Induction of labour

Approximately one quarter of women have an induction of labor. You will only be offered an induction if your health or your baby’s health is at risk. The most common reasons are:

  • 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.

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

Some women will choose to ‘wait and see’ if labor 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 cesarean section.
  • Women who are induced are more likely to experience above average blood loss after the birth.

How is labor induced?

123 First the doctor  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
  • Cervical ripening balloon catheter.

An induction might involve on 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 labor 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 labor 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 labor. 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 slowy releases the prostaglandin over 12 to 15 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 labor will be any more painful than a labor that has started naturally.
  • A few women will react to the prostaglandin and have nausea, vomiting or diarrhea, 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.

Cervical ripening balloon catheter Your doctor may recommend using a cervical ripening balloon catheter over prostaglandin. This is a thin tube or catheter with balloons on the end. The catheter is inserted into your cervix and the balloons are inflated with saline. 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. Fifteen hours after the catheter has been inserted or when it falls out, you will be re-examined. During this time 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.

Forceps birth

Forceps are used to help the baby out of the vagina. They may be used if you are too exhausted to push, the baby is in an awkward position or there are concerns for your baby’s well being. Sometimes the forceps leave a mark on the baby’s cheeks, but these soon fade. You will usually need an episiotomy.

Vacuum (ventouse) birth

This is more commonly used in labor than forceps. The vacuum cup is made of plastic and is attached to a suction device. The cup is inserted into the vagina and creates a vacuum against the baby’s head. This helps the doctor to gently pull the baby out. It may cause a raised bruise on the baby’s head, but this soon fades, usually within a day. You may need an episiotomy.

Episiotomy

An episiotomy is a cut made in the perineum (the tissue between the vagina and the anus). Sometimes it is necessary to make the opening to the vagina bigger, especially if you need a forceps birth or if the baby is distressed. A local anaesthetic is used to numb the area and you will need stitches afterwards. The stitches will dissolve by themselves and you will be offered ice packs to reduce swelling and pain. Some caesarean births are planned in advance (elective caesarean) because of existing problems with your pregnancy. In other cases, the decision to perform a caesarean is made during the course of labour. This is called an emergency caesarean.

  • An emergency caesarean is recommended for the following reasons:
  • concern for your baby’s well being
  • your labor is not progressing
  • there are maternal complications, such as severe bleeding or severe pre-eclampsia
  • There is a life-threatening emergency for you or your baby.
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2 thoughts on “Induction of labour

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