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Maternity Unit

Induction of labour

Most labours start spontaneously between 37-42 weeks of pregnancy, but for women who are still pregnant after 41 weeks or for some pregnancy concerns, we would offer an induction of labour.


Membrane sweep explained

Maternity induction of labour beds

A ‘membrane sweep’ can sometimes be enough to bring on labour. It is a simple technique that can be done in a few minutes, either during a clinic visit or in your home. It involves an internal examination, where the midwife or doctor will feel the cervix (neck of the womb). If it is beginning to open, they will gently ‘sweep’ their finger round this area. This can release hormones called prostaglandins which help to start labour. The examination and membrane sweep is safe but can feel uncomfortable. Sometimes there may be some ‘spotting’ of blood followed by cramp-like pains, a little like period pains, this is normal.

If you are at home please provide the midwife with hand washing facilities and a private environment for yourself. If you have other children it is helpful if someone can care for them for a few minutes during this visit. The membrane sweep is more likely to work if your body is ready to go into labour and your cervix has already begun to soften and thin. Ten in every 100 women respond to the membrane sweep and labour without the need for further induction methods.

Why induce labour?

Induction of labour may be recommended if it is felt that either you or your baby would be safer as a result. Your doctor and midwife will discuss the benefits and risks of inducing your labour with you.

One of the commonest reasons for inducing labour is if the pregnancy goes beyond 41 weeks. This reduces the risk to the baby without increasing risks to the mother compared to waiting for labour to start naturally.

Can induction of labour be avoided?

If you do not want your labour to be induced you should discuss this with your doctor. The risks to your baby are slightly increased after 42 weeks and we recommend additional monitoring of the baby. Unfortunately, such monitoring will not predict or prevent all potential problems.

On arrival to the RVI

The Maternity Reception staff (Level 4, Leazes Wing) will direct you to the Induction Suite. This is a four-bed room where your midwife will explain the induction procedure. The midwife will check your blood pressure, pulse, and temperature then feel your abdomen to see how your baby is lying and may perform an ultrasound scan to ensure the baby is head down. This scan will only confirm the position of the baby.

Before the induction a cardiotocograph (CTG), which is a recording of the baby’s heart rate, will be performed by placing a monitor on your abdomen to ensure your baby is healthy.

Prostin

If the cervix (neck of the womb) is closed the midwife will insert a tablet (pessary) into your vagina. The tablet contains a drug called prostaglandin (‘Prostin’) to help soften and open the cervix, it may also cause some cramplike abdominal (tummy) pains and backache.

After inserting the Prostin your baby’s heartbeat will be monitored again by CTG for approximately one hour. After this, you can walk around if you wish. Depending on what happens to your cervix, you may require another Prostin tablet six hours later.

Occasionally a third Prostin pessary is required six hours after that. Each individual woman responds differently to the action of Prostin, so the process of induction can take some time.

Artificial rupture of membranes

If your cervix has started to dilate Prostin is unnecessary and we can artificially rupture your membranes (ARM) ‘break your waters’. Reaching the membranes sometimes causes discomfort but breaking the waters itself is not painful.

Once your waters are broken, if the contractions are not coming very often or are not strong enough, you will be offered a drug called oxytocin to help the contractions. Oxytocin is given slowly in measured amounts through a drip in the back of your hand. The drip will normally stay in place until after the birth of the baby. During this time, your baby’s heart rate will be continually monitored using the CTG monitor.

Frequently Asked QuestionsShow [+]Hide [-]

Who can accompany me?

Although visitors are not allowed in the Induction Suite you may bring your birthing partner who can stay with you during the day. If you are not in established labour by the evening your birthing partner will be asked to return home to allow both of you to get some rest. If your labour starts overnight, they will be contacted. You can invite up to two birthing partners once you are in established labour and transferred into a delivery room.

How long does induction take?

The time induction takes can vary, especially the ‘latent phase’ (the time when the cervix shortens and softens but before it dilates). If this is your first baby, the average time from admission to delivery is 25 hours, although the labour itself usually lasts about 12 hours. If you have had a baby before, the average time from admission to delivery is 18 hours, however, the labour itself usually lasts 8-12 hours.

What is the success rate of induction of labour?

If this is your first baby:

  • 33 in every 100 women have a normal vaginal delivery
  • 33 in every 100 women have a ventouse or forceps delivery
  • 33 in every 100 women have a caesarean section

If you have had a vaginal delivery before:

  • 70 in every 100 women have a normal vaginal delivery
  • 15 in every 100 women have a ventouse or forceps delivery
  • 15 in every 100 women have an emergency caesarean section

If you have had a previous caesarean section:

  • you should discuss the success rate of induction and the potential benefits and risks with your obstetrician.

What if the induction is unsuccessful?

Model of babySometimes it is still not possible to break your waters after three Prostin tablets have been given. If this occurs, a doctor will discuss your options with you. These options will include the offer of a caesarean section.

This image shows the baby in the normal head down position. The cervix is a closed tubular structure which needs to dilate to10cm for the baby to be born. Before opening the cervix shortens and softens. Prostiglandin tablets enable the cervix to soften and shorten, usually without causing contractions. Once open the membranes can be reached and if necessary artificially ruptured by the midwife or doctor. This usually results in contractions starting in the next one to two hours. If not then a syntocinon drip is used to encourage the uterus to contract.

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