ARTIFICIAL INDUCTION OF LABOUR
WHAT DOES IT MEAN TO INDUCE LABOUR?
Your labour is “induced” when it is started artificially.
Most labours begin naturally. And although it’s usually best to let nature take its course, sometimes the birth process may need a little help.
You are offered an induction if the risks of prolonging your pregnancy are more serious than the risks of delivering your baby straight away.
WHY MIGHT MY LABOUR NEED TO BE INDUCED?
You are likely to be induced if:
- Your pregnancy has gone beyond 40 weeks and is considered overdue. You’ll usually be offered an induction sometime between 40 and 41 weeks to prevent your pregnancy continuing beyond this time. Most doctors in India prefer not to wait longer, as your placenta may not deliver sufficient oxygen to your baby. In other countries it is usual to wait until 41 weeks before inducing labour.
- Your waters have broken but labour hasn’t started. Most women go into labour within 24 hours of their waters breaking. If this doesn’t happen to you, there is a risk that you or your baby could develop an infection.
- You have a chronic or acute condition, such as pre-eclampsia or kidney disease, that threatens your wellbeing, or the health of your baby.
- You have diabetes, especially if you’re taking insulin to control the sugar levels. If your baby is growing normally, it’s recommended that you’re offered an induction after 38 weeks of pregnancy.
Doctors may sometimes induce labour if you ask for it. Perhaps your husband is travelling and would otherwise miss the birth. Sometimes family members want the baby to arrive on a particular date for astrological reasons.
HOW WILL MY LABOUR BE INDUCED?
There are a number of ways your doctor may try to initiate your labour. She may need to repeat a method, or switch to another before your labour begins. Talk to your doctor about which method is most suitable for you.
Here’s the order in which you are likely to be offered particular induction methods.
- In a membrane sweep, the membranes that surround your baby are gently separated from your cervix. This action can stimulate labour. You may be offered two or three membrane sweeps before moving onto other methods of induction.
- Your doctor may offer you a sweep if you are full-term and waiting for labour to start. She’ll suggest a sweep at your 40-week appointment if this is your first baby, or at your 41-week appointment if you’ve had a baby before.
- During a sweep, your doctor carefully separates the membranes that surround your baby from your cervix to stimulate the production of prostaglandin. If your cervix is not dilated enough to do a sweep, she may stretch or massage your cervix instead.
- It can be uncomfortable if your cervix is difficult to reach. You may need several membrane sweeps before you can gauge its success.If you are unclear about anything, ask your doctor to explain.
- Prostaglandin is a hormone-like substance, which helps stimulate uterine contractions. It is also used to ripen and prepare the closed cervix for labour. In a ripened cervix, it can bring on labour.
- Your doctor will insert a tablet, pessary or gel containing prostaglandin into your vagina to ripen your cervix. You may need a second dose of the tablet or gel after six hours, if labour hasn’t started. Pessaries release the prostaglandin slowly over 24 hours, so only one dose is needed.
- Vaginal prostaglandin is the most commonly recommended method to induce labour because it often works better and has fewer disadvantages than other methods.
- There is a very small risk that using induction drugs like vaginal prostaglandins, may overstimulate or hyperstimulate your uterus. Hyperstimulation of the uterus seriously reduces the oxygen supply to your baby. Drugs can be used to stop or slow down the contractions if this happens.
- In a worst-case scenario, hyperstimulation can cause your uterus to rupture (tear). This is more likely to happen if you are having a “trial of labour” following a previous caesarean section.
ARTIFICIAL RUPTURE OF MEMBRANES (ARM)
- ARM is sometimes called “breaking the waters”. Breaking your waters isn’t recommended as a first method of induction unless vaginal prostaglandins can’t be used. However, some doctors may still use it to speed up labour if it’s not progressing.
- This procedure can be done during an internal examination. Your doctor makes a small break in the membranes around your baby. This is done by using either an amniohook (a long thin probe which looks a little like a fine crochet hook) or an amnicot (a medical glove with a pricked end on one of the fingers).
- ARM often works when the cervix feels soft and ready for labour to start. It can be quite uncomfortable, so you may be offered gas and air (entonox) to help you to cope with the pain.
- ARM does not always work, and, once your waters have been broken, your baby could be at risk of infection. This is why it’s no longer recommended as a method of induction on its own and is best used after labour has started. If your doctor suspects an infection, she will give you antibiotics.
- Syntocinon is a synthetic form of the hormone oxytocin. You will be offered syntocinon only if a membrane sweep or prostaglandin has not started your labour, or if your contractions are not very effective. Your waters have to be broken before you can be given syntocinon.
- Syntocinon has several disadvantages, hence, if other methods of induction haven’t worked, you may be offered a caesarean instead.
- You will be given syntocinon through an intravenous “drip”, allowing the hormone to go straight into your bloodstream through a tiny tube inserted into a vein in your arm. Once your contractions have begun, the rate of the drip can be adjusted. This allows contractions to happen often enough to make your cervix dilate, without becoming too powerful.
- Syntocinon is started at a very low dose and increased gradually. It can cause strong contractions and put your baby under stress, so you will need to be monitored continuously. The contractions brought on by syntocinon may be more painful than natural ones. So you may choose to have an epidural for pain relief.
- There is also a very small risk that using syntocinon may cause your uterus to become overstimulated or hyperstimulated. You will be given medication to slow your contractions if stopping syntocinon isn’t enough.
HOW CAN I PREPARE FOR MY INDUCTION?
Before the onset of your labour, you may discuss with your doctor whether or not to have an induction and what methods may be used. Your doctor may suggest a certain method, depending on how soft and ready your cervix is for labour. However, once labour has started, your doctor may take decisions based on what she feels is best for your and your baby’s health without consulting you first.
Before any method of induction is used, your doctor will examine your cervix to assess if it is ‘ripe’ and ready for labour. The ripeness of your cervix affects how successful induction is likely to be. The riper it is, the greater the chance that you’ll go into labour.
Sometimes induction may fail to initiate labour, especially if your cervix is unripe. If this happens to you, your doctor may talk to you about trying a stronger method of induction or doing a caesarean section. Think ahead about what you would prefer if this happens to you.
There’s some evidence that you are more likely to need instruments such as forceps or ventouse to help your baby be born after an induction. This is regardless of the method of induction. This may be due to complications in the pregnancy that led to the induction, but it may also be due to problems caused by the induction itself.
WHY HAS AN INDUCTION BEEN RECOMMENDED FOR ME?
Induction of labour has been offered because continuing with the pregnancy may cause risks to you or your baby’s health. These are some of the common reasons when induction may be offered to you:
- Your waters have broken prior to labour starting on it’s own
- You have diabetes in pregnancy
- If you are overdue (More than 41 weeks)
- Your baby is not growing well or is small for dates
- You have high blood pressure in pregnancy
- You have had serious bleeding in pregnancy
- There are concerns about your baby (low fluid around the baby, less fetal movements)
- Maternal age (40 years and over)
WHAT HAPPENS DURING AN INDUCTION?
There are a range of methods that can be used to induce your labour. During your Induction your baby’s heart beat will be monitored with a Cardiotocograph (CTG) machine. You will also have an IV line (a drip) inserted in your hand or arm.
PROSTAGLANDIN GEL –This is a hormone gel that is placed in the vagina that works to soften and open the cervix. Prostaglandin gel often works slowly and you may need more than one dose if this is your first baby. In a 24hr period 2 or 3 doses of gel may be needed. Some women experience painful tightening’s.
THE BALLOON CATHETER– This is a small soft plastic tube that is inserted through the cervix and a tiny balloon inflated. This puts pressure on the cervix. The balloon is usually left in place for up to 24 hours. If contractions start, or the waters break, the balloon may fall out before it is due to be removed. Let your midwife know if this happens.
ARTIFICIAL RUPTURE OF MEMBRANES – (BREAKING THE WATERS) –This procedure is when the waters are artificially broken with a tiny hook during a vaginal examination. This can only be done if the baby’s head is low and the cervix is open enough to allow this to happen.
SYNTOCINON –This is a hormone that mimics your own natural hormone. It is given through your IV line in small amounts until contractions become strong and regular. It is usually given after the waters are broken. This procedure will be done in the Labour and Birthing Unit.
- Your LMC will arrange for you to be admitted to hospital as an in-patient.
- The induction process will be explained to you and your baby’s heart rate will be monitored.
- While you are waiting for labour to start, you can eat, drink and walk around. It’s important to drink plenty of fluids.
- When labour is established, you will be transferred to the Labour & Birthing Suite.
WHAT ARE THE RISKS OF AN INDUCTION?
- The amount of time your induction takes may make a difference to the type and amount of pain relief you require. It may also mean you are unable to walk around freely or use the pool.
- Induction can be more painful than spontaneous labour.
- A small number of women experience vaginal irritation from the prostaglandin gel
- There is a chance that prostaglandin gel can over stimulate the uterus causing too many contractions. This can sometimes result in stress to your baby and require medication to relax the uterus.
- After your waters are broken you may require a Syntocinon (hormone) infusion to ensure good, regular, strong contractions. You and your baby will be monitored continuously.
- There is a chance that Syntocinon can over stimulate the uterus and sometimes this can result in stress to your baby. This can be a serious complication, especially if you have had a previous caesarean section.
- An Epidural for pain relief is more commonly used in women having an induction.
- There is an increased risk of needing an instrumental delivery (Ventouse or Forceps) or a Caesarean.
- There is a chance the induction may not be successful. If this happens, your LMC and a Doctor will discuss the options with you, so you can make an informed decision about either continuing with the induction or delivering your baby by Caesarean.