Induction of Labour. An information guide
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1 TO PROVIDE THE VERY BEST CARE FOR EACH PATIENT ON EVERY OCCASION Induction of Labour An information guide
2 Induction of Labour What is induction of labour? Labour is a natural process that usually starts on its own between 37 and 42 weeks. Sometimes labour needs to be started artificially; this is called induced labour. Why is labour induced? Induction is recommended when the health of mother or baby is thought to be at increased risk if the pregnancy continues. Your doctor or midwife will discuss your choices, the procedures and the care involved with you before any decision is reached. The most common reasons for induction are: your baby is overdue but labour has not started naturally by the 41st 42nd week. Induction does not increase the chance of you needing a caesarean section or assisted delivery but does reduce the small risk of stillbirth your waters have broken, you are over 37 weeks but labour has not yet started. A waiting period of 24 hours is recommended to see if you go into labour naturally then induction will be offered to reduce the small risk of infection. Your chances of having a caesarean section will not be increased by waiting 24 hours your waters break very early (more than 34 weeks but less than 37 weeks). A doctor will discuss with you the appropriate time of induction your health or your baby s health is thought to be at increased risk if the pregnancy continues. For example, pre-eclampsia, diabetes or if your baby is not growing well. Important: If the maternity unit is very busy, your planned induction may be delayed to enable us to provide safe care for you 2
3 and your baby. Please make sure your partner and relatives are aware of this. What are the risks of induction? induction of labour may fail, especially if the cervix is not ripe your baby s heart rate may react abnormally to the induction which may necessitate delivery by caesarean section. How is labour induced? Inducing your labour takes time. It is a process which may take a couple of days especially if this is your first pregnancy. The process can involve ripening of the cervix, breaking your waters and giving you a hormone drip. Some women only require one method before labour starts, but some women may need all three. It is impossible to predict with accuracy how you as an individual will respond to the induction process. How does my cervix ripen? Before labour 0% effacement Early effacement 30% Complete effacement 100% Complete dilation Your cervix or neck of the womb must open to allow the baby to move down the birth canal to be born. During the pregnancy your cervix is long, firm and closed. Towards the end of your pregnancy natural hormones soften, shorten, and open the cervix in 3
4 preparation for labour - this is also known as effacement. If this does not happen you may need some help. 1. Membrane sweeping A sweep will be offered before other methods are used as it increases the chances of the cervix ripening and labour starting naturally. A woman who has never had a vaginal birth before will be offered a sweep at 40 weeks and other women at 41 weeks. A sweep involves your midwife or doctor putting a gloved finger just inside the cervix and making a circular, sweeping movement to separate the membranes from the cervix. This can be done at home, in a community clinic or in hospital. The procedure may cause some discomfort or bleeding, but will not cause any harm to your baby and it will not increase the chance of you or your baby getting an infection. Membrane sweeping is not recommended if the membranes have already ruptured. 2. Using prostaglandins (Propess) This is the most common method of induction. The aim is to soften and prepare the cervix to enable the waters to be broken although occasionally labour starts without any further intervention. If your cervix is not effaced, we will try to ripen the cervix using a pessary called Propess. It looks like a small tampon which is inserted into your vagina. It has a string attached should we need to remove it. The pessary contains a naturally occurring hormone known as prostaglandin. Your midwife will perform an electronic monitoring of your baby s heartbeat before inserting the pessary. Once inserted, the pessary will stay in the vagina for 30 hours slowly releasing the hormone until the cervix is more favourable and we can break your waters. 4
5 Occasionally we may use a similar product called Prostin which is a vaginal tablet. The main difference is that with Prostin an internal examination is required every six hours which may be uncomfortable, and more than one tablet may be required. Medicines can affect people in different ways. The possible side effects of prostaglandins are: abdominal discomfort, nausea and vomiting, diarrhoea, abnormally strong uterine contractions which may cause problems with the baby s heart rate and vaginal irritation/swelling. What happens after the Propess pessary has been inserted? You will be asked to rest in bed for 30 minutes to allow the pessary to swell to prevent it from falling out. Take special care when wiping yourself after going to the toilet and if the string from your pessary moves outside the vagina be careful not to pull it out. Should this happen, please inform the midwife immediately as it will need to be reinserted. Let your midwife know if you are in pain, you think your waters have broken, you have any fresh bleeding or if you are worried about anything. Your midwife will perform general checks on you and your baby s wellbeing until you go into labour. The frequency of these checks will depend upon why you are being induced. You will be given an Induction of Labour timeline leaflet which will give you more information about what will happen, and useful advice about how to optimise your early labour. You should then be able to move around freely and eat and drink as usual. If you leave the ward, please let the midwife know. Your partner may prefer to go home to get some rest before labour starts fully, and staff will contact them if there are any changes. Your birthing partner may be able to stay with you on the ward. However, we have limited facilities for partners and are unable to 5
6 provide food, drink and showering facilities. If you partner does wish to stay we ask that you respect the privacy and dignity of other patients by moving about the ward quietly and only as often as necessary. Bring things with you that you find helpful and relaxing such as magazines, music, electronic tablet, games, snacks and comfy pillows as the induction process can sometimes take a couple of days. You should also bring your night clothes, toiletries bag, baby clothes and nappies. You may prefer to wear your usual clothing during the initial phase of induction. Remember that you will have to store everything in a very small locker. For a useful checklist suggesting what to bring in with you, go to What happens if my labour does not start within 24 hours of the pessary being inserted? Your midwife will carry out a further electronic monitoring of your baby and perform a vaginal examination to see if the cervix is now suitable to have the waters broken. Breaking the waters is called artificial rupture of membranes (ARM). If your cervix is not suitable for ARM then the pessary is left in place for a further 6 hours. If your cervix is suitable for ARM you will be transferred to the labour ward as soon as a bed becomes available, but remember transfer may be delayed if the labour ward is very busy. What happens if my labour does not start within 30 hours of the pessary being inserted? The pessary is then removed, a further electronic monitoring of your baby s heartbeat is performed, and you will be reviewed by the doctor and a management plan agreed. Your options may be to have one or two further doses of prostaglandins in the form of a 6
7 Prostin tablet, with reassessment six hours later, or caesarean section at this point may be the right option for you. If you have any questions or concerns, or you have not been reviewed by a doctor at this point please inform the midwife. 3. Using Oxytocin (Syntocinon infusion) Syntocinon is a synthetic hormone that encourages the womb to contract. It is usually only used for induction of labour if your waters have broken but labour has not started. It is given by an intravenous drip in your arm on the labour ward. The rate of the drip can be adjusted so that your contractions increase in strength and frequency to mimic normal labour. Your baby s heartbeat will be monitored throughout the labour using an electronic fetal heart monitor which may restrict your ability to move about freely. Very occasionally syntocinon can cause the uterus to contract too much which may affect your baby s heartbeat. If this happens you will be asked to lie on your left side and the drip will be turned down or off to reduce the contractions. An injection may also be given to slow down the contractions. What if I do not want to be induced? As previously explained the risk of stillbirth increases after 42 weeks. If you choose to wait for labour to start naturally we will support you in your choice and offer you additional monitoring comprising of twice weekly checks of your baby s heartbeat and a twice-weekly ultrasound test to check the depth of amniotic fluid surrounding your baby. However, you should be aware that no form of monitoring can predict with certainty which babies will suffer from stillbirth. 7
8 Further information & evidence supporting this information NHS Choices is a free on-line information service for parents, packed with information and advice on pregnancy and babies. Other information leaflets available from your midwife: Induction of labour time line Partners staying overnight Rupture of membranes at term Pain relief in labour Epidural in labour 8
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12 If English is not your frst language and you need help, please contact the Ethnic Health Team on Jeżeli angielski nie jest twoim pierwszym językiem i potrzebujesz pomocy proszę skontaktować się z załogą Ethnic Health pod numerem telefonu For general enquiries please contact the Patient Advice and Liaison Service (PALS) on For enquiries regarding clinic appointments, clinical care and treatment please contact and the Switchboard Operator will put you through to the correct department / service Date of publication: November 2006 Date of review: May 2015 Date of next review: May 2018 Ref: PI_WC_277 The Pennine Acute Hospitals NHS Trust Wood pulp sourced from sustainable forests
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