Membrane sweeping

A membrane sweep makes natural labour more likely and reduces the need for induction.

A membrane sweep is an internal examination during which your doctor or midwife places a finger just inside your cervix and making a circular, sweeping movement to separate the membranes from the cervix. It can be carried out at home or in hospital.

You may feel some discomfort from the procedure and may notice a show of blood. This is normal and is nothing to worry about.

Membrane sweep is usually offered at 40 weeks and is strongly recommended that a membrane sweep is performed if they are still pregnant at about 41 weeks. Please ask your midwife if you have not been offered a membrane sweep before induction of labour.

Dilapan-S is a non-hormonal method of inducing labour and is safe for you and your baby even if you have other medical conditions such as diabetes or asthma, or have previously had a caesarean section.

Dilapan-S is an osmotic dilator, produced from a patented hydrogel that absorbs fluid from your cervical canal and therefore increases in volume. This helps your cervix to soften, open and get ready for your labour in a gentle and natural way.

Each thin rod will expand slowly over 12 hours and open your cervix by causing it to dilate and soften to help prepare you for labour, a total of 5 rods will be inserted. They will remain in from 12-15 hours, if your cervix is not sufficiently dilated, the process of insertion of another set of Dilapan-S rods for a further 12 hours will take place up to a maximum of 24 hours.

There is a reduced risk of strong uterine contractions while your cervix is dilating, which makes the initial part of the induction process more comfortable and safer. One of the added benefits of this method is that you can be managed as outpatient while the rods are in, as long as we do not have any concerns about you or your baby.

Dilapan-S is inserted into your cervix during a vaginal examination.

It will take approximately 5–10 minutes. Your legs will be raised on the bed and a speculum will be inserted by your midwife. The Dilapan rods will then be inserted into your cervix. The procedure can be a bit uncomfortable, but generally it is well tolerated by most women.

• Some minor bleeding might occur during or after insertion; this is common and should not be a concern.
• Inserted DILAPAN–S® does not limit your regular activities.
• You can go to the bathroom, shower normally and perform your normal daily activities. You will need to avoid sitting in a bathtub and vaginal douching while the rods are in place.
• Most women can relax or sleep during cervical ripening as there is a low rate of uterine contractions. If there is any excessive bleeding, pain or other concerns that occur during the ripening process, please report that to your midwife immediately, or call the 24 hour helpline.
• Under no circumstances should you try to remove the rods yourself.

PROSTIN

Prostin (tablet) is a hormone and it prepares the cervix for labour. It is inserted into the back of the vagina and works over a six hour period. You may need more than one dose of the tablet if the cervix is still not dilated enough.

PROPESS

Propess pessary (10mg dinoprostone) is a tablet that is attached to a ribbon, similar to a tampon, which is placed inside your vagina. The pessary slowly releases prostaglandins over a 24 hour period and prepares the cervix for labour. Once the pessary is inserted we like you to walk around to help encourage labour, and you can also still shower, eat and drink normally.

Before giving the prostaglandin your midwife should monitor your baby’s heartbeat using a monitor called cardiotocograph (CTG). After being given prostaglandin you should lie on your bed for at least thirty minutes to give the prostaglandin time to dissolve. Once it is established that everything is ok, the CTG should be discontinued. After this your will be able to move around.

‘ Breaking the waters’ is also known as artificial rupture of membrane (ARM). A vaginal examination is performed and a small hole is made in the membranes with a slim sterile plastic instrument. It may be uncomfortable for you but does not hurt the baby.

Following this, you will feel a gush of warm fluid which confirms your waters have been broken. In some cases this may not be obvious and we may need to repeat this.

If you have not gone into labour after using Dilapan rods or Prostaglandin, then you will be examined to see if it is possible to break the waters. This is done on the Labour Ward or Birth Centre depending on the reason for induction.

There is a very small risk of the cord coming out the vagina when the membranes are broken. If this happens you will be advised to have an emergency caesarean section. Very occasionally it is thought best to induce labour with an ARM, this is if you and your baby are thought to be at higher risk from the use of prostaglandin. If the labour ward is very busy there can be a delay in performing the ARM but every effort will be made to keep you informed of the plans and any reason for a delay.

Sometimes your labour will start soon after breaking the waters, but if this does not occur, you will need a hormone drip (Syntocinon) to encourage contractions.

This is given on the labour ward, though a tiny tube (intravenous cannula) in your arm. As labour can be more painful with the Syntocinon, you should be encouraged to discuss the pain relied options that you want. Once contractions have begun the rate of the drip can be adjusted so that your contractions occur regularly until your baby is born. The midwife should monitor your baby’s heartbeat continuously whilst the Syntocinon is being given.

Having a drip will limit your ability to move around. Whilst it may be okay to stand up and sit down, it will not be possible to have a bath or move from room to room. If you have had a caesarean section before and you need Syntocinon, there is an increase in the risk of the scar tearing.