Induction of labour

An induction of labour, or induced labour, is when we try to start labour artificially. This means we use a tablet, pessary, gel, or other medicines to start your labour. In the UK, about 1 in 3 labours are induced.

There are different ways your labour can be induced. How we induce labour depends on different things, like:

your pregnancy and medical background
a vaginal examination which will tell us how soft and open your cervix is

It is important to remember that your waters might break, or your contractions might start, naturally at any time during induction.

Why we might induce labour

We might offer to induce your labour if:

your pregnancy goes beyond its due date by 7 to 14 days or more (prolonged pregnancy)
your pregnancy is affected by a medical condition, such as high blood pressure, diabetes, or a liver condition called obstetric cholestasis
you are expecting two or more babies
you are aged 40 or older
If your waters have broken but labour doesn’t start (we call this augmentation of labour)

We prefer labour to start naturally. However, we offer induction when the benefits for you and your baby are greater than the risks. Our priority is the wellbeing and safety of you and your baby. The decision to induce labour is never taken without discussing it fully with you.

Benefits of induction if you are overdue

After 42 weeks of pregnancy (2 weeks after your due date):

the very small risk of stillbirth increases
babies are more likely to pass meconium (their first poo) during labour. This rarely causes a problem, but if your baby breathes meconium into their lungs, it can cause a serious breathing problem (meconium aspiration)
the placenta might not function as well, and this can reduce the oxygen and nutrients available to your baby.

Having an induction 7 to 13 days past your due date reduces the chance of these things happening.

If your waters break

Your waters may break before labour starts. This happens to approximately 1 in 12 women after 37 weeks of pregnancy. If this happens, you may feel a slow trickle of fluid from your vagina or a sudden gush that you cannot control, or you may just feel damp.

If you think your waters may have broken:

wear a maternity sanitary towel (not a tampon)
observe and note of the colour and amount of fluid leaking from your vagina
call the Maternity Telephone Assessment Line, who will invite you to come in for a check of you and your baby

Most women go into labour soon after their waters break:

6 in 10 of women go into labour naturally within 24 hours
9 in 10 of women go into labour naturally within 48 hours

If your waters break and labour does not start

If your waters break and you do not go into labour, you will be offered an appointment for induction of labour around 24 hours after you first noticed your waters broke.

This is because there is a small risk of an infection developing in the amniotic fluid surrounding your baby. An infection could affect you and your baby.

As the length of time between your waters breaking and your baby being born increases, so does the likelihood of an infection. It is important to remember the chance of infection developing in the first 24 hours after your waters break is low, and the likelihood of labour starting naturally is high. You can either:

wait and see if your labour starts naturally, or
request an induction of labour, if you prefer

If you choose to wait and see (also called taking an ‘expectant management’ approach), you can go home while you wait for labour to start. At home you will probably be more relaxed and comfortable than you would be in hospital.

Induction methods

Different medications are used at different stages of your induced labour.

Dinoprostone pessary (Propess)

This is a pessary attached to a ribbon (like a small tampon) that is put in your vagina. It contains a hormone called prostaglandin, which is gradually released and helps to soften the cervix before labour starts.

Dinoprostone vaginal tablet (Prostin)

Sometimes we may need to give you more doses of prostaglandin. You may have a Dinoprostone pessary inserted followed by Dinoprostone tablets if labour has not started. When we recommend doing this depends on how you respond to the pessary. Occasionally we just use the Dinoprostone tablets.

Dilapan

Dilapan-S® is a slender rod made from a synthetic firm gel. Typically, three to five rods are delicately inserted into the cervix to soak up fluid from the nearby tissue. Each slim rod gradually expands up to 14 mm over 12 hours. As these rods grow, they gently open and soften the cervix, helping prepare for labour.

Artificial rupture of membranes (ARM)

Breaking the membrane that contains the waters (amniotic fluid) around your baby is often enough to make your contractions stronger and more regular. A doctor or midwife can do this using a small hook. This is also known as artificial rupture of the membranes (ARM).

Hormone drip (Syntocinon)

Syntocinon contains a manufactured form of the hormone oxytocin. It makes the muscles of the womb contract. An intravenous drip is used to deliver a precise dose of syntocinon to allow for strong, regular contractions.

Risks of inducing labour

There are no major risks to you or your baby. Your midwife or doctor will discuss the benefits and risks to you before your induction is booked.

There are some small risks to inducing labour. The hormones might cause your wombs to contract too much. If this happens, we try to reduce your contractions by:

removing the pessary
turning the hormone drip down, or off
giving you medicine

If your womb contracts too much it can affect the baby, so your baby’s heart rate will be monitored continuously throughout labour. This may affect your choice of place to give birth.

Inducing your labour at term does not increase the need for a caesarean section.

Not being induced

Induction of labour is a choice that has benefits, risks and alternatives.

99 in 100 labours start naturally by 42 weeks of pregnancy. If you have not gone into labour by 42 weeks and you choose not to have your labour induced, your obstetrician will support you to create a plan for the rest of your pregnancy.

If you are offered an induction for a medical reason, this will be offered earlier in your pregnancy after an individualised birth plan is made with you alongside your clinical care team.

If you are offered an induction and you choose not to have it, you will be offered regular checks of your baby’s wellbeing that monitor the health of your baby at that time. These checks cannot predict how your placenta will continue to function, and complications can still occur. You can discuss this with your consultant when you come in for checks.

You will be offered:

twice-weekly assessment of your baby’s heartbeat at the Maternity Assessment Unit (MAU) using an electronic fetal heart monitor (also known as a CTG)
a weekly ultrasound scan to check the amount of amniotic fluid (waters) surrounding your baby.

Preparing for your induction

After 36 weeks of pregnancy, we recommend everyone having their baby with us attends our online ‘Induction of Labour’ parent education session to learn about the induction process and options.

At 38 weeks, we discuss induction with everyone we see, including:

the option of a membrane (cervical) sweep and its potential to make going into labour naturally more likely
risks associated with pregnancies that last longer than 42 weeks
advantages and disadvantages of induction
options available to you if you choose to decline induction
when, where, and how labour can be induced
how induced labour differs from labour that starts naturally
what happens if induction is unsuccessful

Membrane (cervical) sweep

A membrane sweep is also known as a cervical sweep. It makes natural labour more likely and reduces the need for induction. We usually offer a membrane sweep at 40 and 41 weeks.

During a membrane sweep, we insert a finger into your vagina and ‘sweep’ the neck of your womb. This is to separate the membranes of the amniotic sac that surrounds your baby from your cervix. This can encourage your body to release a hormone called prostaglandin and start labour naturally in the next 48 hours.

You might feel some discomfort from the procedure or notice a small amount of vaginal bleeding (spotting). This is OK and is nothing to worry about.

How long will my induction take?

This will be different for everyone and depends on how ready your cervix is for birth. In general, it can take two to five days from the start of the induction to the birth of your baby.

Sometimes of our wards are very busy, and this can delay parts of your induction.

Pain management

If you are having your labour induced, you might want to make some changes to your birth plan, such as your choice of pain relief.

All pain relief options for labour can be used during your induction.

The pessary and gel can make early labour pain last for a longer time. You can ask for painkillers (analgesia) during this time, or consider a TENS machine to help you. A TENS machine is a small, battery-operated device that has leads connected to pads (electrodes) that stick to your back.

There is no evidence that labour after induction is more painful. However, more epidurals are requested after induction, compared to those who go into labour naturally.

What do I need to do on the day of my induction?

We call you on the day of your induction to tell you what time you should come in. If you have not received a telephone call by 12 midday, please contact the team where your induction will be done.

We cannot give you a time in advance because it depends on how busy the maternity unit is on the day. We try to keep you updated about any changes to when you can come in.

Sometimes, the maternity unit can get very busy. We understand that delaying your induction can be distressing, but our priority is to provide a safe birthing unit for you and your baby. We might have to delay your induction by 24 to 48 hours or ask you to come in later in the day.

If you have chosen an outpatient induction, you will come into the hospital, and then go home after you have had the pessary inserted. However, going home during your induction is not an option if there are medical risks that make it safer for you to stay in the hospital.

Birth partners

You can bring your birth partner with you when you have your induction. However, if you are not in established labour by the evening, we would encourage them to go home to rest overnight. Established labour means that your cervix has dilated to about 4cm and you are having regular contractions.

If your labour does start during the night, they can be contacted and asked to return to support you.

This is a choice, and you may decide for your birth partner to stay with you at all times.

Locations

William Gilliatt Antenatal Ward, 3rd Floor, Golden Jubilee Building

Nightingale Birth Centre, 4th Floor, Golden Jubilee Building

Contact Details

Maternity Telephone Assessment Line

Further information

NHS website – Inducing Labour page

National Institute of Clinical Excellence (NICE) – Inducing Labour: information for the public