Taking the mystery out of induction of labour

What is induction of labour?

Induction of labour is any process that exerts external influence to try and start the body's process of labour and birth. This may include anything you try to do yourself such as having sex or eating curry and anything you have done by a holistic practitioner such as a chiropractor, acupuncturist or reflexologist to help your body do what you want it to do.
It also includes the 'stretch and sweep' or 'membrane sweep' procedure which involves your care provider inserting their (gloved) finger into your cervix and separating the membranes holding your waters away from the cervix with a circular sweeping motion. This is not always recognised as part of the induction of labour process but it is an intervention with the object of starting labour off.
As with any intervention your care provider needs to make sure you're making an informed decision on whether or not to accept that intervention. So, they will be very happy to help you go through the benefits, risks and alternatives with you and to let you know what will happen if you do nothing. You can ask as many questions as you need and think through what your instincts are at the time before making your decision.

This way of thinking through your choices is very useful and you will notice we frequently reference it. We remember it with the acronym BRAIN (benefits, risks, alternatives, instincts, nothing).

Medical Induction Process

This process starts with you being admitted to hospital and having the usual checks to be sure you and your baby are healthy. An internal exam is given which allows your caregiver to assess if your cervix is open enough for your waters to be broken. If it is then you skip to that step. If not you go through a process of 'cervical ripening' which means moving your cervix from long and closed to short and slightly open. First a pessary is inserted into your cervix, either an artificial version of a hormone prostaglandin called prostin or a balloon catheter (a soft silicon tube  that is  gradually filled with saline solution so it expands to mechanically open the cervix). If this is effective you will then be offered a 'rupture of membranes' which allows your baby's head to press down onto your cervix and hopefully to tip your body over into the process of labour and birth. Sometimes your body will tip over during the first process (usually if it was very close to spontaneously beginning to labour anyway) and sometimes even after your waters are broken contractions won't start. Depending on how your body reacts to these interventions further interventions may or may not be offered. The process is individual to you and to how busy the labour ward is at the time. It may go faster or slower than originally anticipated.

Here are some flow charts produced by our local maternity department. Your care providers may assume that once you agree to start the process, you're expecting to agree automatically to each next step in the intervention process. However, they should also be clear with you that you have the right to make an informed decision about each intervention and that you can change your mind or make different decisions when it feels right to you.
Since these charts were produced, in Portsmouth, it has also become possible for anyone being induced to choose a balloon catheter rather than a prostin pessary. It's no longer just available for those who have had a previous caesarean birth.

The hormone drip.

If you go into labour after the induction process up to the point when your waters have gone you have every chance of going on with your original birth plan including water birth and active birth. However, if you don't start to have regular strong contractions shortly after your waters are broken you will then be offered a syntocinon drip (a synthetic form of the hormone oxytocin which among many things acts on the uterus to cause it to contract). In order to agree to the hormone drip, you can talk through all the benefits, risks, alternatives and what if you do nothing questions with your care provider before deciding what your instinct is to do. If you choose to have the drip you will also need to agree to continuous monitoring. This may limit the amount of moving about you are able to do but you may still be able to stand or kneel. At this point, you may find the methods you've been using to work with your contractions continue to be effective or you may find you want to talk through other alternatives such as an epidural with your care providers.
Many people who choose to use the hormone drip and/or an epidural will go on to have their baby without any further assistance. However, if the pushing stage of your labour goes on longer than expected you may be offered an assisted delivery (either vacuum-cup or forceps) or a caesarean birth. This is another point when you may want to go back to your BRAIN decision-making tool. As always, your decision is totally individual to you.
More details on the process of induction of labour can be found on the NHS website and on the NICE website.

Why Might I be Offered an induction of labour?

Sometimes induction of labour is offered because there is a concern for the wellbeing of you or your baby that means your care providers feel it would be safer for your baby to be born now. One example of this is with pre-eclampsia. Sometimes induction of labour is offered after your waters have gone spontaneously but you haven't started having strong regular contractions within the first 24 hours and your care providers are concerned you or your baby might contract an infection. Sometimes induction of labour is offered because your baby seems to be bigger or smaller than expected.
But the most common reason you will be offered induction is to prevent 'prolonged pregnancy' which is defined as longer than 42 weeks. However, it's more and more common for various reasons for people to be offered induction before this point. Often induction at 41 weeks may be standard due to how long inductions can take and care providers wanting to try and ensure babies are born before 42 weeks. People who are over 40 years old and pregnant, people who have regular or gestational diabetes, babies conceived via IVF are all frequently offered induction at or before 40 weeks of pregnancy.
Because induction is part of the usual care plan offered to everyone by 41 weeks it can often be mentioned in conversation during routine appointments from as early as 36 weeks pregnancy.

Is induction of labour the only alternative? Am I being difficult if I would prefer to avoid induction?

As with every intervention, induction of labour no matter how it's presented is an offer and there are risks as well as benefits and alternatives you can choose if your instincts tell you, they would be better for you. The main alternatives are what's called 'expectant management' - closer monitoring of your health and your baby's health until spontaneous labour begins- or planned caesarean birth.
You're not being difficult even if you let your care provider know in advance, you're not planning to have your labour induced and would prefer they leave any discussion of the option until you bring it up or there is a medical reason that they are suggesting immediate induction of labour. You're also not being difficult if you say I'll have to do some more research. Can you provide me with more information relevant to me personally to help me make my decision? And you're very much not being difficult if you say thanks for the offer but I will decline for now and choose expectant management.

If I consider all the options and decide induction of labour is right for me what can I do to help myself have as positive an experience as I can?

Knowing what to expect can be really helpful, talk through the process at your local hospital with your midwife or doctor, know what the facilities you will have access to will be, know who can be with you to support you and when they can be there.
Be prepared for this to be a long process. If you read the flowcharts posted above you can see it's completely normal for the process to take up to 60 hours before active labour gets going. Sometimes, when your body is pretty much ready anyway, induction works quickly and usual processes take over and babies are born quickly so still be prepared with all the plans you had made for spontaneous labour to help you work through your contractions, hypnobirthing, breathing, movement, using water etc.
But also, be prepared to keep yourself busy and relaxed and not wondering how much longer it's going to be. Take your own favourite and comforting smells with you, your own pillow or blanket or your favourite essential oils or your mum's jumper that smells like her for example. Take an eye mask and headphones or earplugs and sleep if you can. Take a good book or download some funny TV or a funny podcast to take with you. Go for a walk, go relax in the cafe, go meditate or pray in the chapel or prayer rooms, do some gentle movement from your birthing class or pregnancy yoga, phone a friend, facetime your family, bounce on a birth pool, slow dance with your partner, snog a little bit (or a lot if you like), get your partner to give you a head massage or a foot rub, basically anything that makes you feel relaxed and happy.

Check out our blog post on how to help your body labour, the things that help with spontanious labour will also help with induced labour.

Information is your tool to use as it helps you.

As with everything we post we hope you find the information useful and that it helps you to think through your own personal decisions. But we're very clear that we're not offering advice. Our only advice is to talk to your midwife or doctor and make sure you get all the answers you need to make your own informed decision.

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