Induction of Labour

 

Being offered an induction of labour can bring up a lot of questions.

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Why do I need an induction? What will actually happen? How long will it take? Will it be more painful? What choices do I have? And what happens if I decide I'd rather wait?

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Whether I've cared for you throughout your pregnancy or you're looking for additional support because an induction has been recommended, I can help you understand why induction has been offered, what your options are and what the process may look like for you.

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Different hospitals can use slightly different induction methods and pathways, so part of my role is helping you understand what your chosen maternity unit offers and what that means for your birth.

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What Is an Induction of Labour?

An induction of labour is when we use methods to try to start labour rather than waiting for labour to begin spontaneously.

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Induction isn't one single procedure.

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Depending on your hospital, your individual circumstances and how ready your cervix is for labour, the process may involve a hormone pessary, gel or tablet to help soften and open your cervix, a mechanical method such as a balloon, osmotic dilators such as Dilapan-S rods, breaking your waters and/or, where needed, an oxytocin hormone drip to establish regular contractions.

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Some women only need one part of that process. Others may move through several stages.

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And induction can take time, particularly if your cervix isn't yet ready for labour when the process begins.

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Why Might I Be Offered an Induction?

There are lots of reasons why an induction might be discussed with you.

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These can include:

• Your pregnancy continuing beyond your estimated due date

• Your waters breaking without labour starting

• Concerns about your baby's growth

• Concerns that your baby may be particularly small or large

• Reduced amniotic fluid around your baby

• Concerns about placental function or your baby's wellbeing

• Pre-eclampsia or high blood pressure

• Diabetes in pregnancy

• Certain other medical conditions affecting you or your baby

 

This doesn't mean that everybody with one of these circumstances will automatically need exactly the same plan.

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I want you to understand why an induction is being recommended to you specifically.

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We can talk through the reason you've been given, what your results are showing, the potential benefits and risks of induction, and what alternatives may be available in your individual circumstances.

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Different Hospitals Use Different Methods

This is something I think is really important for parents to understand.

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There isn't necessarily one identical induction pathway in every hospital.

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Depending on the hospital and your individual clinical circumstances, cervical ripening may involve hormonal preparations such as a pessary, tablet or gel, or a mechanical method such as a balloon catheter or osmotic dilator.

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Your cervix will usually be assessed to help determine which method may be appropriate.

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That's why I don't want to tell you, “This is exactly what your induction will look like,” without first knowing where you're booked and why you're being induced.

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Instead, we can look at the plan your maternity team has recommended and I can talk you through what each stage means.

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What Happens During an Induction?

For many women, the first aim is to help the cervix soften, shorten and begin to open.

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Once your cervix is ready, your maternity team may be able to break your waters, which is known as an artificial rupture of membranes.

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Sometimes contractions establish following this.

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If contractions don't start or aren't becoming regular enough, you may then be offered an oxytocin infusion, commonly known by the brand name Syntocinon.

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Oxytocin is given through a drip into a vein and the amount can be adjusted according to your contractions and how labour is progressing.

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When oxytocin is being used, your baby's heart rate will usually be continuously monitored because we need to know how your baby is coping with the contractions.

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Not everybody follows every one of these stages, and your own induction pathway should be discussed with you.

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Where Will My Induction Happen?

This depends on your hospital, your individual circumstances and which stage of induction you're at.

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The earlier stages of an induction may take place on an antenatal or dedicated induction ward. Some maternity services also offer outpatient induction to suitable women, meaning you may be able to return home for part of the process.

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If you need an oxytocin infusion, this would normally happen on a labour ward where you and your baby can be appropriately monitored.

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Your own hospital should explain where each part of your induction will take place and whether your birth partner can remain with you throughout.

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Induction Can Involve Waiting

One thing I would definitely prepare you for is that an induction doesn't necessarily mean you arrive at hospital and have your baby a few hours later.

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It can take time for the cervix to respond, especially if it's your first vaginal birth, and there can sometimes be periods of waiting between different stages allowing your body time to process

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This is why I recommend being prepared.

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Bring your phone charger, headphones, something to watch or read, playing cards or a travel game and things that make you feel comfortable.

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Your birth partner should bring things for themselves too.

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Is Induced Labour More Painful?

Induced labour can feel more intense than labour that begins spontaneously, and NHS guidance advises that induced labour is usually more painful.

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That doesn't mean you have to decide beforehand exactly what pain relief you will use.

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Your options can include things such as movement and breathing techniques, water where available and appropriate, gas and air, opioid pain relief and an epidural.

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If an oxytocin infusion is recommended, I think it's particularly important that we talk about pain relief beforehand.

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Oxytocin can make contractions stronger and more regular quite quickly.

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An epidural is one of the options available to you, and we can discuss what having an epidural involves, its benefits and possible disadvantages, so that if you do want one you're making an informed decision rather than trying to understand everything while coping with strong contractions.

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You can also change your mind during labour.

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Does Having an Induction Mean I'll Need More Intervention?

Not necessarily.

Many women who have an induction go on to have a vaginal birth.

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However, induction can change the experience of labour. You may have more examinations and monitoring, and some women need additional intervention during birth.

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If you have an epidural, for example, there are benefits and potential disadvantages to consider.

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Epidurals can provide very effective pain relief, but they can affect mobility and may prolong the second stage of labour. Depending on your individual circumstances, assisted birth with forceps or ventouse may sometimes be needed.

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This doesn't mean that having an induction or epidural automatically leads to an assisted birth or caesarean.

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Every labour is different.

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What If the Induction Doesn't Work?

Sometimes induction doesn't establish labour.

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If that happens, it doesn't automatically mean there is only one possible next step.

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Your maternity team should reassess you and your baby and discuss what happens next.

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Depending on your circumstances, options might include waiting for a period and reassessing, trying another induction method, or discussing a caesarean birth.

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Again, I want you to understand why a particular next step is being recommended rather than feeling as though decisions are simply happening around you.

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What If I'm Offered Induction Because I'm Overdue?

Being offered induction because your pregnancy has continued beyond your due date is very common.

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If you're unsure whether you want induction at that point, we can talk about why it has been offered,

the benefits and risks of proceeding, and what continuing the pregnancy may mean for you and your baby.

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If you choose to wait longer, you can also discuss with your maternity team what additional monitoring may be appropriate.

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Depending on your gestation, circumstances and local hospital practice, this may include CTG monitoring to assess your baby's heart-rate pattern and an ultrasound scan to assess the amount of amniotic fluid around your baby.

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Where appropriate, ultrasound assessment may also include Doppler measurements looking at blood flow through the placenta and to your baby.

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Monitoring Is a Snapshot in Time

This is something I think is particularly important to understand.

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A reassuring CTG, ultrasound or Doppler assessment gives us valuable information about how your baby appears to be at that particular time.

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It cannot promise that everything will remain exactly the same tomorrow or two or three days later.

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That's why we look at the whole picture, your gestation, baby's movements, growth, amniotic fluid, your health, any individual risk factors and the reason induction has been offered.

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Monitoring can help inform your decisions, but it cannot predict the future with certainty.

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Can I Say No to an Induction?

Yes.

Being offered an induction doesn't remove your right to make decisions about your own care.

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You should be given information about why induction is being recommended, the potential benefits and risks, the alternatives available to you and what may happen if you decide not to proceed.

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You can ask questions.

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You can ask for time to think where the clinical situation allows.

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You can ask what your alternatives are.

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And you can decide whether you want to proceed.

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My role isn't to make that decision for you.

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My role is to give you information, help you understand the recommendations being made and support you to make an informed decision that is right for you and your baby.

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How Can I Support You With an Induction?

You don't have to be receiving all of your pregnancy care from me to ask for support.

If induction has been recommended and you're feeling overwhelmed by the information, we can arrange a one-off appointment specifically to talk it through.

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We can discuss:

• Why you've been offered induction

• Your individual circumstances

• The induction method your hospital uses

• What the different stages involve

• Questions you may want to ask your consultant or maternity team

• Monitoring

• Pain relief

• Epidurals

• Birth preferences

• What happens if the induction takes a long time

• What may happen if induction is unsuccessful

• Your choices and alternatives​​

 

Sometimes just having time to go through everything properly can make an enormous difference.

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I can't promise you how your labour will unfold, and I won't tell you that one particular type of birth is guaranteed.

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What I can do is make sure you go into the process understanding what is happening, why it's happening and what questions you can ask along the way.

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I provide personalised private midwifery support across London, Essex and Hertfordshire.

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If you've been offered an induction and would like time to understand your options and prepare for what may happen, get in touch to arrange a free 20-minute consultation.