Induced labour – the process and the reasons
Sometimes there is a need to artificially stimulate or ‘induce’ labour. This is usually the case if there are complications associated with the pregnancy and the health of the mother or the baby is at risk. Also, and quite commonly, it is a method used to bring on labour if labour has not established by week 42 of pregnancy.
If induction of labour is deemed necessary for you, rest assured, your midwife will discuss the reasons, process and risks with you ahead of time.
Reasons why an induced labour may be advised
There are several reasons why you might be advised to have your labour induced. Most commonly these include:
Baby is overdue
Once you have gone past your due date, your midwife will regularly monitor you and your baby. If you reach 10 to 12 days past your EDD and have still not given birth, it is likely that you will be offered an induction. The NHS says there is an increased risk of stillbirth from 42 weeks, so all women under their care will be offered an induced labour.
High-risk pregnancy
In some instances, induced labour will be recommended if there is a higher than average risk to you or your baby because of certain health conditions. These include:
- maternal diabetes
- pre-eclampsia (high blood pressure)
- obstetric cholestasis
Waters break before labour is established
If your waters break before 37 weeks, or your waters have broken and no further signs of labour begin within 24 hours, you and your baby are at increased risk of infection. In these cases you will be offered an induction.
Methods use for inducing labour
There are several options and methods used to induce labour. These include:
Membrane sweep
The first phase of an induction that you will be offered is a membrane or cervical sweep. This is where your midwife or doctor ‘sweeps’ their finger around your cervix. It is an action that separates the membranes of the amniotic sac from your cervix. In turn this releases a hormone called prostaglandin, which helps to stimulate and progress your labour. The process can be uncomfortable and sometimes there will be bleeding or cramping afterwards.
The procedure can be carried out at your 40-week appointment and repeated again if no progress is made. A membrane sweep will not be recommended if your waters have broken to avoid risk of infection.
If the membrane sweep is unsuccessful and you do not go into labour, you may then be offered a more active method. This will be carried out at the hospital.
Prostaglandin pessary
Your midwife will need to check that your cervix is ready to go into labour. This examination creates a ‘Bishop score’ based on a set of measurements to show whether the cervix is “ripe” or “favourable”. Your baby’s heartbeat will also be monitored for 30 minutes.
If you the examination and monitoring are positive, you will be given a pessary, in tablet or gel form, that is inserted into your vagina. The pessary will contain the hormone prostaglandin.
The prostaglandin will slowly release into your system with the aim of encouraging your cervix to soften and commence the dilation stage of labour.
Induction is not always quick and you may find that you are waiting a while before any signs of labour begin. Sometimes, if progress is slow, you may be asked to go home, but if contractions begin, be sure to inform your midwife.
If you show no sign of contractions within six hours you may be given an additional dose.
In some cases, there is a small risk that your womb can become over stimulated and cause stress to you and your baby. If you experience this, you will be offered medication to help slow down your progress.
Balloon catheter
Some hospitals will use an implement known as a balloon catheter. This helps to apply physical pressure to open your cervix.
A deflated balloon is inserted into your womb and gradually filled with saline solution. As it inflates, it should help to stimulate your cervix to dilate. It will be left in place for up to 12 hours and you will be monitored. If you display signs of progressing into labour, the balloon will then be removed.
Having a balloon catheter can be a bit uncomfortable but the risk of hyper stimulation to your womb is lessened.
Rupturing your membranes
If your waters have not broken, another way to speed up labour can be to artificially rupture you membranes.
This method is often used in addition to the prostaglandin pessary when contractions are increasing in length, frequency and intensity.
To break your waters the midwife will use a probe or medical glove designed to prick the membrane and release the fluid. It can be uncomfortable and pain relief will be provided if required.
Due to the risk of infection, this method will only be used once labour has begun.
Oxytocin (syntocinon)
Oxytocin is naturally released when your body goes into labour. You may be offered an intravenous drip containing the hormone if other methods to induce your labour have not worked or if labour is progressing very slowly.
Your baby’s heartbeat and wellbeing will be continuously monitored as the oxytocin can quickly increase the intensity of contractions.
Contractions can become very painful and you will receive regular monitoring and pain relief options.
The experience and risks of induced labour
Induction of labour is a managed procedure, which is likely to take place in hospital so that both you and your baby can be monitored throughout.
Because an induced labour is a medical process, the feeling of labour can be different: often more intense and longer, and you may need stronger pain relief as a result.
Following induction of labour there is also an increased likelihood of assisted birthing methods being necessary at delivery – forceps and ventouse.
Your midwife and doctor will ensure you are kept informed and involved in the decision-making processes throughout.
