The Complete Guide to Induction of Labour
Most people will go into labour naturally between 37 and 42 weeks, but often medical teams will offer an induction of labour for a range of reasons we cover in this blog.
What is an induction of labour
What is an induction of labour?
Induction of labour is a medical intervention that aims to start or accelerate the process of labour and birth. It’s important to emphasise that it’s entirely your choice as to whether you embrace or decline an induction of labour. There might be medical reasons that make an induction the best choice for you, or you might choose to ‘wait and see’. You also have the option of a caesarean in many cases. But to make this choice, you need to know all the facts!
Types of induction of labour
When it comes to inducing labour, there are several methods that your healthcare provider will consider. Each approach depends on various factors, such as how ready your body is for labour and the specific circumstances of your pregnancy. Most people need a combination of these methods to induce their labour. So, what are they?
Membrane or cervical sweep
Not technically part of the induction process - before you are induced, you may be offered a membrane sweep and in the UK these are routinely offered at your antenatal appointments from 39 weeks.
Your healthcare provider will gently sweep their finger around the cervix to separate the amniotic sac from the uterine wall, which can release hormones that trigger labour. Although a sweep is intended to induce labour, it doesn’t mean you will go on to have an induction if the sweep doesn’t work immediately, it’s just one of the things you can try to bring on labour without an induction.
Need to know
It is widely debated as to how effective sweeps are, although there is evidence to suggest that they can induce labour. Sweeps are a low level of intervention and so some people want to accept a sweep to give it a try.
Sweeps themselves shouldn’t hurt, though can be uncomfortable and unpleasant.
Sweeps can cause some soreness and bleeding afterwards.
Prostaglandin or pessary
A common first step of an induction is to use a synthetic hormone called prostaglandin. This is administered via vaginal pessary (a tablet that’s put inside your vagina), or gel. Sometimes you are given a tablet to swallow. Prostaglandin works to soften and stretch your cervix and may also encourage contractions to begin.
Need to know:
Once administered, you will need to lie down for 30 minutes
A small number of people experience nausea, vomiting and fever
Prostaglandin can bring on surges that are too strong or long. If so, there is medication to counteract it.
Your midwife will want to closely monitor you either through intermittent or continuous monitoring. So this is a good question to ask if you are thinking about accepting an induction as it can impact your birth preferences.
This is just one step and most people will need further assistance for labour to begin.
Balloon catheter
A balloon catheter is another option, often used instead of prostaglandin. A balloon catheter is a thin tube that’s inserted into your cervix and inflated with water. The goal here is to stretch, soften and dilate the cervix to prepare it for the next stage of labour.
Need to know:
Once inserted, the balloon catheter stays in for 12 hours. You can move around normally and might be able to go home during this time.
This is just one step and most people will need further assistance for labour to begin.
Artificial rupture of Membrane
Commonly known as breaking your waters, this is where a device is inserted into your cervix, which has hopefully dilated and softened by this stage, to break the amniotic sac that surrounds your baby. The purpose here is to put additional pressure on your cervix and advance labour.
Need to know:
This is a straightforward procedure and although it can be uncomfortable, it shouldn’t hurt. There are some small risks, such as infection or prolapse, but your care-givers are trained to avoid this.
Breaking your waters alone is unlikely to induce labour, so you will probably need to have the oxytocin drip afterwards.
Oxytocin
Oxytocin, the feel-good hormone that is important to progress labour is administered via a drip, with levels increased every half hour until you go into labour. At this point the level stays steady. Everyone needs a different amount to bring on surges at the correct rate.
Need to know:
As oxytocin is administered via a drip, you will need to be in hospital, a midwife tends to stay with you throughout.
Your baby will require continuous monitoring which might hinder your movement, depending on how your hospital does this. Ask them as some trusts have wireless monitoring available.
Occasionally, oxytocin brings on surges that are too strong. If this happens, the level of drip will be reduced and you may receive medication to counteract the oxytocin.
Reasons you might be offered an induction
Medical reasons for induction
Various medical conditions may lead to you being advised to consider an induction of labour. These include gestational diabetes, preeclampsia or intrauterine growth restriction. As a midwife, I advise you to engage in open communication with healthcare providers to fully understand the specific medical reasons for induction in your unique situation. Always ask and use the BRAIN acronym. What are the benefits, risks, and alternatives? What is your instinct and what would happen if you do nothing?
Prolonged Pregnancy
Post-term pregnancies, where a pregnancy extends beyond 41 - 42 weeks is one of the most common reasons to be offered an induction The NICE guidelines recommend offering an induction to ‘low risk’ women at 41- 42 weeks so that the baby is born by 42 weeks. The evidence for this is much debated and if you would like to learn more about the evidence, midwife Sarah Wickham offers some great analysis of the data.
Your waters have broken
If the amniotic sac ruptures (ie your waters break) and labour has not begun spontaneously, you may be advised to induce labour to avoid infections and ensure the well-being of both you and the baby. Typically this is offered after 24 hours but sometimes your caregivers will stretch the window to 48 hours. Parents should be aware of the signs of premature rupture of membranes and you should seek prompt medical attention if you think your waters have ‘gone’ prematurely. Always pick up the phone and get advice from your caregivers if you aren’t sure.
Infection
In cases of infection within the amniotic fluid and membranes, known as chorioamnionitis, induction may be necessary to prevent the spread of infection to the baby. Parents should be vigilant about any signs of infection, such as fever, and report them promptly to their healthcare providers.
‘Big’ baby
Some babies are said to be ‘large for gestational age’. We have more information on how babies are measured and what we mean by a big baby over on our blog. If you are being offered an induction due to a suspected big baby and your pregnancy is otherwise deemed ‘low risk’, take particular care in gathering information about your situation. The NICE guidelines suggest that a large baby alone should not be the reason for an induction to be offered, however, in your situation, you may feel it is the best course of action.
Maternal age and IVF pregnancy
In the UK, women over 40 are offered an induction at around 39/40 weeks. The reason for this is that some of the research points to an increased risk of stillbirth if you are 40+ and go beyond 39/40 weeks. Many women having IVF are also offered an induction of labour for specific reasons related to the individual pregnancy.
The key thing, if you are being offered a prolonged pregnancy induction, is that your care providers should inform you about the potential benefits and risks and allow you to make an informed decision.
The downsides of induction
No two birth experiences are the same, so these ‘downsides’ are possibilities that may or may not bother you and contribute to your decision as to whether to accept an induction or not. Make sure you use your BRAIN (more on that below) for your specific situation to decide though.
Inductions are not a quick process, so from start to finish, your birth experience can be longer
Induced labours have been reported to be more painful, with a less positive experience. Please read the section on steps to take to have a positive induction below
You will need to give birth in hospital or on a labour ward with an induction, so this might impact your birth plan.
Monitoring can have an impact on your birth preferences and ability to use a pool or move around freely.
Induced labour can cause your surges (or contractions) to be too strong for you or baby, so you and baby will most likely be constantly monitored.
Induction does not always work and some people go on to have a caesarean.
The upsides of induction
The key thing to realise here is whether an induction is the correct choice for you and your pregnancy. For whatever reason, if you feel that an induction is the best thing to do, then you should take confidence in your decision-making ability (our Hypnobirthing Pack will help with that) and that you know best!
There are many ways to have a positive induction, some are detailed below and the best thing about an induction is that you will be meeting your baby soon!
Deciding if you want an induction
In deciding whether or not to have an induction, we recommend you take the following steps:
Be very clear on what the reasons are for your induction.
Talk through what a possible induction could look like for you personally. Specific areas to talk about are:
Your risk of stillbirth (not just national averages)
Wait times on the wards
Impact of induction on other areas of your birth plan
Ways in which your birth plan could be accommodated or adapted for an induction
Your risk of other intervention such as caesarean section or instrumental birth
Once you have all the details you need for your own situation, use your BRAIN.
B.R.A.I.N = Benefits, Risks, Alternatives, Intuition, Nothing.Take some time to decide. Whilst you might be in an urgent situation, inductions are not an emergency procedure, so there is time, even if it’s just over a quick cup of tea, talk it through with your birth partner so you make the decision that is best for you and your baby.
How to have a positive induction
If you decide to accept an induction, you might feel a little disappointed or nervous about the process and how it is going to impact your birth. More than ever, it is important to have your hypnobirthing toolkit at the ready, so sign up to the Hypnobirthing Pack to get prepared for your positive induction experience. Here are a few other tips to help you:
Positive birth stories
Read about the positive experiences of other women and people. There are women out there having positive inductions all the time. Hearing about negative experiences before your induction can leave you upset and anxious, which is a sure way to impact your natural birth hormones and make the process longer. Try to focus on the positive - you will be meeting your baby soon! Read positive induction birth stories here.Positive affirmations
For the same reason, use positive affirmation cards or write down mantras that suit your own situation. Let this be your inner narrative and remember your body is amazing and designed to birth your baby.Entertainment
If you are having an induction, you can be waiting around for some time. Prepare for this by accepting the wait, viewing it positively as time to relax, bring snacks to hospital, watch a boxset, do some knitting, paint your nails, have a picnic in the hospital grounds, whatever it is that will keep you entertained and not staring at the clock! If your labour does progress quickly, then it’s a bonus!Environment
While inductions need to take place in a hospital setting, you can still make changes to the environment to promote your own comfort and relaxation. Take your own pillows and bedding. Once you are ready to transfer into the labour ward, ask for low lighting. Take in LED candles and fairy lights. Many units now have stargazer projector lamps. A beautiful room makes a calm space. Put calm music or affirmations from the Freya app on a bluetooth speaker. Ask the midwives to keep chat to a minimum and people to knock and wait before coming in. If this is on your birth preference sheet it helps to remind staff to keep your room a sanctuary of peace and calm. Rub essential oils on your wrists and wear comfortable clothes. All these things are going to help you get into the right mental state and physical position to relax and let your body do what it was built to do.Make friends!
Lifelong friendships are made on maternity wards - just think, you are going through similar experiences at the same time. You might live nearby and be on maternity leave at the same time - get networking!Snuggle up
Remember kissing and cuddling all help increase your oxytocin, as well as nipple stimulation! So it’s worth bearing this in mind, especially if you are going home for an ‘outpatient induction’, where you have the first pessary and can go home for a few hours.Use a birth pool
You might assume that having an induction means you can’t use a birth pool, but ask your midwife. Is there a pool available and if you need to be monitored, does the hospital have a wireless monitor that can go in the pool? If you don’t have access to a pool, you can try standing in the shower. Sometimes the warm water on your back can get you through that last hurdle!Keep an open mind
Keep all conversations open and ask for more time (if you need it) to make any decisions. It’s your birth, your choice, your baby and your special day. The doctors and midwives are here to support you and your midwife should be your advocate to help speak up for you and your birth choices.Don’t make assumptions about pain relief
One element of the induction process is an oxytocin pessary or drip. It is impossible to know how this will impact each individual. Some people have a strong reaction and surges are felt intensely, especially if natural levels of oxytocin were already elevated. Others have less of a reaction. But regardless, there is no way to predict how you will cope and only you can decide when you would like to embrace or decline pain relief. Avoid conversations in which your caregivers make any assumptions about how you will cope.Take your labour as it comes and use your pain relief options as and when it suits you.
No matter what birth you're planning our Hypnobirthing Pack will help you prepare for your birth, giving you the knowledge and tools you need to make it an empowering and positive experience. There is a dedicated section on inductions and it will equip you with all you need to Find out more and sign up here: https://thepositivebirthcompany.com/digital-pack
Sources:
https://www.thewomens.org.au/images/uploads/fact-sheets/Induction-of-labour-181018.pdf
