Induction of Labour - East and North Herts NHS Trust

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General Information
This leaflet is for all pregnant women using Maternity services at
East and North Hertfordshire NHS Trust, and is designed to give
information about induction of labour to help you understand the risks
and benefits of induction for you and your baby.
What is induction of labour?
Induction of labour is a process designed to start your labour
artificially.
Why am I being offered induction of labour?
Induction of labour is offered for a variety of reasons where it is felt
that giving birth sooner would benefit the health of you or your baby.
This may be because of medical conditions, for example diabetes or
pre-eclampsia, or concerns about the baby’s growth or development.
If this is the case, your doctor or midwife will discuss this with you
fully.
In most pregnancies labour will start spontaneously between 37 and
42 weeks but some normal healthy pregnancies continue
beyond this time. After 41 weeks there is a slight increase in the risk
of your baby developing health problems. After 42 weeks, more
severe complications may be more likely. Induction of labour is
therefore recommended between 41 and 42 weeks. Being induced
because you are overdue does not increase the chance of you
needing a Caesarean section.
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In a normal, healthy pregnancy where you are well and your baby is
well grown, there is evidence to show that there is no benefit to
induce before 41 weeks. Although you may be feeling impatient and
uncomfortable at this time, there is still a strong chance of going into
labour and giving birth naturally.

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Statistically at 41 weeks
Six out of ten women will have their baby in the next three days
Nine out of ten women will have their baby in the next seven
days
At the Lister and QEII hospitals you are unlikely to be offered
induction of labour until you are 10 – 12 days overdue (based on your
dating scan), unless there is a clear medical indication to induce before
this.
What are the benefits and disadvantages of induction?
Benefits
Allows for early birth when mother’s or baby’s health is at risk.
Babies born after 42 weeks of pregnancy are slightly more likely
to have a difficult birth and a low Apgar score (a measure of well
being at birth).
Babies born after 42 weeks are more likely to open their bowels
(pass meconium) during labour. This rarely causes a problem,
but it can cause breathing problems if your baby inhales
meconium.
Disadvantages
It may take longer for you to go into established labour.
You may need more than one intervention to start or continue
your labour.

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The induction may not work, which may result in further
intervention, or a Caesarean section if you fail to go into labour.
Your baby will need to be monitored more closely during labour.
You are more likely to need assistance with your birth, e.g.
ventouse (suction cap) or forceps.
Is there any way to stimulate labour naturally?
You may be able to help labour start naturally
Raspberry leaf tea (made from fresh leaves or a sachet of dried
leaf) or tablets taken after 36 weeks of pregnancy is said to tone
the uterus. (There is no clear evidence that this helps but it does
no harm.)
Women have found other ways to stimulate labour, but these have not
been fully researched for their safety or effectiveness. They include:
Gentle nipple stimulation from 39 weeks is thought to encourage
the release of natural oxytocin, which helps the uterus to
contract, but you may not find it comfortable.
Sexual intercourse – semen contains prostaglandin hormones
that can help prepare your cervix for labour. However you
should avoid full penetration if you have been told that you have
a low placenta.
Clitoral stimulation (female masturbation) could encourage
uterine contractions.
Gentle walking – gravity pushes your baby’s head down onto the
cervix, and may help things along.

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A number of complementary therapies such as acupuncture or reflexology
could be used. If you are interested in these you should seek advice
from a fully qualified therapist, as some treatments may not be
safe during pregnancy.
If I choose to be induced, how will this happen?
There are different methods for inducing labour outlined below. You
may need only one, or all of these.
Membrane sweeping
The National Institute of Clinical Excellence (NICE) recommends that
you should be offered induction from 41 weeks. If you agree to this, the
first stage is that your community midwife will offer you a membrane
sweep at 41 weeks. (There is no evidence to support membrane
sweeping before 41 weeks).
This involves the midwife doing an internal vaginal examination and
placing a finger inside the cervix and making circular movements to
separate the membranes from the cervix. Membrane sweeping can be
uncomfortable, and you may lose a small amount of blood afterwards
but it will not harm the baby, or increase the risk of infection.
This has been shown to increase the chance of labour starting within
the next 48 hours and reduces the need for other methods of induction
of labour. Membrane sweeps may be done either at clinic or at home
and can be repeated after a few days, as this may help you to go into
labour naturally.

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What happens next
Following your sweep, if you choose to continue with an induction
process, your midwife will arrange a date for you to be admitted to the
hospital for further induction methods. This is usually between 10 and
12 days past your due date.
If your pregnancy has been uncomplicated your induction will be
started on the antenatal ward. If your pregnancy is high risk, for
example you have had a previous Caesarean section operation, or
your baby has not grown well, your induction will be started on the
delivery suite. You will usually stay in hospital until after the birth, so
you should bring your full hospital bag with you.
Although we aim to start your induction promptly, there may be a
delay at any stage of the induction if the maternity unit is unusually
busy. While you are on the antenatal ward waiting for your labour to
start, normal visiting hours will apply. When you are in labour and
moved to the delivery suite, your birth partner can stay with you all the
time if you want.
Before the induction can begin your baby will be given a heart tracing
(CTG) for about 30 minutes to check that your baby is healthy.
The midwife looking after you will suggest an internal examination to
assess which method of induction is most appropriate for you.
Prostaglandins
This is the most common method of induction. Prostaglandins are
drugs that stimulate the cervix to soften and begin to open, allowing
contractions to start. The tablet is inserted behind the cervix during a
vaginal examination. More than one dose may be needed to induce
labour, and labour may still take several days to start.
After the prostaglandin has been given, you will be asked to remain on
the bed for 30 minutes so that your baby’s heartbeat can be
monitored. After this, you can get up and walk around if you want to.

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When you are having regular contractions you will be offered a further
heart tracing which, if satisfactory, can be discontinued to allow you to
mobilise.
Advantages
Can stimulate labour
There is no evidence to suggest that labour induced by
prostaglandin is more painful than spontaneous labour
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Disadvantages
Very occasionally the prostaglandin can cause the uterus to contract
too much, which can affect your baby’s heartbeat, so this
will be monitored closely
The vaginal examination can be uncomfortable, and the
prostaglandin can cause some vaginal soreness
Some women may experience some period type pain, severe
pain, backache, or regular contractions soon after prostaglandins.
This can subside after a time, or may develop into labour.
Pain relief is available if you need it, just ask the midwife looking after
you.

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Artificial rupture of the membranes (‘breaking your waters’)
If you do not go into active labour following the prostaglandin, but your
cervix has begun to open, your membranes can be ruptured during a
vaginal examination. This will then be followed as soon as possible
by administering syntocinon, which is performed on the delivery suite .
Disadvantages
The procedure may be slightly uncomfortable, and may cause
your contractions to increase in strength
It is more likely that you will require stronger methods of pain
relief
Your amniotic fluid will continue to leak, so you will be given
sanitary towels to wear
After it is done, you will be given a couple of hours to walk around to
see if labour starts by itself.
Syntocinon
Syntocinon is a drug that encourages contractions. It is given directly
into your bloodstream through a cannula (tiny tube) into a vein in the
hand or arm. It can only be given on the delivery suite. When
contractions have started, the drip can be adjusted to keep your
contractions regular until after the birth.
Disadvantages
Very occasionally, syntocinon can cause the uterus to contract
too much, which can cause the pattern of your baby’s heart beat
to change. It is recommended that your baby’s heart beat be
monitored continuously throughout your labour

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Syntocinon should not usually be started until at least six hours
after your last prostaglandin
Contractions may become strong and painful more quickly
You are more likely to require an epidural for pain relief
You will be less able to remain very mobile
Syntocinon is usually the final option for induction, so if this does not
lead to the birth of your baby, you may need a Caesarean section.
What if I choose not to be induced?
Your doctor or midwife may offer induction of labour, but it remains
your choice whether to go ahead with it or not. If you choose not to be
induced, it is important to check that you and your baby remain
healthy.
You will be asked to let the midwife or hospital know if your
baby’s movements become less frequent or change
significantly.
You may be offered an ultrasound scan to check that there is
enough fluid around the baby, and that it is a good size and
there is good blood supply from the placenta (Doppler). This will
be discussed with your obstetrician.
You will be offered twice weekly heart tracings (CTG). If you
prefer to be monitored more frequently (even daily) this can be
arranged. CTGs take approximately 30-60 minutes and check
that the baby is healthy, but CTGs cannot predict how well the
baby will cope once labour starts.

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Further information
Our hospital policy is based on the recommendations of the National
Institute for Clinical Excellence (NICE). For more information you can
visit their website at www.nice.org.uk
We have produced a separate leaflet ‘What to do if your waters have
broken?’
MIDIRS informed choice leaflet ‘When your baby is overdue’
www.infochoice.org
www.nhsdirect.nhs.uk
Contact details
Should you need further information to help you to decide if induction
is right for you, talk to your community midwife or doctor, or contact
the hospital.
Lister Antenatal Clinic 01438 314333 ext. 4070
QEII Antenatal Clinic 01707 328111 ext.4600
NHS Direct Tel 08 45 46 47
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