Induction of Labour. Division of Women s and Children s Services. Maternity Services. Patient Information

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1 Division of Women s and Children s Services Maternity Services Patient Information Induction of Labour This information leaflet has been produced by Gateshead Health NHS Foundation Trust Maternity Unit to provide information to pregnant women who are being offered induction of labour. Page 1 of 6

2 What is induction of labour? Labour is a natural process that usually starts on its own. Sometimes labour needs to be started artificially; this is called induced labour. Labour Most women go into labour between 37 and 42 weeks of pregnancy (from three weeks before, to two weeks after their due date). Only 4% women give birth on their due date. By 40 weeks 58% women will have given birth, this increases to 74% by 41 weeks and 82% by 42 weeks. Before labour, the neck of the womb (cervix) softens or becomes ripe. This process may take several days and you can experience irregular painful contractions (tightenings) before you go into labour. You may also have a show which is a mucus discharge that may be blood streaked. Why you might be offered induction Most women have a normal pregnancy and a normal birth, but sometimes it can be best to induce labour: To avoid a pregnancy lasting longer than 42 weeks (known as a prolonged pregnancy), If your waters break but labour does not start. If you already have or develop medical conditions during the pregnancy which might necessitate induction between 38 and 39 completed weeks. The most common reason for induction is to avoid a prolonged pregnancy. Your midwife or obstetrician should offer to discuss this with you at your 38 week antenatal appointment. If your waters break early in pregnancy, an individual plan of care will be discussed with you. If your baby is larger than expected, you should not normally be offered induction for this reason alone. If you are healthy and have had a trouble-free pregnancy, induction of labour will be offered when your pregnancy has gone 12 days past your expected due date. Page 2 of 6

3 If you choose not to be induced at this stage, a plan of care will be discussed with you, to include daily electronic monitoring of the baby s heartbeat, and twice weekly scan to measure the amount of fluid around the baby. When induction of labour is being considered, your doctor or midwife should discuss your options with you before any decision is reached. This should include explaining the procedure, the care involved and any risks to you and your baby. You should be told what your options would be if inducing your labour doesn t work. You should be given plenty of time to discuss induction with your partner or family before making a decision, and your healthcare professionals should support you in whatever decision you make. Before you are offered induction You will be offered a membrane sweep to help you go into labour before 42 weeks. This has been shown to increase the likelihood of spontaneous labour within the next 48 hours, and in some cases, can reduce the need for other forms of induction of labour. This involves your obstetrician or midwife placing a finger into the cervix and making a circular, sweeping movement to separate the membranes that surround the baby, or massaging the cervix if this is not possible. It may cause some discomfort, pain or bleeding, but makes it more likely that you will go into labour naturally. How the labour is induced Before being induced, the midwife will check the baby s heartbeat using electronic monitoring. She will also perform a vaginal examination to assess the readiness (favourability) of your cervix for labour using a scoring system. You will be offered one or all of the methods described below, depending on the score and individual circumstances. Prostaglandins This drug (Prostin) is a tablet, and acts like the natural hormones that start labour by encouraging your cervix to soften and shorten. As the cervix changes, your womb may start to contract, which may start labour off without further treatment. Your baby s heartbeat is monitored before and after the drug is inserted into your vagina, and will be checked again when contractions start. Page 3 of 6

4 Further doses of prostin can be administered six to eight hours after the previous dose up to three times. Should your cervix still be unfavourable after this time, a further plan of care will be discussed with you on an individual basis and you will be fully involved in the subsequent decision making. Very occasionally prostaglandins can cause your womb to contract too much and you may need to be given another drug to stop this. One of your birthing partners may stay with you if you are admitted to the induction suite (low risk). If you are admitted to the antenatal ward for closer observation (high risk) your birthing partner will only be invited to stay at visiting times. However if you are transferred to the delivery suite at any point both your birthing partners can be contacted to support you immediately. You may also eat and drink as normal throughout this process. Artificial Rupture of Membranes (breaking your waters) This will happen by making a hole in the bag of fluid surrounding your baby, using a special instrument. This releases the water and allows the pressure of the baby s head to press on the cervix and stimulate contractions. This procedure will cause no harm to your baby, but the procedure may cause you discomfort. Following the procedure the waters will continue to leak until the baby is born. There is a small risk of infection, but this is not usually an issue as you will be giving birth within 24 hours. You may then be advised to mobilise for two hours to encourage contractions to start, or to maintain existing contractions. If contractions are not established after this time, a Syntocinon drip will be commenced. Intravenous Syntocinon Drip - This is another artificial form of the hormone that causes contractions and is given via a drip in a vein in your forearm. A monitor attached around your abdomen will continuously record your baby s heartbeat until birth, but we encourage you to walk around and you can still adopt any birth position you choose (as long as we can continue to monitor your baby s heartbeat). The drip is increased very slowly until your womb is contracting regularly and strongly. These contractions are similar in strength and pain intensity to those you would have if you went into labour naturally. If you start contracting too much, your midwife can reduce the drip. Page 4 of 6

5 If you are being induced because your waters have broken, you may be given a single Prostin tablet and then start the Syntocinon drip six hours later. Pain relief Induced labours are often more painful than spontaneous labours. You should be offered support and whatever pain relief is appropriate to you in the same way as if your labour had not been induced. You should also be encouraged to use your own coping strategies for pain relief. Labouring in water provides good pain relief, however the birthing pool is only available for low risk labour and birth. If you have a drip, or your baby s heartbeat is continuously being monitored the pool is not advised. All other types of pain relief are available. Disadvantages: By inducing a labour and delivery there is an increased risk of an instrumental delivery, caesarean section and increased blood loss. How can I find out more information? Please discuss any queries or concerns with your midwife or consultant during your appointment; alternatively if you need any more information please do not hesitate to contact the Maternity Pregnancy Assessment Unit to speak to a midwife. Pregnancy Assessment Unit or (24 hours, 7days a week) Other information: National Childbirth Trust Royal College of Obstetricians and Gynecologists National Institute of Clinical Excellence References: National Institute for Clinical Excellence (2008): Induction of Labour Clinical Guideline 70 Page 5 of 6

6 Data Protection Any personal information is kept confidential. There may be occasions where your information needs to be shared with other care professionals to ensure you receive the best care possible. In order to assist us improve the services available your information may be used for clinical audit, research, teaching and anonymised for National NHS Reviews. Further information is available in the leaflet Disclosure of Confidential Information IL137, via Gateshead Health NHS Foundation Trust website or the PALS Service Information Leaflet: NoIL248 Version: 2 Title: Induction of Labour First Published: December 2009 Last Reviewed: February 2012 Review Date: February 2014 Original Author: Jo Crawford (Modern Matron) Reviewed by: Lesley Waugh (Midwife) This leaflet can be made available in other languages and formats upon request Page 6 of 6

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