Induction of Labour

npatient induction involves the use of hormone drugs, breaking your waters, or a combination of both. We have provided further information below.

Sometimes the whole process from being admitted to hospital for an induction of labour, to becoming established in labour, can take up to 5 days. (Including a rest day, where this is sometimes necessary to give your body time to respond)

When you are offered induction we use an assessment tool called a ‘Bishops’ score’ based on how your cervix feels on vaginal examination, and a change in the ‘Bishops’ score’ can be very positive. The main role of prostaglandins is to soften the cervix and allow it to open enough for us to break your waters. This can take several days. Some women will experience the onset of contractions during this time although it is not the primary aim of the medication. Usually more than one dose may be necessary to induce your labour.

It is easy to feel disheartened if contractions do not happen right away, but in fact it is not expected at this stage. For some women the response to the prostaglandins can be quicker and that is okay also. For women who experience immediate contractions this can be the start of labour, but is more likely to be a response to the induction drug.

We use two forms of prostaglandins; Propess and Prostin. Propess is usually offered first and slowly releases prostaglandins over 24hrs. You will then be offered prostin, usually 2 tablets 6 hours apart. Some women describe the Propess as a small ‘teabag’ like piece of gauze that is inserted in your vagina and releases prostaglandin. Prostin is a tablet roughly the size of an almond that is placed high in the vagina and dissolves over a few hours.

If your waters have broken naturally before labour (with no other signs of established labour) you will be offered a full discussion of the most appropriate induction method depending on your bishop’s score, your pregnancy and medical history, whether you have had babies before and your personal preference. Propess is likely to help limit the amount of recommended vaginal examinations and give you a more gentle build up to established labour.

If your cervix has already started to open (which can be felt during an internal examination) then the membranes covering the baby’s head can be broken with your consent. This is performed on the Obstetric unit. Some women will become established in labour after having their waters broken, however often it is necessary to continue the process with the addition of a syntocinon drip (which is a synthetic form of Oxytocin.

As with a natural labour, some women experience discomfort as the cervix begins to soften. Midwives will support you to manage this, and will be able to discuss your options depending on your experience. Discussing non-medical approaches such as using your TENS machine, Aromatherapy Oils, finding a different position/walking/using the birth ball, water therapy or massage can be helpful. You can also discuss medication such as paracetamol, codeine, pethidine and gas and air. It is important to be aware that the IOL drugs used can over stimulate the uterus.

For the majority of women it does work, however, for some women it is not always successful. Your Midwife and Obstetrician will assess your condition and your baby’s wellbeing and discuss all options with you which may include a rest day and trying again or birth by a Caesarean Section.

We know that no two births are the same and women have individual preferences for their birth experience. Our ultimate aim is to support you to have a positive birth experience. For most women and babies, having a vaginal birth means that you have a quicker recovery, your baby is less likely to need the support of our neonatal unit and breast feeding is more likely to be successful. Vaginal birth has many sensory and cognitive benefits to the new-born baby.

We also know that following induction of labour, women are more likely to have an assisted delivery (forceps or ventouse). than women who have a spontaneous labour. After 37 weeks of pregnancy, you re no more likely to have a Caesarean Section, than someone who goes into labour on your own.

The most likely outcome is to have a vaginal birth. The position of your baby and the natural birth hormones you release can affect your progress through labour, so during the induction process there are many ways that you can optimise your chance of a vaginal birth.

Please talk to your midwife about this further but some of our suggestions include being upright and mobile as much as possible, creating a calm and familiar environment by bringing pictures of your loved ones, positive affirmations and personal items from home (like your perfume or a pillow case), using a birthing ball, adopting positions like all fours or leaning over a birthing ball and having a good understanding of the process of birth

You will need to bring your hospital bag in with you which should contain all necessary items for both you and your baby. As it is normal for an induction of labour to take some time, we encourage you to bring some snacks for both you and your partner, and entertainment for your comfort. The Grange University Hospital offers free Wi-Fi, Some people have found books, audiobooks, crafts and electronic devices helpful to pass the time.

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