Could somebody explain the general process of an NHS induction please?

[Mads199]

Im scheduled for an induction at 40 + 10 this Friday, I’m honestly hoping I go into labour before then but also preparing for the induction at this point too as baby girl seems very comfortable in there!

I’ve realised (a bit too late) that basically all of my research about giving birth was geared around going into labour spontaneously. It turns out I know literally nothing about the induction process or how it works. I’ll ask my midwife a few questions at my appointment tomorrow, but I’d love if anyone could share what the process was like for them? (Please nothing too scary, I’m a total wimp and have an awful habit of fixating on all the bad before the good 😭)

I have questions like do you stay in hospital throughout the duration of the whole induction or do they send you home at the start? How long can it all take? Are you strapped to a monitor the entire time? Do you have to have the hormone drip or does that depend on the beginning bit? Did you have the option to give birth on a midwife led ward or did it have to be in the consultant led ward?

My birth preferences were to go into spontaneous labour and try for a water birth on the midwife led unit with gas and air, because I heard pethidine can make you feel off your head/ out of control of your body and I really hate that feeling (I am sober - history of drink/drug abuse) and as I said, a total wimp, so the thought of the epidural actually scares me more! However, with this new potential plan of induction, I feel like a lot of those preferences are about to go out the window real fast 😂

Have a look at this OP

www.nhs.uk/pregnancy/labour-and-birth/signs-of-labour/inducing-labour/

So if you need the hormone drip you will have to be on the consultant led unit, as you won't be midwife led anymore.

The first part of the induction process is usually done on the antenatal ward. Depends according to your local hospital but where I am a Foley's catheter is used first. The catheter is passed through your cervix and the small balloon filled with water so that it puts lots of pressure on your cervix to encourage it to efface (thin out). Some places use dilapan rods but it's the same principle. If these don't work then pessaries are used. Again the main purpose of the pessaries is to efface the cervix, not to send you into labour necessarily. For some women it will cause the body to go into labour, but for many it doesn't.

Once your cervix is dilated enough to break your waters you will be transferred to the labour ward. Usually a midwife will break your waters and if you don't start contracting regularly after that then a hormone drip will be used. It's recommended that your baby's heartrate is continuously monitored when the drip is used as it can be stressful for baby. The midwife will offer regular examinations to make sure your body is making progress.

Hope this helps a little bit!

Hello OP

I can share a bit of info if it helps?

I had an induction booked in at 41+5 I think (or thereabouts) but started contractions prior to that.

At the point of being booked in for the induction, the midwife had given me a helpful leaflet which explained the process. For me it would have been coming in at a prearranged time with my partner, then they would've checked that baby was head down and monitored the heartbeat for a while to confirm they were happy to start the induction, before inserting the gel, which was called prostaglandin. That's meant to kick things off! There then would be a period of monitoring to see how you respond, and further gel applied if needed etc. There was explanation on options as well for pain relief further down the line.

As it was I went into labour and had contractions at home for 3 days. I was eventually admitted and as things didn't progress they put me on the Oxotocyn (synthetic happy hormone stuff - forgotten the right name sorry) drip. I had already said I wanted an epidural which worked well for me as I was tired from 3 days of little sleep. I then rested and my waters were broken to speed things along. Thanks to the epidural I rested and within a few hours was 10cm dilated so ready for pushing.

All in all for me the experience (although not induction in the usual sense as you've requested info about) was fine.

I had read beforehand it can be a long process so prepare to keep yourself entertained. Whether at home or in hospital, I guess your midwife will explain the protocol in your hospital.

Wishing you all the best and hope it goes well!

I stayed in for the entire time for induction, but it was for medical reasons - if the only reason for induction is because of dates they might let you home.
I was in consultant led unit but most of my labour was supported by only a single midwife.

I avoided hormone drip because they tried pessary first and that worked for me. I think having a private room for the induction helped with this because my contractions much stronger when alone - I definitely recommend requesting privacy if you are induced.

I managed to get through labour with gas and air - it's not a given you will need pain relief. Although everyone is different- and might depend how ready your body is for labour and position of baby etc.

If you are monitored they should be able to do it without strapping you to the bed (if you have an epidural that might stop you moving though)
I was able to move around with monitors - just not too far from the bed. But might also be worth asking if wireless monitoring as option if you are recommended monitoring. I think being able to move makes a difference to dealing with pain etc.

Hi,
I was induced at 41+2. I was 2cm dilated already but cervix wasn’t effaced so basically not going to happen anytime soon. I started with the pessary which they leave in for 24 hours. You have to be in the hospital for this as they need to monitor you every few hours. I was worried about that but my hospital visiting hours were 8-8 so wasn’t too bad with DP there as well.
I was told if the pessary did nothing they’d use some gel and leave me another 6 hours, then use gel again if that didn’t work.
The pessary did however do a little and made it easy for them to break my waters. So at that point I was moved to the delivery suite and waters were broken. After a couple of hours I hadn’t progressed so they put me on the drip. They increase the dosage every half an hour until you are in active labour.
It sounds awful but honestly the drip was fine in my experience. At one point the dose was abit high but they just turned it down and contractions eased off bit.

As for pain relief, I didn’t have an epidural and felt no need to. I had one dose of pethidine that didn’t seem to do much other than help me relax. I didn’t like the gas and air, it made me sick and feel completely out of control so bare that in mind! I did use a tens machine though, it was probably more mental than anything but I really think it helped.

I was so so anxious about being induced but it was fine! Looking back now I really wish I’d not let myself worry so much and just enjoyed the last few days of pregnancy.

I’m sure you’ll be fine, good luck!

So it depends on your hospital and if you’ve had a previous baby and how dilated you are.

Most start out with prostaglandin of some sort, there is either a 6 hrs gel which I believe you can have as an out patient or a 24 hrs pessary, some do this outpatient I believe but my hospital was in patient. Something to be aware of, these often start quite strong contractions that aren’t actually doing a lot by way of dilating. In fact during my induction, I was having the one min long super intense contractions one minute apart and from my birth classes I thought oh yeah this is the end now, brill, they checked me and I’d only dialated .5cm.
Rarely to the prostaglandins put you into full labour (did for me but I think it’s quite rare) they are aiming to dilate you enough to break your water. This then should send you into labour but if not they’ll put you on the drip. This for most people is painful, made worse by the fact you are bed bound on a monitor, most women here opt for an epidural.

For my hospital induction meant delivery suite so no MLU, and it’s a very different staff. Whilst the delivery suite midwife was fine a lot of my birth preferences I was bs’d out of because they were moderately inconvenient for the staff. The gynae that checked me too was a vile man. So I’d be prepared to be forceful but you can still have a water birth unless you have an epidural. I don’t think Induction is anything really to be feared but you do need to go in prepared. Part of that preparation is also the knowledge that you don’t have to be induced you can opt for expectant management if you chose

Would just like to add I was not bed bound for the drip. Obviously I couldn’t go for a walks around the ward but I was able to stand up, change positions and go to the toilet fairly easily

I've had 2 inductions. I'll refer to both, but since my second was only last week I'll go by that one.

So. All inductions start off on the antenatal ward. I was an inpatient prior to induction both times, but if you aren't, then you will be phoned with an appointment about a week beforehand.

On appointment day, you turn up on the ward, and are bought to the induction bay. Usually this is a 4 bed bay. You'll have a set of observations done, and baby listened into via Doppler. Then you'll have a vaginal examination. This can be uncomfortable, so if you think you might need some pain relief, make sure you've taken some paracetamol in advance. Gas and air was not on offer, but then I did not ask for it. Once the examination is complete, you'll have a brief discussion of what is the best course of action to take next. The primary purpose of this stage of induction is to open your cervix enough to break your waters, not to put you into labour. It's a possibility it might happen, but that's more a happy result than anything.

The options at my trust are: balloon catheter, prostaglandin gel, or nothing. As I found with this induction, a balloon catheter will only be used if baby is engaged in your pelvis. As my baby was still riding high, I had a dose of the gel. Gel/pessary isn't used as frequently as the mechanical method of the balloon catheter is considered a more natural way of opening the cervix. Artificial hormones are more likely to trigger contractions and irritate the cervix. The nothing option is reserved for when your cervix is already open enough (2+cm) to allow for an ARM (artificial rupture of membranes). After anything is done, your baby will be monitored by CTG for up to an hour.

Next up is the waiting game! If you had a balloon, and there is no medical reason keeping you in hospital, you can go home, and return in 24 hours to have it removed. If it doesn't fall out by itself in the meantime! If you had a gel, then ideally in 6 hours you would be examined again, and another gel applied if needed, with a CTG done again if it is. If the second gel doesn't work, they can try again the next day. If the second round doesn't work, they can try a third the day after that. If

You’ve had lots of useful experiences shared, so I will try not to repeat everything others have said!

I’ve had 3 inductions, one at one hospital and other two at a different hospital.
One was pessary.
One was gel > ARM > synto drip.
One was gel > ARM.

All were inpatient inductions. I could have gone onto the birth centre (midwife-led) if circumstances were different with the non-drip inductions. As it stands, I needed consultant-led births for those (so labour ward/delivery suite) regardless of induction, however all of my births were still midwife-led experiences. No consultant was actually in the room for delivery as that wasn’t necessary.

I had an epidural placed prior to the drip as it had been recommended to me by other women a lot. Probably the thing that scared me most! But it was all fine and did the job. Other two I had just gas and air.

My midwives tried to make the labour as calming and according to preference as possible. Reality is I didn’t have many preferences, but the key was that it did feel very woman-centered which is lovely. That is to do with the hospital and its culture far more than anything else, and I got that from both consultants and midwives.

My induction experiences have all been different but all been positive. FWIW my first labour was spontaneous, birth centre, gas and air. That was fine too, but pushing stage took ages (2hr, not blaming that on lack of induction, just how that went!) and I narrowly missed being taken to theatre. All just to say, nothing is ever really predictable and hopefully you can have a good experience no matter the birth

Stupid finger.... Anyway....

If that still doesn't work, and a balloon isn't a possibility, you'll need to consider a C-section. Which you can ask for at any time in the process if you no longer wish to continue induction. Gels are also used if 24h of balloon didn't work. I believe you have to remain an inpatient if gels are used.

This is the point where you might have to wait a bit. They can't break your waters until there's enough beds free and staffing available. And as long as you're not in labour and waters intact, there's no rush. In my more recent case, after my first gel, I wasn't examined until 24h afterwards owing to staffing pressures. As I was 2cm, the induction could be paused until there was space in delivery suite to break my waters. There wasn't space for me (baby boom!) until 3 more days later. So time line is: gel Monday noon, examination Tuesday noon, delivery suite Friday morning. My first baby was: gel Wednesday morning, second gel Wednesday afternoon, delivery suite Thursday early morning. Be prepared for a wait.

So time to have your waters broken! In both my cases, I had to have it done on delivery suite for medical reasons. However, they could also be done on the antenatal ward in private rooms. Consideration still has to be taken of the state of delivery suite, as they want you to have your baby there with 1:1 care, rather than on the antenatal ward where there isn't that ratio of staffing.

Waters being broken is a very odd experience. I've had a controlled ARM both times, as my babies really like riding high. You need some observations done, monitoring on CTG, and potentially a cannula inserted. Then it's go time! You lie back as in an examination, while a midwife uses a long stick with a hook on the end to rummage until the membranes break. In a controlled ARM, a second midwife will be applying fundal pressure to push baby firmly into your pelvis to reduce the possibility of cord prolapse. Gas and air will be available, in either circumstance. I highly advise making use of it. Eventually you'll feel a little pop and a whole lot of lovely warm fluid floods out and everything feels much more comfier bump wise.

I forgot to mention that if baby is high, they might do a bedside scan to ensure there's no cord in the way first. They'll also check via vaginal examination there's nothing pulsatile in the way as well.

So waters are gone. Now it's a short waiting game. You'll be given 1-3 hours for contractions to start. If they do, wonderful, they'll see how you get on. If they don't, it's drip time.

If you do need the drip, unfortunately a water birth is no longer possible, and a MLU birth isn't either. But that's fine! Both times I had zero contractions prior to the drip, and both times I've had wonderful (albeit very different) births. You need continuous monitoring at this point, but wireless is very prevalent nowadays, so even with a drip, you are far from tied to a bed. The drip starts at 1ml/h and is doubled in rate every 30 minutes (up to 32ml/h) until you're contracting regularly, strongly and for long enough.

Beyond this, it's all very personal and individual to you. Up to you what pain relief you want to take, and up to what level. Some women want to immediately have the epidural prior to the drip even beginning. Others take the pain as it comes, and increase pain relief as needed. All options are valid and correct for you.

Oh I forgot. With the drip, it's recommended to have vaginal examination 6 hours after the start of the drip, then every 4 hours after that first examination.

As for how my inductions ended.

First was 11.5 hours on the drip. I did not want to move from the bed. I had gas and air and diamorphine at 5cm (6 hours in). Had a spontaneous vaginal birth with small second degree tear.

Second was 18+ hours on the drip. I spent more than half the labour moving around and in a very nice position leaning onto the bed on my knees. I had gas and air throughout, and an epidural at 4cm (16 hours in). I had 2 hours off the drip to allow for some passive descent (and some sleep!), then a further 2 on a low dose. Unfortunately at this point baby was getting slightly distressed, I was only 5 cm, and it was clear baby was not coming out any other way than via the sun roof. For my entire pregnancy, of you had told me it was going to end in a C-section I would have cried. But when it came down to it, it was absolutely the right decision, and I was more than happy. I still am, and recovery is going well.

I hope my vast amounts of rambling helps in some small way. Good luck for Friday. Unless baby comes before then!

I had induction at 38 weeks for medical reasons so was induced on the labour suite. It was my easiest labour by far. It was a twin pregnancy (don't know if that makes any difference).
I had a hormone drip then they broke my waters. It was a 6 hour labour and I was up and around afterwards no problems.
My sil had her waters broken on antenatal ward at 41+6, following a pessary and never made it to labour ward as she had baby on antenatal ward 30 minutes later.
Every induction is different but we both had great experiences.

Take a book or magazine as it the bit before labour starts is very boring!
I had two inductions with hormone drip & epidural and both were straightforward labours.

I'll add a bit from my experience - there's lots more to my birth story, but these are the bits relevant to induction.

I was induced at 39 weeks, unplanned, due to leaking hindwaters - basically a hole in the sac but above the baby, so my waters didn't 'go' as gravity wasn't helping. This is a significant infection risk, so there was no waiting around after the gel didn't get things going - baby had to be delivered ASAP.

Gel was given at about 11pm, I was moved to the delivery suite at 3am, waters were broken and hormone drip was started.

I absolutely could not easily move from the bed. I had the drip, monitoring wires for me, monitoring wires for the baby - I was basically confined there. I constantly felt like I needed the loo with the pressure of the contractions starting, but getting there was a massive palaver. I couldn't go without a midwife to help me up without dislodging anything, and to untwist everything after. I absolutely had not planned for this. I note pps saying they could move around easily, and wireless monitoring is now common - I am so pleased to hear this. But do give some thought to your coping strategy if that is not the case. I hadn't, all my plans involved being active, and then I couldn't and I was suddenly terrified.

I have only experienced an induced labour, but my feeling is that contractions with the drip were very different to contractions as they had been described to me before. There was no 'building up', no time to prepare myself - I either wasn't contracting, or it was suddenly there, full force. This could just be me and how my body works, or my misunderstanding of what to expect, or that's just how the drip works. Again, I wasn't prepared for this.

The way I was contracting meant that gas and air did nothing for me - with no build up to the contraction, by the time I reacted, breathed it in and the effect kicked in, the contraction was finishing it, so I got the effect afterwards, when it just made me feel ill. I didn't want pethidine (personal choice), and was very happy to have an epidural. It worked well and just made everything better - didn't constantly need the loo, contractions were manageable, actually managed to rest (I'd been awake for 48 hours by that point). I won't be having another baby, but if I had done, I would have had an epidural in my birth plan right from the start.

It took about 9 hours from the point that the drip went in to when I was fully dilated and ready to push. This was much, much faster than anyone expected, and took the midwife by surprise. If you do have an epidural, then be aware that you need to listen very carefully to the midwives on when to push, as you otherwise won't (necessarily) know.

However - I want to stress that despite everything I've said above, my daughter's birth was a very positive experience. The midwives were wonderful throughout, and I felt very safe, supported, listened to, and well cared for at all times.

Thank you so much everyone for sharing your experiences and also your tips! I really appreciated reading them and it has made me feel a lot more prepared ❤️

I ended up being induced yesterday due to reduced movements (and honestly just so much anxiety about Friday that I thought it’d be best to just get the process started!) I had the pessary yesterday at around 5:30pm snd my cervix was completely closed and backwards, then I had a big bloody show at 3:00am and now I’ve been having contractions since 5:00am…hopefully this means my cervix is doing something!

I have to say, it’s quite nice just being in the hospital already and not having the ‘when should we go’ stress!

Good luck, @Mads199!

I had the pessary to start things off. Next evening they wanted to use balloon catheter and then break my waters but I declined. My waters went naturally next day, by that evening I was in delivery suite with hormone drip and gave birth just before midnight. I heard horror stories but despite being back to back, forceps and induced I didn't think the pain was unbearable and remained calm. Good luck.

I was admitted as in patient for my induction at 39 weeks...

They start with having you sit for a while with straps around you to monitor the baby's heart rate initially. Then they put in a gel prostaglandin pessary for the 6 hours. It didn't hurt at all getting put in. Kept me on the monitor on the bed during this time to keep an eye on the heart rate. It was fluctuating for me but they weren't concerned. I expected this whole induction process was going to last days but just a few hours after the gel was put in I stated to her backache that slowly got more intense. Eventually around 5 hours later I was buzzing the midwives and telling them the pain was too unbearable and I needed something strong and not just some paracetamol! The main problem was there was no gaps between the pain (contractions) for a break/relief. They examined me at the end of the 6 hours and found I was 4-5cm so moved me to the labour ward and just as they were wheeling me my waters broke. 5 hours later (on just gas and air) I pushed my baby out. I had a small episiotomy but otherwise the labour and birth was absolutely fine. This was a first baby for me also so I was really surprised from start to finish it was only 11 hours. I did however have a retained placenta and postpartum haemorrhage but I can't tell if the induction was a factor in this. They quickly took me to theatre and got it all sorted though so all was fine!

@Mads199 completely agree with the positive of being in hospital for it all and not having a panicked rush there in labour/pain! I had excess amniotic fluid so it was a flood when it went and I'd have freaked if I was at home or on route when it happened 😅 i hope you don't have much longer to wait 🤞

Oh wow @Mads199! Sounds like things could be starting. Best of luck! I hope baby is behaving now too.

NGL, while part of me wishes I'd had the whole "when do we go" experience, it is kinda nice having everything handled and in place for you.

I read back through your OP, and saw what you said about being worried about strong pain relief and epidural. In regards to opioids (pethadine, diamorphine, meptid), talk to your midwife about what's on offer, and see what they have to say. I was completely out of it on diamorphine. I was only conscious for brief moments at the peak of contractions. I remember very little of those few hours. The feeling of being out of my own body never bothered me, but now I've tried both epidural and opioids, I would definitely go for an epidural every time. I initially felt the exact same way as you about an epidural, but when it came down to it, it was the complete opposite to what I feared. The anaesthetist will stop and start whenever you're ready. And if you feel anything sharp (other than the initial injections of local anaesthetic, which hurt only for a moment), they'll keep putting in more local until you don't. After that, it's all just a matter of pushing and prodding in the small of your back, before that blessed cool relief spreads across your body as the good stuff goes in. Hopefully you won't need either, but if you do, don't be afraid to get it.