Information about Induction of Labour

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1 Birmingham Women s NHS Foundation Trust Information about Induction of Labour This information is important if you: are 38 weeks pregnant or more have been advised to have your labour induced (or started off) It tells you how we can assist you to encourage labour in an attempt to avoid induction. The reasons we recommend trying to start labour off. Some information about the best ways to induce or start labour. Information to assist you to make choices.

2 What is induction of labour? Labour is a natural process that usually starts on its own between 37 and 42 weeks for most women but sometimes we recommend assisting the natural process of labour. This is called induction of labour. Why might I be offered induction of labour? Induction is recommended and offered for the following reasons: To avoid a pregnancy lasting longer than 42 weeks. We know that the placenta is not always as efficient as it is earlier in pregnancy, leading to a slightly increased risk of stillbirth after 42 weeks without any warning signs. If your waters break but labour does not start within 24 hours on its own because there is a slightly increased risk of serious infection in both you and your baby If there are problems in your pregnancy which can affect either your or your baby s wellbeing If you are over the age of 40 Can labour be helped to start naturally? Yes. We strongly recommend that you ask your midwife or doctor for a membrane sweep - it is the first step to starting labour. A membrane sweep is recommended prior to induction. A membrane sweep is usually done in clinic or at home by your midwife. We know it reduces the need for other methods we offer. It can assist labour to start, usually within 48 hours of having it done. At this hospital we offer a membrane sweep to all women at 40 and 41 weeks. After the sweep, we recommend that you remain upright and active. What is a membrane sweep? It requires you to have an internal vaginal examination. A finger will be inserted into the cervix or opening of the neck of your womb. By rotating the finger in the cervix, it stimulates the hormone prostaglandin. 1

3 Are there any side effects from a membrane sweep? A sweep is a bit uncomfortable and can cause slight bleeding and contractions afterwards. Should you continue to lose blood, or your baby s movements reduce, then please ring us in triage: A sweep will not cause any harm to your baby and will not cause infection. Is there anything else? There are other ways of trying to start labour (herbal supplements, acupuncture, homeopathy, castor oil, hot baths and enemas, sexual intercourse and breast stimulation), but we don t have enough information about these to say if they do help to start labour or not so are not recommended. Will I be offered an induction of labour date? Yes, you will be offered a date. If your pregnancy goes over your due date, we will offer you a date at between 10 and 12 days after your due date. If offered earlier, the reasons for the decision will be explained in detail to you. Can I decide not to be induced? Yes, of course, as this is your choice. If you decide not to be induced against our advice, we will offer additional checks for you and your baby, depending upon your personal situation. Usually this will include monitoring of your baby s heart using a monitor for about 30 minutes a day until labour starts naturally. An ultrasound scan to check on the baby s wellbeing may also be offered. 2

4 What preparations do I need to make before coming in for induction? Inducing labour is unpredictable and also depends upon how your body and your baby respond to the treatment we offer you. Lots of factors can affect how quickly you can return home and everyone is different. We urge you to plan for your induction to take many hours and potentially up to several days before you will go home with your baby. We suggest that you bring a book, magazines and light snacks or similar with you. We will also need to prioritise women according to their clinical need which means that sometimes you may have to wait for induction to be started off. What happens on the day of my induction appointment? You will be offered a date for your induction. Before arriving on that day, we ask that you ring the place you have been booked by 8.00 am which will be either Induction Suite or ward 1. We might need to advise you to arrive later than planned if the hospital is busy. Very occasionally, we need to postpone inductions. If this happens, please be reassured that we will keep you fully informed regarding any changes to your care. We are equally keen to start your labour off and will be doing all that we can to do so. On arrival for induction: You will be shown to your bed and any questions answered Your wellbeing and your baby s position will be checked We will monitor your baby You will need to have an internal vaginal examination to check the cervix (neck of the womb). Some women will need Propess (Page 4) some women will not need Propess and will need to have their waters broken (Page 6). Others will need both. Until we examine you to see we will not know, but will explain after your vaginal examination. 3

5 What methods are used to induce labour? There are a number of methods used, which are offered according to your own situation. Your midwife or doctor will discuss these options with you. 1. Propess - a prostaglandin vaginal pessary Propess (which looks like a flat tampon with a string attached) is inserted close to the opening to the neck of the womb (cervix). The hormone prostaglandin is then released slowly to make the cervix soften and shorten (ripen). Most women will need to remain in hospital once Propess has been given. What happens next? Labour usually doesn t start straight away. Some women without complications will be offered the choice to go home until labour starts (see going home with Propess) - For many women, the womb (uterus) contracts regularly and labour progresses without the need for anything else. Once your contractions become painful and regular, a tracing of your baby s heart beat will be undertaken to ensure that your baby is happy. If you are otherwise suitable for the birth centre (and are being induced for postdates only), once labour establishes the birth centre will be an option for you. - For other women, Propess will just ripen the cervix enough for your waters (membranes) to be broken artificially. To have your waters broken you will be transferred to delivery suite once a room is available where you will receive 1:1 care from a midwife. Some women will then progress in labour without the need for anything else. Some women will need a hormone drip to start contractions. - Occasionally, Propess does not work enough for us to break you waters and we are unable to start your labour. If this happens a doctor will need to offer you additional choices. 4

6 Additional Information about Propess Please be careful not to pull on the string because the pessary may fall out. Tell a midwife if this happens. Let a midwife know when your contractions become regular or your waters break so that we can monitor your baby s heartbeat. We encourage you to move around. Try using the stairs or ask for a birth ball. Movement will help your baby to get into a good position. If your contractions don t start about 24 hours after Propess, see if it is possible for us to break your waters. If it is not possible to break your waters we will leave the Propess to continue to work for another 8 hours. Tell us if you have any concerns. What are the possible side effects of having Propess? We know Propess is safe for both women and babies. However, as with any drug, some people have a reaction. Usually a reaction is very minor, such as nausea or diarrhoea. Occasionally, women can experience contractions that are too frequent. If this happens, we will remove the Propess and monitor your baby closely. We might also offer a small injection to reduce the contractions. Very occasionally babies may need to be delivered by Caesarean section. Going home with Propess Some hospitals in the country have been offering women the opportunity to go home after they have had Propess. Going home appears to be safe and women like the opportunity to be in the comfort of their own home while waiting for labour to become established. The time you will be at home varies from woman to woman. We are now able to offer this service for some women. Going home might be an option for you ONLY if: You have no problems in your history or in this pregnancy Under the age of 40 years If the ONLY reason for your induction is that you are past your due date You and your baby s observations on the day you are booked for induction are completely normal. This includes an ultra-sound scan (within 48 hours of receiving Propess) to measure the fluid around your baby 5

7 All is well with both you and your baby after receiving Propess You are willing to go home; live within 30 minutes of the hospital; have transport available; have access to a mobile phone and someone can be with you whilst at home If going home with Propess appeals to you and you fulfil all of the above then please see page 7 for further information. 2. Breaking your waters (Artificial Rupture of Membranes) Once your cervix is opened enough (either naturally or after Propess), we will offer to break the membranes surrounding your baby. In order to have this done, you will need a vaginal examination and a slim hook will be used to make a hole in the bag of waters. This will not harm your baby, but can be uncomfortable for you. Once your waters have been broken, we will check your baby s heart beat. The method chosen to monitor your baby s heartbeat during labour will depend upon your individual circumstances. 3. Hormone drip - Syntocinon Oxytocin is the hormone, naturally produced, which aids contractions. Syntocinon is an artificial version of the hormone oxytocin. It is given through a drip and carefully regulated to ensure that you have regular contractions until the birth. The hormone is usually used only after your membranes have broken, particularly if contractions don t start on their own. It is only available when you are in a delivery room on delivery suite and we recommend that your baby is continuously monitored whilst receiving it. Having a drip and being monitored continuously can restrict your movement. We encourage you to be as upright and as mobile as possible because we know that standing up helps labour to progress, as well as helping to relieve discomfort and pain. 6

8 What are the possible side effects of syntocinon? Occasionally, it may increase your contractions by making your uterus contract too frequently (called hyper stimulation). This is why we advise that your baby s heart rate is monitored continuously and electronically. Syntocinon can sometimes cause changes in your baby s heart rate. If this happens, you may be asked to lie on your side and the drip will be reduced or turned off. We might also offer a small injection to reduce contractions. Very occasionally a Caesarean section might be needed. What about my partner during induction of labour? Your birth partner may remain with you during your induction, but he/ she also needs to rest before labour establishes. During the night, if labour hasn t become established, your partner is better resting at home because there is no family accommodation available on the ward. He/she can sleep in readiness for supporting you in labour. Going Home with Propess (continued from page 5) If the idea of going home with Propess appeals to you and you are suitable then please mention it to your midwife. Booking the option of going home with Propess When your induction of labour is booked at around 41 weeks your community midwife will discuss going home with Propess with you. You will be advised regarding where to go on the day of your induction. 7

9 What will happen on the day of my induction before I can go home? If you have chosen to go home with Propess you will be advised to attend the Day Assessment Unit at the hospital at hours for an ultra-sound scan. This will ensure that your baby has plenty of amniotic fluid. NB: If you are being induced on a Saturday your scan will need to be done on either Thursday or Friday. If your induction is booked for a Sunday your scan will need to be done on the Friday before. If you have had a scan within the previous 48 hours of your induction day then please ring ward 1 directly at hours on the day that your Induction is booked ( ). Following your scan you will need to go to ward 1. Sometimes a bed is not immediately available on ward 1, but we will be working hard to minimise any inconvenience. Please be available to attend from between and up to hours. We will ring you as soon as a bed is available. Once on the ward, you will spend about 2 hours with us so that we can assess you and your baby and how you respond to the Propess. Providing that you are not in established labour, you will then be able to go home (see What happens on the day of my induction appointment? (page 3) and Propess - a prostaglandin vaginal pessary (page 4 of this leaflet). Once you have gone home, we encourage you to remain mobile during the day and carry on as normal. We recommend that you have someone with you whilst at home. When should I contact you after going home? (Triage Tel no: ) We would like to have a telephone conversation with you about 12 hours or so after you receive the Propess to check that all is well. Please ring Triage to let us know how you are. 8

10 You will also need to call us if: Your Propess falls out (please put it in the box we gave you or a clean bag) Your waters break or you have vaginal bleeding Contractions become regular i.e 3-4 every 10 minutes lasting about seconds or too frequent i.e less than one minute gap between contractions or feel continuous There is a change in your baby s movements If you are worried / unhappy at home If labour starts after going home with Propess and on arrival in Triage the tracing of your baby s heart rate is normal, the Birth Centre will be an option providing you are no later than 14 days after your due date and everything else is normal. For any of these above reasons we advise you to ring and come to Triage. If labour has not started after 24 hours following Propess You will need to return to hospital after 24 hours or so. Please ring us on ward 1 at 10am. Tel: first to confirm that a bed is available. When you arrive w will assess both you and your baby and discuss your on-going plan of care with you. Please be prepared to stay in hospital until your baby is born. 9

11 Your induction of labour has been booked for: Date:... on Ward please ring at 10.00am Induction Suite please ring at 08.00am Further information Talk to your midwife or doctor. You might also find the following helpful: Birmingham Women s NHS Foundation Trust website and on line access to leaflets and information for women NICE Induction of Labour NHS Choices Pregnancy Care Planner PregnancyHome.aspx Association for Improvements in Maternity Services, (AIMS) AIMS Helpline: National Childbirth Trust (NCT) Leaflet reviewed and updated by: Paula Clarke - Consultant Midwife, Women who have used our service, Supervisors of Midwives, Obstetricians and Clinical Midwives. Ref 78/03/2014 Review 03/2017 Birmingham Women s NHS Foundation Trust Edgbaston, Birmingham B15 2TG Tel: Fax: Printed by Kall Kwik Walsall. Tel:

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