Labour – as we discuss during our antenatal classes, rarely begins on your ‘estimated due date’ EDD, especially if it is your first baby. In reality your due date is probably more accurately described as a ‘due window’ – of 5 weeks, as babies are born often between 37 to 42 weeks in a straightforward, term pregnancy.
In most pregnancies, labour will usually start naturally on its own within those 5 weeks, but there are times that it may need to be started artificially. This is called induced labour – to help your cervix to soften and open out and your uterus (womb) to start contracting.
Why would I need to be induced?
Most labours will start naturally by 42 weeks, but there are occasions where you may be advised that your healthcare team feel it is best to induce labour.
This can be due to a variety of reasons such as:
- Your baby hasn’t arrived by 42 weeks
- Your waters have broken but you haven’t gone into labour
- Your baby’s growth is affected (too big or growth has slowed down)
- You have had a very fast labour before (called precipitate labour)
- You or your baby has a health condition that means it is safer for baby to be born sooner such as:
- type 1 or type 2 diabetes
- gestational diabetes
- intrahepatic cholestasis of pregnancy (ICP)
- pregnancy-induced hypertension
Before you are offered an induction of labour, you should be offered a membrane sweep. This makes it more likely that you’ll go into labour naturally and won’t need an induction.
Do I have to agree to an induction of labour?
No – your informed consent must always be given and you will not be forced into having any procedure you are unsure about or have declined. You will be supported whatever decision you make.
It is important to bear in mind that your doctor/midwife will only offer an induction of labour if they feel there is a medical need for it and should advise you of why this is in an unbiased, non-judgemental, clear way.
Being induced is fairly common – every year, 1 in 5 labours are induced in the UK.
To help you decide, your doctor or midwife should give you more information about:
- why you’re being offered an induction
- when, where and how the induction will be carried out
- what support and pain relief is available
- what other options are available
- what the risks and benefits are
- what your options are if induction doesn’t work.
Don’t be afraid to ask any questions and take some time to think about your options. You may find it helpful to talk to your partner, family or trusted friends before deciding.
What are the side effects of induction?
It is important to remember that an induction of labour, though quite common, is a medical intervention, and weighing up the risks and benefits is important.
- There’s no guarantee that an induction will work.
- Induction of labour may carry risks for mums, especially if they are not ready to labour.
- Risks might be finding labour more painful and possibly a higher risk of having an assisted vaginal birth.
- An increased risk of haemorrhage after birth, bacterial infection and having a caesarean section.
Your midwife or obstetrician should explain why you are being offered an induction and explain the risks, benefits and alternatives. They should also encourage you to look at information about it and discuss your decision with your partner or family. Midwives or obstetricians should always support you in whatever decision you make.
What happens during an induction of labour?
There are different ways to induce labour. Your doctor or midwife will advise on what they think may be the best one for you. You may need a combination of different methods.
Different ways of inducing labour include:
- Stretch and Sweep Membrane
During a vaginal examination, the midwife or doctor makes circular movements around your cervix with their finger. This action should release a hormone called prostaglandins. You do not need to be admitted to hospital for this procedure and it is often done during your antenatal appointment.
This can be enough to get labour started, meaning you will not need any other methods.
You’ll be given drugs called prostaglandin, which act like the natural hormones that kickstart labour. These are inserted into the vagina as a gel, tablet or pessary. This can take a while and you may need more than 1 dose of prostaglandin if you haven’t had any contractions after 6 hours.
If you have a controlled-release pessary inserted, it can take 24 hours to work. If you aren’t having contractions after 24 hours, you may be offered another dose.
- Cervical ripening balloon catheter
A cervical ripening balloon catheter is a small tube attached to a balloon that is inserted into your cervix. The balloon is inflated with saline, which usually puts enough pressure on your cervix for it to open. It stays in place for up to 24 hours, and then you will be examined again.
Dilapan-S is a small rod that gradually absorbs fluid in the neck of your cervix; this increases in size in order to dilate the cervix. This method contains no drugs and is known as mechanical induction.
You may need a hormone drip to speed up the labour. Once labour starts, it should progress normally, but it can sometimes take 24 to 48 hours to get you into labour.
- Artificial rupture of membranes (‘breaking your waters’)
Your midwife or doctor may also break your waters if they haven’t broken yet. This method of induction is called artificial rupture of the membranes (ARM) or amniotomy. This will feel a bit like an internal examination, and it doesn’t hurt your baby.
You shouldn’t be offered an artificial rupture of membranes unless the doctor or midwife can’t use prostaglandins.
Do I need to stay in hospital for the induction of labour?
You may be kept in hospital if you have prostaglandins (although some hospitals may offer you to go home), and you will be kept in if you’re having your waters broken.
Your birth partner may be able to stay with you, although this depends on hospital policy and your birth partner may need to leave for a while.
If you are having your labour induced by mechanical methods, such as a catheter balloon or Dilapan-S, you may be able to go home.
Is it painful to be induced?
No, the induction process itself is not painful, but you might feel discomfort. Our class on birth variations covers in detail how to prepare for an induction, what to pack and what to expect.
Induced labours can be more painful than labours that start on their own. But you should have access to the same pain relief as you would with a natural labour.
What if the induction doesn’t work?
If you don’t go into labour after an induction, your doctor or midwife will talk to you about your options. You may be offered another induction or a caesarean section.