Induction of labour

Sometimes is it necessary to help a woman to start her labour using artificial methods. This is called induction of labour.  It might involve having your waters broken or taking medicines to encourage the birth process to start. Approximately one-third of women have an induction of labour.

Watch this short video presentation and read below for more information.

Why is induction of labour recommended?

The most common reasons are:

• you have health concerns, such as diabetes or high blood pressure
• the health of your baby
• the pregnancy has gone more than 10 to 12 days beyond the due date and there is a risk that the placenta can no longer sustain the baby’s life
• your waters have already broken, but you are not having contractions.

You will only be offered an induction if your health or your baby’s health is at risk. 

When your doctor or midwife recommends an induction you can expect that they will explain:

• why it is a good idea for you to be induced
• the possible risks to your health or your pregnancy if you wait for labour to start naturally
• the possible risks if you have an induction
• how they plan to induce your baby.

If they don’t explain, use this list to ask them questions.

Some women will choose to 'wait and see' if labour will start on its own. It’s important that you consider all the risks and benefits in your particular situation so that you are able to make a well-informed decision.

Risks with induction

While not having an induction can put the health and even the life of your baby at risk, there are also risks with having an induction. 

• Having an induction for reasons other than prolonged pregnancy may increase the chance that you will need an emergency caesarean section.
• Women who are induced are more likely to experience above average blood loss after the birth.

How is labour induced?

First, the doctor or midwife will do an examination of your cervix. The examination takes only a few minutes but it can be a little uncomfortable. Based on this examination your doctor or midwife will recommend one of the following methods of induction:

• artificially breaking the waters (the membranes or the sac around your baby)
• artificially breaking the waters and oxytocin
• prostaglandin
• balloon catheter.

An induction might involve one or several of these methods.

Breaking your waters 

If your waters have not broken, the midwife or doctor can do this for you. The procedure is called Artificial Rupture of Membranes or ARM. The midwife or doctor makes a hole in your membrane sac to release the fluid inside. This procedure is done through your vagina using a small instrument. Sometimes releasing the waters is enough to get things going and labour will start. However, most women will also need oxytocin.

Things to know

• The vaginal examination needed to perform this procedure may cause you some discomfort.
• Although ARM is usually straightforward, it can increase the risk of cord prolapse, bleeding and infection

Oxytocin

Oxytocin is the hormone that causes contractions. A synthetic version can be given if your waters have broken but contractions don't start. Oxytocin is given through a drip in your arm. Once contractions begin, the rate of the drip is adjusted so that contractions occur regularly until your baby is born. This process can take several hours. Your baby's heart rate will be monitored throughout labour using a CTG machine.

Things to know

• It will be hard to move around because you are attached to a drip and the CTG monitor. While you can stand up or sit down, it will not be possible to have a bath or move from room to room.
• Sometimes oxytocin can cause the uterus to contract too frequently, which may affect the pattern of your baby's heartbeat. If this happens you will be asked to lie on your left side and the drip will be slowed to reduce the number and strength of your contractions. Another drug may be given to cancel the effect of the oxytocin.

Prostaglandin

Prostaglandin is a hormone that prepares your body for labour. A synthetic version can be inserted into your vagina, either in the form of a gel or a pessary. When the prostaglandin is in place, it’s a good idea to lie down and rest for at least 30 minutes. Once the prostaglandin has been inserted you will need to remain in hospital.

When the prostaglandin takes effect, your cervix will soften and open. If you have the gel, you may need one, two, or three doses (given every six to eight hours). The pessary slowly releases the prostaglandin over 12 to 24 hours. When the cervix is soft and open, your body is prepared for labour. The next steps will vary from woman to woman – some might need an ARM to break their waters, and some women might need oxytocin to stimulate the contractions.

Things to know

• Prostaglandin sometimes makes your vagina sore. However, there is no evidence to suggest that your labour will be any more painful than labour that has started naturally.
• A few women will react to the prostaglandin and have nausea, vomiting or diarrhoea, but this is rare.
• Very occasionally prostaglandin can cause the uterus to contract too much, which may affect the pattern of your baby's heartbeat. If this happens you will be asked to lie on your left side. You may be given a medication to relax the uterus. If you have a pessary this may need to be removed.

Balloon catheter

Your doctor may recommend using a balloon catheter over prostaglandin. This is a thin tube or catheter with a balloon on the end. The catheter is inserted into your cervix and the balloon is inflated with saline water. Once inflated the balloons apply pressure to the cervix. The pressure should soften and open your cervix.

When the catheter is in place, you will need to stay in hospital but you can move around normally. The catheter is left in place for up to 12 hours then, after the water is taken out from the balloon, the catheter is removed and you will be re-examined. During the time the catheter is in place the midwives will periodically check you and listen to your baby’s heart.

What happens next will vary from woman to woman – some might need an ARM to break their waters. Some women might need oxytocin to stimulate the contractions.

Things to know

• The vaginal examination needed to perform this procedure may cause you some discomfort.

---

---