membrane sweeping makes the chances of labour starting on its own more likely. A doctor
or a midwife will perform a vaginal examination and place two fingers through the neck of
the womb (cervix), stretching it and sweeping the membranes above. You might experience
some bleeding and discomfort from this. As long as this is small in amount and your baby is
moving like normal, it should not worry you.

You may be offered a stretch and sweep at 40 weeks if this is your first baby, or 41 weeks if
this is not your first baby.

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Medical Induction of Labour

Our inductions are carried out on the delivery suite. We use a number of methods during
the induction process:

Healthy mum
and healthy
baby

Delivery Suite can sometimes be very busy and this can sometimes mean that the next
step in your induction can be delayed as we work to keep all the women and babies in the
department safe. If there are delays in your induction process the mdiwfe looking after you
will come and explain why there is a delay to your treatment. You will be kept updated as to
when we will be able to continue with your induction.

Propess Pessary

What is Propess and how does it work?

Usually the first stage of the induction process is to use ‘prostaglandins’, hormones which
are usually produced by the body. These ripen the neck of the womb (cervix) causing it to
soften, shorten and start to open. The Propess pessary contains a synthetic prostaglandin
and is placed high into the vagina next to the neck of the womb. The pessary looks like a
small flat tampon and has a tape attached which makes it easier to remove if needed.

What happens when I am given Propess?

For induction using Propess, you will be admitted to the delivery suite and your baby’s
heart rate will be monitored. Providing this is satisfactory a midwife or doctor will perform a
vaginal examination to assess the neck of the womb and then insert the pessary. After you
have had the medication, you will need to stay on your bed for an hour, during which time
your baby’s heart rate will again be monitored. After this you will be encouraged to walk
about and eat and drink normally.

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A member of the midwifery team will check on you
regularly to assess contractions, pain, fetal movements and your general well-being.

Simple pain relief is available, as are birthing balls and TENS machines should you require
them. Baths can also be very helpful to ease the discomfort of early labour.

The pessary remains in the vagina for up to 24 hours and can be easily removed when
required – once labour is established or after 24 hours.

We ask you to take special care when wiping yourself after going to the toilet, after washing
yourself and getting on and off the bed to avoid accidental removal of the Propess. If you
think that the pessary has come out, please inform the midwife immediately as the
pessary may need to be reinserted.

We also ask you to inform your midwife if you experience regular contractions (one
contraction in every 5 minutes), if your waters break or you have any other concerns.

If I go into Labour with the Propess, what happens next?

If you are contracting strongly and regularly your midwife will remove the Propess and
examine you internally. If you are more than 3cm dilated your labour can now be managed
in the usual way. You may not need to have your waters broken or the syntocinon drip if
you make normal progress in labour

What happens if I am not in labour 24 hours after the propess pessary is inserted?

You will need another internal examination at this stage. If your cervix has opened up to at
least 2-3 centimetres dilated and the baby’s head is well engaged (low down in your pelvis),
your waters will be broken (see below under Artifical Rupture of Membranes).

If it is not possible to break your waters a second Propess pessary may be inserted if
appropriate.

If you have questions at any time please ask the midwife looking after you.

Artificial Rupture of Membranes (ARM)

How are the Waters broken?

Once the cervix has opened up the next step in the induction process is breaking the
waters, also known as artificial rupture of membranes (ARM). This is used to encourage the
womb to contract so that labour begins.

You are examined internally and using a small plastic hook the membranes are caught and
broken. Following this, the baby’s heart rate is monitored for around 30 minutes. You will
then be encouraged to get up and walk around to help labour start.

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What happens after my waters are broken?

If you develop good contractions (3 or 4 strong contractions in a ten-minute period) then

regular assessments will be carried out to monitor labour progress. These assessments
include vaginal examinations (4 hourly) and monitoring your baby’s heart rate.
If good contractions do not follow you will need a syntocinon drip to help you progress in
labour.

Syntocinon Infusion

Syntocinon is an artificial form of the natural hormone, oxytocin, and is used to start or
strengthen contractions for labour. It is given by a drip in your hand or wrist and is started at
a slow rate. It is increased gradually until you are having regular contractions coming at the
right strength. Once a syntocinon drip has started, your baby’s heart rate will need to be
monitored continuously until delivery.

How long will the induction take?

Induction can take between 24 to 48 hours. The amount of time varies from person to
person. Some people go into labour very quickly, in others, it takes time. Please be
prepared that it could take 48 hours to get to a point that you are able to have your waters
broken or get into labour. Bring plenty to read/music/things to do and be aware that walking
around is helpful too.

Are there any risks?

Like any drug or medical procedure, induction carries risks, which must be balanced
against the potential benefits.

Some women may experience an unusual reaction to the medication and experience
strong contractions without a break in between. This is called ‘hyperstimulation’ and can
lead to disturbance in the baby’s heartbeat. If this happens, a midwife and a doctor will
come and explain what is happening. Sometimes medication is needed to reduce the
contractions and this can return the baby’s heart beat to normal. In some cases an urgent
delivery by caesarean is needed.

Induction of labour can be associated with an increase in intervention in deliveries, such as

requiring an instrumental delivery (e.g. forceps) or a caesarean section.

Occasionally, despite trying all the induction methods, labour may not begin. If this happens
to you, a doctor will come and discuss the next steps with you. The options might include a
caesarean section for the delivery or resting for a few days and starting the process again.

Your midwife or doctor will be happy to answer any questions or discuss any
worries you have throughout the induction process.

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Can my Partner stay with me?

Your partner is welcome to be with you throughout the induction process. Your midwife will
be happy to discuss our ‘partners staying overnight’ policy with you. All other visitors are
restricted to normal visiting times of 2.00 pm – 4.00 pm and 6.00 pm – 8.00 pm but you
may not feel like having visitors if you are uncomfortable and/or tired so think carefully
about what is right for you. You will be allowed to leave the ward for short periods during
the induction process after discussion with your midwife.

Coming into hospital for induction

Your midwife or doctor will arrange a date for your planned induction. Please note that you
may not be induced on this date as high activity on the unit may require your induction to
be delayed. Inductions may also require prioritisation on the basis of clinical need. We do
our very best to keep delays to a minimum, but we hope you will understand that these
delays are for reasons of clinical safety of mothers and babies already present on the unit.

You will be asked to telephone the Delivery Suite on the date of your planned induction
where you will be advised about the current status for your induction. This is to check if
your admission may have to be delayed or to arrange an alternative time to attend. You will
also be advised if any monitoring for you or your baby is required during this time.

Your planned induction of labour is on:

Date:

Time to call Delivery Suite: 08:30am

Please ring the Delivery Suite on 01423 553184/553185 on your planned induction date
and ask to speak to the Delivery Suite Co-ordinator.

Further Information

For further information about induction of labour and all aspects of pregnancy and
childbirth, please talk to your Midwife or Doctor.

References: NICE (2008) Clinical guideline – Induction of labour. For information about
NICE clinical guidelines programme you can visit their website at www.nice.org.uk

If you require this information in an alternative language or format (such as Braille,

audiotape or large print), please ask the staff who are looking after you.

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