Induction of Labour

When labour is started artificially, it is called Induction of Labour Before making a decision about induction of labour it is important that you understand the reasons why induction is being offered, when, where and how the induction could be carried out, the arrangement and support for pain relief (as we recognise that you are likely to find induced labour more painful than spontaneous labour), what your alternative options are, the risks and benefits of induction of labour and what your options are if induction is not successful. It is also important to be aware of ways to optimise the success of induction if this is what you choose. We hope this leaflet gives you some insight into induction of labour at Aneurin Bevan University Health Board and should be used as well as a full discussion with your Midwife or Obstetrician. Please take time to discuss the information about induction of labour with your birth partner, look at a variety of sources of information, ask questions and think about your options. Please also discuss with your Obstetrician or Midwife about a membrane sweep that can be performed in a clinic setting or in your own home.

Why is Induction of Labour necessary?

There can be many reasons why induction of labour is recommended. The most common reason is to avoid the risks associated with a prolonged pregnancy. Your labour may also need to be induced due to medical reasons concerning either you or your baby or both. For example, if you have diabetes or there are concerns around your baby’s growth, induction may be recommended. Common reasons for IOL are to reduce the risk of stillbirth and harm to yourself and baby from continuing the pregnancy.

What happens if I decide to have an induction?

Induction in ABUHB is undertaken in one of two ways:
Outpatient induction

Outpatient induction is routinely offered to mothers who are 13 days overdue and have not experienced any complications in their pregnancy. This means that you can choose to go home for up to 24 hours after having the process of induction started. If you respond to the first dose of the induction drug, your recommended place of birth would be on an alongside midwifery unit (at The Grange University Hospital).

Alongside BC.jpg

Inpatient Induction of Labour

If you decide to have an Inpatient Induction, you will be admitted to the Antenatal Ward or Induction Suite. You will be contacted on the day of your planned induction of labour to advise of what time to attend.

The Midwife will ask to carry out a full antenatal check, including blood tests, and monitor your baby’s heartbeat for approximately 30 minutes. The process will be explained to you and if you are happy to continue, a vaginal examination will be offered.


Labour ward room.jpg

The Midwife will ask to carry out a full antenatal check, including blood tests, and monitor your baby’s heartbeat for approximately 30 minutes. The process will be explained to you and if you are happy to continue, a vaginal examination will be offered.

CTG monitor.jpg

Inpatient 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.

Please click here for further information including

Please click here current visiting information.

Outpatient induction of labour

Induction of labour is the process of starting labour artificially. We can offer induction of labour either in hospital or for part of the process as an outpatient. Outpatient induction of labour will be offered to you if you have a ‘low risk’ pregnancy and are over your due date by 41 weeks + 6 days .

  • A reduction in the time you spend in hospital before you give birth
  • Makes the process of Induction of labour feel more normal
  • Allows you to spend more time in your home environment with your family

  • You have an uncomplicated pregnancy requiring induction for prevention of prolonged pregnancy (Due date 41 weeks + 6 days)
  • You have an uncomplicated previous birthing history
  • You have had no more than four previous births
  • You have access to a telephone
  • You have had a full examination and are suitable for induction
  • You have had a reassuring heart monitoring of your baby

  • You will be asked to attend the Day Assessment Unit at your hospital
  • A full antenatal assessment will be carried out, including a 30 minute electronic heart monitoring of your baby and an internal examination to assess your cervix
  • If suitable the induction medicine, called Propess, will be inserted into the vagina. Propess is like a small flat tampon containing prostaglandin, which is used to encourage the cervix
  • To soften ready for labour to start. Propess remains inside for up to 24 hours and has a string which is used during removal.
  • The Propess string will lie inside the vagina and it is very important that you take care when wiping yourself after going to the toilet or when washing, so that you do not pull or drag on it.
  • Heart monitoring of your baby will be repeated for 30 minutes and if this is normal you can go home.
  • You will be given a time, approximately 12 hours following insertion of the Propess, to return to the hospital so that the midwife can check that everything is normal. At this visit you will have a repeat heart monitoring of your baby, but will not have an internal examination, unless you are experiencing contractions or have expressed concerns that require vaginal examination. If all is normal you can go back home and will be given a time to return to the hospital in approximately 12 hours, at which point the Propess will be removed and a plan will be made for continuation of the induction of labour as an inpatient.

  • The Propess you have been given acts to prepare the cervix. This means that the cervix, softens, shortens and begins to open. You will commonly feel a period type pain while this is happening and you may be aware of your womb tightening and relaxing intermittently. Sometimes Propess can result in labour contractions starting. It is ok to stay at home if you have tightening. You can take a warm bath and keep mobile, which will help you to relax. If you experience contractions which are every 5 minutes or less and think you may be in labour you can still be offered the opportunity to birth in our Alongside Midwifery Led Units (telephone numbers below). If you have pain that is constant you should telephone the hospital emergency telephone numbers on this leaflet and come in for assessment.

  • You think your waters have broken
  • You have regular and painful contractions and think you may be in labour
  • You have constant pain
  • You are worried and don’t feel that you are coping at home
  • You have any fresh bleeding vaginally
  • Your baby’s movements are reduced
  • The Propess falls out or drops low into the vagina

Propess can occasionally produce some side effects which are usually mild and include nausea, vomiting, dizziness and rarely palpations and fever. If any of these occur to a distressing level, you should telephone the hospital. There is a very rare chance that you may be very sensitive to Propess and start contracting very frequently and strongly:

  • More than 5 contractions in 10 minutes
  • A run of contractions each lasting 2 minutes or more
  • Severe abdominal pain.

If this happens you must telephone the hospital and attend the unit immediately. If possible you should also remove the Propess by pulling on the string, as you would when removing a tampon.

Hospital contact numbers

Royal Gwent Hospital Day Assessment Unit - 01633 234752 (8am - 5pm)

Nevil Hall Hospital Day Assessment Unit - 01873 732139 (8am - 5pm)

Ysbyty Ystrad Fawr Day Assessment Unit - 01443 802657 (8am - 5pm)

Triage - The Grange University Hospital - 01633 493530 - 24 hours

The Alongside Birth Centre - The Grange University Hospital - 01633 493613 (24 hours)

Improving the physical and emotional health and wellbeing of expectant mothers, infants, children and young people throughout Aneurin Bevan University Health Board Area.

(N.B: The Family and Therapies team at ABUHB is NOT responsible for the content on the webpage links that we refer to in our resource sections and linked information to external sites. All information was accurate and appropriate at the time the webpage was created.)

Accessibility tools