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Induction of Labour

In most cases labour starts naturally but it is sometimes recommended that labour is started artificially.  In this article you can get to fully understand the process and how best to prepare yourself.

Why you may be advised to have induction of labour

There are many reasons why you may be advised or decide to go for an induction of labour.  One of the most common reasons is that your baby has not arrived by 42 weeks of pregnancy.

It is believed that there is a slightly increased chance of stillbirth from 42 weeks and therefore if labour doesn't start naturally by this point you will be offered induction.

Other reasons for induction of labour include; waters breaking without the onset of contracts, maternal age, reduced fatal movements, obstetric cholestasis and other health complications with either Mum or baby.

In most cases induction of labour will be planned in advance so you should discuss any concerns you may have with your specialist or midwife.

What happens when you are induced?

Prior to being induced you may be offered a membrane sweep.  During this procedure the midwife or doctor will locate the opening to the cervix during an internal examination and run their finger between the cervix and the membranes.  This is thought to trigger the release of hormones called prostaglandins which are needed to start labour.

If the sweep is unsuccessful you will be offered induction via the insertion of synthetic prostaglandins.   It is important to assess the wellbeing of your baby before any intervention so  you will be put onto the Cardiotocograph (CTG) before induction is started.   After about 20-30 minutes a pessary or gel will be inserted just behind the opening of the cervix to encourage the muscle fibres to soften and start to open.

After the prostaglandin has been inserted the baby will be monitored for another short period to check everything is OK and in some cases you may be able to go home to await events or you may be advised to stay in hospital.  It just depends on the reason for the induction.  Every 6 hours the CTG will be repeated to check on baby.  The aim over the initial 24 hours is to soften the cervix enough that the waters can be broken using an amnihook.  

Some hospitals have started to use a Cook Balloon as an alternative to using medications and therefore reduces the risk of side effects.  The catheter has two balloons; one is inserted one the uterine side of the cervix and filled with a solution called normal saline (salt water basically), the second balloon is inflated on the vaginal side.  By naturally adjusting to the contours of the cervix the equal pressures work to gradually open the cervix.  After 12 hours the balloons will be deflated and the catheter removed.  The opening of the cervix will be assessed and hopefully will have dilated enough that the membranes surrounding the baby can be broken.  To allow the baby's head to move further down and reduce the risk of the cord coming before baby this is usually done a few hours later.  The image below demonstrates perfectly how the Amnihook is used to break the waters.  As you can see the hook shouldn't actually touch you as it is kept between the operators fingers.

What is induction of labour like?

Couples often worry about the prospect of being induced and it is rare that it was part of their original birth plan.  Being induced is like playing a game of snakes and ladders but starting on -66.  The aim of induction is to get you into labour so, anticipate that it could be a few dates after the process starts before you have your baby in your arms.  What is important is that you plan. The process can take a long time and, if you are not advised to go home, it can be very tiring while you sit and wait for events to unfold.

Have a think over the next few weeks about how you could occupy your time.  One new Mum told me about how her husband secretly put together a video of all their old photos and mini film and surprised her on the day. Load up your iPads with games like Monopoly, Cludeo etc.  These things help to distract and pass an hour or two whilst taking your mind of what your body is doing.  The more relaxed you are the more responsive your body will be to the prostaglandins.

The hormones drugs given during the process can make the contractions much more intense sooner that during natural labour.  For this reason women are more likely to request an epidural and also have an increase chance of having an instrumental delivery such as forceps or ventouse.

There is also a possibility that the induction doesn't work.  If this happens you will be offered either delivery be c-section or another attempt at induction, probably after 24 hours rest.  The options will be discussed with you and you will be advised according to your personal circumstances.

If you have more questions about this or any other pregnancy related topic just use the chat facility below to ask The Virtual Midwife.