Induction of Labour. Patient Information. Gynaecology and Obstetrics Department

Transcription

1 Induction of Labour Patient Information Gynaecology and Obstetrics Department Author ID: CS Leaflet Number: Obs 043 Version: 3 Name of Leaflet: Induction of Labour Date Produced: December 2015 Review Date: December 2017 Induction of Labour Page 1 of 9

2 In a normal healthy pregnancy where you are well and your baby is well grown, there is no evidence to show that there is any benefit to induce labour before 41 weeks. Although you may be feeling uncomfortable and impatient at this time, there is still a strong chance of going into labour and giving birth naturally. What is Induction of labour? Induction of labour is a process designed to start labour artificially. In most pregnancies, labour will start naturally between the 37 th and 42 nd week. Why is it done? The most common reasons for having an induction are: 1. Prolonged pregnancy Available evidence tells us that after 41 completed weeks of pregnancy the risk of a baby developing health problems increases slightly because the efficiency of the placenta starts to decrease. At Wrightington, Wigan and Leigh NHS Foundation Trust, we offer induction between 41 and 42 weeks unless there are medical indications to induce labour earlier. If you have been booked under Midwife-Led Care, your care will need to be transferred to Consultant-Led Care but a Midwife will still provide your care during labour and delivery. 2. Pre-labour rupture of membranes In one out of every 20 pregnancies, the bag of waters surrounding the baby ruptures (or breaks ) before labour starts. This is known as pre-labour rupture of membranes. When this happens, labour usually begins within 24 to 48 hours. The longer the time between pre-labour rupture of membranes and the birth of your baby the higher the risk of infection to you and your baby. Therefore, if you are more than 37 weeks pregnant and your waters have broken but you do not go into labour, you will be offered an induction. If your waters rupture before 37 weeks we will start you on antibiotics to reduce the risk of infection. 3. Medical reasons There are a number of medical reasons why induction of labour may be considered. These include having diabetes, having blood pressure problems, persistent bleeding during your pregnancy or your baby being considerably smaller than would be expected for gestational age. Any decision to deliver a baby early for medical reasons would be made after careful consideration with you of the risks and benefits to both mother and baby. This will vary, depending on gestation (the stage of pregnancy) and the severity of any condition which is affecting the health and well-being of either the mother or the baby. Induction of Labour Page 2 of 9

3 How is labour induced? Depending on your individual circumstances there are several ways your labour may be induced. You may need only one or possibly all of them. 1. Membrane sweeping Membrane sweeping (or a cervical sweep') is when the midwife or doctor places a finger just inside your cervix and make a circular, sweeping movement to separate the membranes from the cervix. This procedure will increase the chance of you going into labour naturally within 48 hours and is the first method of choice when your pregnancy has gone beyond 40 weeks. This should, if possible, be done prior to any other method. However, this will be unlikely if you are being induced for medical reasons. Membrane sweeping can be carried out at home, in the antenatal clinic or hospital: it may cause you some discomfort. Afterwards, it is not uncommon for you to have a bloodstained loss from your vagina or a mucous show. This will not cause any harm to your baby and it does not increase the risk of infection to you or your baby. If your waters have broken, membrane sweeping is not recommended because of the risk of infection. 2. Prostaglandin induction If your waters have not broken, then giving prostaglandin is the recommended method of inducing labour. Prostaglandins ('Prostin') are drugs that help to induce labour by encouraging the cervix to soften and shorten (known as 'ripening'). Once this has happened contractions will usually start and the cervix will begin to open. Prostaglandin is given in the form of a pessary, a tablet which is inserted into the vagina. Sometimes more than one dose is required and, if necessary, a further dose is given after six hours. You will then be left to rest overnight. If a third dose is felt to be required then this will be determined by a senior doctor the following morning. The timing of each pessary will depend on what time the induction procedure was commenced, and may be delayed if clinical circumstances prevent it being safe to continue. Any delays will be fully explained to you on the day and we would always encourage you to ask any questions regarding your care and management of your labour and delivery. Your baby may not be born on the same day as you first receive a prostin pessary: the whole process may take a couple of days. Before the prostaglandin is given, your baby's heartbeat will be monitored for 30 to 60 minutes to ensure all is well. After this, the midwife or doctor will ask for your consent to do an internal examination. During this examination we will assess the position, length and softness/firmness of your cervix, so that we have a baseline against which to measure your progress. We will then insert the pessary if required (as it may be possible that we can break your waters). After this, you will need to stay in bed for approximately one hour. Induction of Labour Page 3 of 9

4 You will then be encouraged to get up and move around as this will help your labour to progress. The midwife will check you at intervals, although she will be available between these times as well. If we are able to break your waters sometimes it is possible to go straight to the delivery suite for this procedure. At busy times however, you may have to wait for a room and midwife on Delivery Suite to become available. Your midwife will keep you informed of this. Your partner may stay with you on the maternity ward during the partners visiting periods if your induction is being performed on the maternity ward. Visiting time for partners and designated birth partner are: 10:00am to 12:00pm 1:00pm to 5:00pm 6:00pm to 8:00pm Protected meal times are in operation on all wards throughout the Trust (except delivery suite and neonatal unit) and all partners and relatives are asked to leave the ward at these times. Unfortunately we do not have facilities for partners to stay overnight when induction is performed on the maternity ward. 3. Breaking the waters Artificial Rupture of the Membranes (ARM) If your waters have not broken, you will be offered a procedure called Artificial Rupture of the Membranes on Delivery Suite. This is when the midwife or doctor breaks your waters artificially using a slim plastic instrument called an amnihook. The procedure involves an internal examination during which, the amnihook is passed through the vagina and cervix and a small hole is made in the membranes surrounding the baby. This allows the fluid surrounding the baby to drain away. This procedure, although it may be uncomfortable, will not harm you or your baby and stimulates contractions to start or become more effective. 4. Oxytocin This form of induction is only used on labour ward. You will hear it referred to as Syntocinon infusion. Oxytocin is a drug that encourages contractions. It tends to be used when contractions have still not started or are not building up as required despite having tried the above methods. It is given through a drip in your arm or in the back of your hand. Once the contractions have started, the rate of the drip will be adjusted via an infusion pump until your uterus is contracting regularly three to four times in every 10 minutes. This rate of contraction will be maintained until your baby is born. If you have an oxytocin drip, your baby's heartbeat will need to be monitored continuously with a monitor known as CTG. Induction of Labour Page 4 of 9

5 Oxytocin can cause strong contractions, so you may be more likely to ask for an epidural for pain relief. As you are attached to a drip, you will also be less able to move around but you will still be able to sit out of bed or stand up if you wish. Very occasionally, as with prostaglandin, the drug can cause the uterus to contract too frequently or too strongly which may affect the pattern of your baby's heartbeat. If this happens we will ask you to lie on your left side and the drip will be turned down or stopped. Oxytocin is not given for at least six hours after prostaglandin. Pain relief during induction of labour Women vary as to when they start to need pain relief during induction of labour. Pain relief of your choice will be available to you both on the maternity ward and on labour ward whenever you need it. If you need any information about pain relief ask your midwife when you first come into hospital for the induction. Alternative options If you are hoping to avoid medical induction of labour, some of these natural methods may be worth considering. Raspberry leaf tea from 36 completed weeks (there is no clear evidence that this helps, but it does no harm). These methods have not been fully researched for their safety. Gentle nipple stimulation from 39 completed weeks is thought to release oxytocin into the blood stream causing the uterus to contract. Sexual intercourse. Semen contains prostaglandins which work on the cervix to prepare for labour. However this is not advised if you have a low lying placenta or your waters have broken. Clitoral stimulation/ orgasm encourages the uterus to contract. A number of complementary therapies such as reflexology and acupuncture are believed to help labour commence naturally. If you consider these, always seek advice from a fully trained and qualified therapist. Having considered the advantages and disadvantages you may choose not to have your labour induced after your pregnancy has gone past 42 weeks. In this case you will be offered twice weekly checks of your baby's heartbeat, using an electronic fetal monitor and an ultrasound scan to check the depth of the amniotic fluid ('waters') surrounding your baby and the placental blood flow to the baby. Having considered the benefits and disadvantages of induction of labour you may decide to wait beyond 48 hours to see whether labour starts naturally after your waters have broken. In this case there may be a risk of infection so, if you choose this option you will need to check your temperature four hourly and be alert for any changes in the colour and smell of the fluid which is leaking. Also, if you begin to feel unwell at all, or if the pattern of the baby's movement changes, it is important to let the delivery suite or your midwife know. Induction of Labour Page 5 of 9

6 Reason you have been offered induction of labour and proposed method Reason Method Planned admission Date: Time: Place: Induction of Labour Page 6 of 9

7 Membrane Sweep Prostaglandin Artificial Rupture of Membranes Oxytocin Benefits Risks Alternatives May allow you to go into labour naturally within 48 hours of procedure. You may continue to have a home birth if this is your choice. Prostaglandin induction is very safe; serious side effects are very rare. This induces the labour by encouraging the cervix to soften and shorten (ripening). Occasionally this can stimulate the onset of labour and no further intervention may be required. Usually results in a quicker onset of labour compared with induction with prostaglandin. This is only used when, on balance, it is considered the best option to induce or accelerate your labour. This is given when labour is not progressing or contractions have stopped or weakened considerably. May cause some discomfort. Occasionally overstimulation of the womb (uterus) may occur. It may take up to 48 hours to ripen the cervix. Home birth or water birth is not an option A small number of women do not respond to prostaglandin and, in these cases, we will need to perform a Caesarean Section to deliver the baby. The procedure will not be performed if there is a significant risk of a complication but it can result in prolapse of the umbilical cord. Contractions may become much stronger once this has been performed. Occasionally overstimulation of the womb (uterus) may occur. Drugs can be given to reverse this in extreme cases. Caution is needed when there has been a previous Caesarean section. To wait and see if labour begins naturally. To wait and see if labour begins naturally. To have an elective Caesarean Section if medical conditions are the reason for induction after consideration of all the options, risks, the stage of pregnancy and urgency for delivery. To wait and see if labour begins naturally or labour progresses as expected. To have an emergency Caesarean Section after consideration of all the options, risks, the stage of labour and urgency for delivery have been identified. Home birth or water birth is not an option. Induction of Labour Page 7 of 9

8 Further information All of these options and any risks involved will be discussed more fully with you before any decision is made. If you do not understand any part of the process, please ask. Clinical staff do not mind, because we believe it is important for you to understand exactly what will happen and what are the risks, benefits and alternatives, before you make your final decision. References National Institute for Clinical excellence (NICE) Contact Numbers Delivery Suite Maternity Ward Antenatal Clinic (Thomas Linacre Centre) Antenatal Clinic (Leigh Infirmary) Community Midwifery Office Induction of Labour Page 8 of 9

9 Comments, Compliments or Complaints The Patient Relations/Patient Advice and Liaison Service (PALS) Department provides confidential on the spot advice, information and support to patients, relatives, friends and carers. Contact Us Tel: (Monday to Friday 9am to 4pm) The Patient Relations/PALS Manager Wrightington, Wigan and Leigh NHS Foundation Trust Royal Albert Edward Infirmary Wigan Lane Wigan WN1 2NN Ask 3 Questions Become more involved in decisions about your healthcare. You may be asked to make choices about your treatment. To begin with, try to make sure you get the answers to three key questions: 1. What are my options? 2. What are the pros and cons of each option for me? 3. How do I get support to help me make a decision that is right for me? This leaflet is also available in audio, large print, Braille and other languages upon request. For more information call Wrightington, Wigan and Leigh NHS Foundation Trust All rights reserved. Not to be reproduced in whole or in part without the permission of the copyright owner Induction of Labour Page 9 of 9