Induced labour

Why labour might need to be induced

Labour can be induced because:

• Your baby is overdue. Being pregnant for longer that 42 weeks could lead to a higher risk of stillbirth or problems for your baby. How overdue you are before being booked in for an induction will depend on your hospital's policy – and your wishes. Being overdue is the most common reason for inducing labour.

• Your waters have broken but labour hasn’t started yet. If labour doesn’t begin within 24 hours of your water breaking, there can be an increased risk of infection for you or your baby.

• You or your baby have health problems, such as diabetes, pre-eclampsia or other acute or chronic conditions such as kidney disease or high blood pressure, or there’s any kind of risk to your baby’s health and they aren’t thriving.

It’s your choice whether you’re induced or not – you can say no if you want to. And it might be worth trying a few things that could help to bring on labour naturally before you go into hospital – the old, pineapple, sex and curry routine.

How is labour induced?

Membrane sweep

You will probably be offered a membrane sweep before anything else, which may well get the job done. If it doesn’t, you might be offered another one.

Prostaglandins

If a membrane sweep doesn’t work, you’ll typically be asked to go to your hospital or birthing unit to be induced, where you’ll have a tablet, pessary or gel inserted into your vagina. This will contain prostaglandins, which are drugs that mimic your own body’s birthing hormones to help soften and shorten your cervix.

You may be able to go home to wait for these to start working, but you should contact your hospital if your contractions begin, or conversely if nothing has happened after six hours.

Depending on the kind of prostaglandins that have been administered, you may be offered more after six or 24 hours later, depending on the type you were given, if they haven’t begun to work – or you might even be told to wait a couple of days before trying them again.

Sometimes the softening of the cervix is all that’s needed to kickstart labour and things will get going without any further help.

Balloon catheter

This helps to gradually open your cervix using physical pressure. A balloon is inserted into your womb while deflated, then slowly filled with saline solution. As it fills, pressure is placed on the cervix, which encourages it to dilate and labour to begin.

The balloon will be left in place for around 12 hours while you and your baby are monitored. If labour begins, your water breaks or your baby becomes distressed, it will be removed. There are other similar devices that have the same effect, so you may be given one of those.

Having the balloon catheter inserted can be uncomfortable, but as your cervix opens it should become less painful.

Artificial rupture of membranes

This is where a doctor or nurse will break your waters, either with their gloved finger or with a thin probe that is often compared to a crochet hook by those who’ve had the procedure. The loss of amniotic fluid can stimulate your womb to start contracting. Having this done can be uncomfortable, so you may be offered gas and air.

Hormone drip

If none of the other methods have had any effect, or if your labour has started but is progressing too slowly, you may be put on a hormone drip of Syntocinon, a synthetic version of the hormone oxytocin that causes contractions.

Syntocinon will be administered by intravenous drip and will start at a low dose to allow your contractions to start gradually. Once they’ve been established, the rate of the drip can be adjusted to ensure that your cervix is dilating without becoming too painful and the contractions aren't coming too fast or strong for you to cope with.

What induced labour feels like

If you’re heavily pregnant and very uncomfortable, it can be a relief to know that your baby is finally going to come out. Inductions are usually scheduled, so it can be helpful to know exactly when you’re going to be visiting the maternity ward. You can prepare your birth plan and have your hospital bag packed and ready to go in plenty of time.

If you have a firm idea of how you want your labour to go, for example wanting a water birth or a home birth, it can be scary to have control taken away by a timetable or a drip. Just focus on the end result and you’ll be holding your beautiful baby in your arms in no time.

Remember all labours, including induced ones, are different – so what works for some women might not work for you. Whatever you decide, you'll be able to make an informed decision because all of the induction options will be explained to you.

Is induced labour more painful?

There’s no getting around it – induced labour can be more painful than labour that starts naturally. This may be because the contractions you experience are stronger or faster due to the methods used to induce it, or because there’s no gradual build up to get you in the zone or used to the pain.

If you’re being induced, your pain relief options are exactly the same as for any other labour, so feel free to ask for whatever you need to get you through it. Women who get induced are more likely to ask for an epidural and are also more likely to have an assisted delivery, where forceps or ventouse suction are used.

Side effects and risks of induced labour

Being induced is very safe, and one in five women who give birth will have been induced.

Like most medicines, those used to kickstart contractions can have side effects. Prostaglandins can make you feel feverish and nauseous, give you diarrhea or make your vagina feel sore – hardly a walk in the park, then. Both prostaglandins and hormone drips can cause your womb to become hyperstimulated, meaning you experience contractions that are very intense, frequent or long-lasting. If this happens you’ll be giving medication to calm your womb down, as it were.

What if induction doesn’t work?

Induction is a gradual slope that ramps up. If a membrane sweep doesn’t work you’ll be offered prostaglandins, if those don’t work you could be offered a drip, and so on. This ensures that the method with the least intervention is tried first before moving on to the next option, so there’s little of chance of induction not working at all. However, if all induction methods don’t seem to be convincing your baby of making an appearance any time soon, you might be offered a c-section.

What Mumsnetters say about labour being induced

“My advice is not to expect it to happen straight away: I thought that full labour would start immediately but this is often not the case. Bring plenty to keep you occupied – music, food etc. Someone I know went round a museum in between pessaries.”

“I was induced and the downside was going straight into full-on labour pains rather than experiencing a gradual build-up. On the plus side, it was fairly quick and therefore not completely exhausting, plus it all took place during the day and so I had a good night's sleep the night before.”

“When I went 14 days past what doctors believed was my due date, they insisted I was induced. They tried twice with prostaglandin pessaries but nothing happened. After that I was scanned and monitored and told to come back to the Foetal Assessment Unit every two days. Eight days later I went into labour naturally and my son was fine.”

“I remember complaining to my consultant that I was sure I was never going to give birth and he kindly assured me that there was no medical record of anyone ever getting to 10 months pregnant. Somehow my pregnancy-addled brain found this comforting.”