Induction of labour
When does labour normally occur?
For most women labour will happen naturally between 37 and 42 weeks, leading to the birth of their baby.
What is Induction of labour and why am I being offered it?
An induction of labour is when we attempt to start labour artificially. There are many reasons that your doctor or midwife may recommend induction of labour. This may be because:
- There are clinical concerns regarding the welfare of you and/or you baby
- Your waters have broken but there are no signs of labour after 24 hours
- The pregnancy has gone beyond the expected due date with no signs of natural labour. If you are healthy and the pregnancy has been trouble free, induction of labour will be offered around 10-12 days after your due date.
We prefer labour to start naturally but offer induction when the benefits for you and your baby are greater than risks. Our priority is the continued well-being and safety of you and your baby, and the decision to induce is never taken without discussing it with you fully.
How will I be Induced?
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.
Cervical ripening rods (Dilapan-S)
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 (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 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.
Rupturing the membranes (ARM)
‘ 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.
What if the induction fails
If it is not possible to break your waters after Prostaglandins and/or Dilapan-S induction then further options will be discussed with you.
Sometimes it is best to have a break between attempts at induction and sometimes a different method of induction may be best, but you will be kept informed of your options.
Coming to the hospital for induction
You will be given a date and time for induction and you will be informed as to whether you should come to the Antenatal Ward (first floor corridor with blue blocks on the floor) or Obstetric Assessment Unit (first floor corridor with purple blocks on the floor).
Very occasionally the Labour Ward is extremely busy; your induction may be delayed or postponed by up to 24 hours. The midwife or doctor will discuss this with you in more detail if it should occur.
When to contact the helpline
If you have any of the following, concerns whilst at home after the procedure, please contact the 24 hours Maternity Triage helpline on 0170843500 extension 2594:
- Concerns about your baby’s movements
- You feel unwell
- The waters around the baby break
- You require any advise
A midwife will talk to you and advise you on what is required.
For further information you can talk with your midwife or doctor.
You can also contact us on the following contact numbers:
Antenatal Ward - 01708435087
Obstetric Assessment Unit - 01708435000 ext. 2596
Reliable websites for information on any aspect of your pregnancy are: