Induction of labour is when labour (contractions) is brought on artificially. There are several ways labour can be started i.e Prostin gel, Artificial rupture of the Membranes (ARM) or by using hormone Intravenous drip (oxytocin) to start your contractions. It is not unusual for all three methods to be used in order to start (induce) your labour.
There are many reasons to why labour may be induced but the common reason is overdue pregnancy (more than 10 days past the due date). Other reasons may be high blood pressure, diabetes or if the baby has a condition requiring treatment after birth. If you are unsure of the reason why you are being induced please check with your doctor or midwife. After gaining your consent the doctor of midwife will perform your vaginal examination to assess your cervix and plan the type of induction that is necessary to get labour started.
Due to unforeseen circumstances your induction day may need to be changed at short notice.
Types of induction
Prostin gel is synthetic hormone similar to the one your body procedures naturally. This hormone softens (ripens) the cervix ready for labour. Prostin gel is used for induction when the cervix hasn’t ripened by itself. Natural ripening usually happens over a few days before labour commences. When the gel is used to the cervix usually ripens overnight.
The Prostin gel is inserted during the vaginal examination. The gel is placed behind the cervix. The Prostin hastens the process of softening the cervix and can cause some contractions, however, most women do not go into labour with gel alone. By softening the cervix overnight, the doctor/midwife can usually break the membranes the next morning and start a hormone IV drip to further stimulate labour.
Artificial rupture of the membrane (ARM). A doctor does a vaginal examination and uses a small hook to make a small hole in the sac of waters in the front of the baby’s head. This may be uncomfortable but it not painful or harmful to you or your baby.
Iv Syntocinon drip is inserted in your arm, after the waters have been broken (ARM) if contractions are not established. The amount is increased as necessary until your contractions have established.
On the day of Induction
You will need to come to the Maternity Ward at 4pm on the day of the induction, a midwife will be assigned to your care and will ask you some questions about your pregnancy and feel your abdomen to find out the position of your baby. A CTG (fetal heart tracing) monitor applied. A CTG involves placing 2 straps around your abdomen with a monitor attached, which records your baby’s heart beat (trace) for about 30mins. After this trace is done the Prostin gel will be inserted by the midwife or doctor, and the CTG will be put back on for another 20mins. Lying down for that time will also assist in absorption of the gel.
After this trace is done you will be able to walk around the maternity wards as you please. After 3 hours another CTG will be attended for at least 20mins to check the baby is well. There is no need to repeat any more monitoring till the morning if the trace is acceptable. You should try to get a good night sleep so you are not too tired in the morning. You may wish to talk to your midwife about night sedation.
Some women will go into labour during the night. This is very unlikely if you are having your first baby.
The next morning
Your induction will commence around 8am in the morning but if birthing unit is very busy that day then there may be delays. Remember that our focus is on the wellbeing of you and your baby.
Around 8am the next morning you will be taken to birthing unit for the rest of your induction. Here you will be greeted by a midwife and shown around. After gaining your consent to proceed with the induction, a senior doctor will carry out a ARM. If necessary the IV syntocinon drip will be commenced and does increased as necessary. Your baby will be monitored frequently with the CTG.
In the case where it is not possible to break the sac of waters, an IV Syntocinon drip will be commenced. After 4 hours the doctor will try again to break the sac of waters. If it is still not possible then a caesarean section may be required.
A small number of women (approximately 3 out of 1000) will not go into labour despite breaking the waters and starting an IV drip. These women will need to have a caesarean section.
Some side effects are: Irritation of the vagina (burning & stinging). Allergic reaction to the gel.
Risks of induction of labour
As with any intervention there are always risks and considerations.
The most common risks are included below. There maybe other unusual risk that are not listed, please ask the midwife or doctor if you have any concerns.
Induction of labour has the following possible complications for the mother:
- The drugs may over stimulate the uterus causing contractions to be too rapid or disordered. This is why it is important to monitor your baby after the Prostin gel
- You may not go into labour despite treatment and a caesarean section maybe required
- Contractions may start but may not be strong enough
- The baby’s cord may prolapse (the cord come out of the cervix before the baby is born). If this occurs you will need an emergency caesarean section.
- Over stimulating the uterus may cause the baby distress.