Most women go into labour naturally at term between 37-42 weeks of pregnancy. However, if there are concerns regarding the safety of the baby and/or the mother the labour may be started artificially.
There are a variety of reasons that Induction of labour may be offered. Some
of the most common reasons are:
You will be given a date and time to attend the hospital to begin your induction process.
You will be admitted to either the antenatal ward or the labour ward depending on which induction method you will receive. For most women induction is a staged process on the antenatal ward which may take several days.
During your stay on the antenatal ward your birthing partner can stay with you during regular visiting hours. When you are in labour you will transfer to the delivery suite where partner can stay with you for the duration of your labour and birth. You will be assigned your own midwife and student to take care of you and your baby during this time.
Induction may involve one or a combination of the following:
A membrane sweep is a process whereby a vaginal examination is performed, the midwife or doctor places a finger just inside the cervix and makes a circular, sweeping movement to separate the membranes from the cervix. By performing a membrane sweep the chances of labour starting naturally in the next 48 hours can be increased. This procedure may cause some discomfort afterwards. It is not uncommon to have a “show” in the hours or days following a membrane sweep. The “show” is a plug of mucous (sometimes blood stained) which is released as the cervix begins to soften. Membrane sweeping is offered by your doctor or midwife from 39+0 weeks gestation.
Pharmalogical cervical ripening uses synthetic hormones to change the cervix. The two types currently being used are Propess and Prostin.
Propess pessary
Propess is a slow-release pessary with a string (like a miniature tampon). The pessary is inserted high into the vagina and left for up to 24 hours. Propess is removed when labour establishes or after 24 hours (whichever is first). If labour has not started, a dose of prostin gel may be given. The advantages of Propess, compared with Prostin gel, are:
Prostin gel
A gel inserted into the vagina to soften the cervix. You will rest for 30–60 minutes after insertion. If labour does not begin, a repeat dose may be given after 6 hours. If labour begins, you will be transferred to the Delivery Suite when a space is available
Mechanical cervical ripening, changes the cervix without the use of medications or hormones. The two types currently being used and Dilapan and Balloon catheter.
Dilapan rods
Dilapan rods are matchstick sized rods that gradually absorbs fluids in the neck of the womb (cervix), and increases to a predictable size which dilates the cervix and also makes your body release hormones that naturally ripen the neck of your womb. This usually takes 12-24 hours. Once your cervix has ripened, we will be able to break your waters and your labour will start; either on its own or by starting a hormone drip (syntocinon) to give you contractions. On removal if the cervix has changed you will be brought to the labour ward to break your waters.
Balloon catheter
The cervical ripening balloon catheter is an induction method used to soften and open your cervix by stimulating prostaglandins similar to the dilipan rods. Your midwife or doctor will insert a soft silicon tube into your cervix during a vaginal exam. The balloon is then inflated with sterile water and is left in place between 12-24 hours. On removal if the cervix has changed you will be brought to the labour ward to break your waters.
When your cervix is open, your waters can be broken. This is usually following a mechanical or pharmalogical cervical ripening. A midwife or doctor performs a vaginal examination and a small plastic instrument is used to make a tiny opening in the bag of membranes. The amniotic fluid (water) will continue to leak or flow until your baby is born. Sometimes an amniotomy is enough to start labour contractions without the addition of a syntocinon drip.
A syntocinon drip is a synthetic oxytocin given through a drip into a vein, which helps the uterus contract. It is titrated to give regular contractions until the baby is born. This method requires continuous monitoring of the baby.
Some women require all steps; others may only need one.
It is important to note that induction can be a long process, sometimes taking several days but your midwife will be there to support you every step of the way!
Induction of labour is a collaborative process between you, your doctor and your midwife. The reasons for recommendation of labour induction will be discussed with you by your team. We will discuss the benefits and the risks involved and you will have time to ask questions and discuss your options.
Using the ‘BRAIN’ acronym may be helpful with decision making for a variety of different choices you may have during your pregnancy and birth
Benefits: What are the benefits for me and my baby?
Risks: What are the risks to me and my baby?
Alternatives: What are the other options available?
Intuition: What does my gut instinct tell me? How am I feeling about this?
Nothing: What happens if I do nothing or need more time?
Preparation:
Induction of labour is completely your choice. It is important to us that you are fully informed and have all your questions answered before making a decision. If you decide that you do not want an Induction of labour you will be offered regular follow up appointments and monitoring which may include an ultrasound scan to ensure that both you and your baby remain well for the duration of your pregnancy.
