Articles

Key takeaways

• Induction of labour means starting labour artificially.
• It may be offered if you are overdue or for health reasons.
• Methods include membrane sweeps, medication, and breaking waters.
• Discuss all options, risks, and benefits with your care team.

Understanding induction of labour

Induction of labour is when labour is started artificially by a health professional. Most people go into labour naturally between 37 and 42 weeks of pregnancy. However, sometimes your midwife or doctor may suggest starting labour artificially.

Reasons for induction

You may be offered an induction for several medical reasons.

• Overdue pregnancy – Induction is often offered if your pregnancy goes past 41 weeks, as a prolonged pregnancy increases risks to the baby's health.
• Waters breaking early – If your waters break but labour does not start on its own, you may be offered an induction of labour. This is to reduce the risk of infection for you and your baby.
• Health concerns – Induction might be recommended if there are health concerns for you or your baby. This could include conditions like high blood pressure or gestational diabetes. It might also be if there are liver conditions, or if your baby is not growing well.
• Other factors – You might also be offered induction if you are aged 40 or over. It may also be offered if you are having more than one baby.

Understanding the risks of induction

It is your choice whether to have your labour induced. Your midwife or doctor will discuss the advantages and disadvantages with you. They will explain why they think induction is right for your situation.

General risks of induction can include:

• Induction not working – Sometimes induction does not start labour. In this case you would likely require a caesarean section.
• More painful labour – Many people find induced labour more painful than natural labour. You may be more likely to need pain relief, such as an epidural.
• Assisted birth – You are more likely to have an assisted birth, where instruments like forceps or a ventouse are used. This can increase your risk of a perineal tear.
• Womb contracting too much – Your womb might contract too much (uterine hyperstimulation), usually due to the medicines used. This could affect your baby's heart rate, requiring monitoring.
• Increased infection risk – There is a small chance of you or your baby getting an infection. This risk is higher if your waters are broken artificially or with internal examinations.
• Tear in the womb – There is a very small risk of induction resulting in a tear in the wall of your womb (a uterine rupture). This is very rare but would require an emergency caesarean section.

Your healthcare team should explain the risks and benefits of all your options. This includes the risks and benefits of waiting for labour to start naturally.

Methods used to induce labour

Several methods can be used to induce labour.

Membrane sweep

A membrane sweep may be offered before other induction methods. Your doctor or midwife inserts a gloved finger into your vagina. They sweep it around your cervix to try and separate the membranes connecting the amniotic sac to your womb wall.

This can release hormones called prostaglandins. These are natural chemicals that can help soften your cervix and may help start your labour.

Cervical ripening

These methods help your cervix soften and open.

• Prostaglandins – These hormones can make your cervix soften, shorten, and help contractions to start. They can be given as a tablet, a gel, or a pessary.
• Balloon catheter – A small tube with a balloon on the end is inserted into your cervix. The balloon is then inflated, and the pressure helps your cervix to open.

Breaking the waters (amniotomy)

If your cervix has started to open, your waters can be broken. The doctor or midwife makes a small break in the membranes around your baby.

This is usually done during a vaginal examination using a small, sterile instrument. Breaking your waters can make contractions stronger and help labour progress.

Synthetic oxytocin drip

A drip of synthetic oxytocin may be recommended if contractions do not start after your waters have been broken, or if they are not strong enough. Oxytocin is a hormone that causes your womb to contract.

This drip is usually given through a vein in your arm.

Making the decision and what to expect

There is a lot to consider when deciding about induction. Your midwife or doctor should help you understand your situation. They will also help you decide what is right for you and your baby.

Unless it is an emergency, you can take time to think about the information. You can also talk to other people.

Questions to ask your healthcare provider

When you are offered an induction, you should ask about:

• Why induction is being recommended for you.
• The timing of the induction and the reasons for this.
• The different stages in the induction process.
• Where each stage will take place, such as on the antenatal ward, obstetric unit. Some hospitals offer some stages of an induction to happen at home.
• How your labour will be started.
• How induced labour might differ from labour that starts naturally.
• Whether you will need to stay in hospital.
• What pain relief options are available.
• What will happen if labour does not start.
• What will happen if you choose not to have an induction.

Your healthcare team should explain your options for giving birth. They should answer any questions you have. They will ensure you understand the possible risks and benefits of each choice. They will also explain how they will check on your baby's health if you decide not to have an induction.

What to expect during induction

You will usually be offered hormones first to see if they work. This is unless there is a medical reason you cannot take hormones. These treatments often take many hours to start working.

You will usually stay in the hospital maternity unit during your induction. In some cases, you may be able to go home.

Induced labour can feel more painful than labour that starts on its own. However, your pain relief options are not limited by being induced. You should have access to all usual pain relief options, such as an epidural.

Sometimes a hormone drip is needed to speed up labour, or you may need to have your waters broken artificially. If induction does not work, your obstetrician and midwife will assess you and your baby. You may be offered another induction method or a caesarean section. You might also be able to wait a few hours and then be assessed again. Your midwife and doctor will discuss all your options with you.