What is induction?

In this article, I’m going to run through reasons you may be offered an induction (note the word offered) and what to expect should you choose to accept or decline. Always remember that you are the birth boss, this is your body, your baby and therefore your choice. Under UK law, no one can do anything to you without your informed consent. If you take anything at all from this article, take that. There are always options and alternatives. You always have the right to ask questions and explore these before committing to an intervention.

What is an induction?

Induction of labour protocols vary between hospital units around the country and the globe, but generally it entails using specific drugs to artificially start labour. This process can be successful fairly quickly, take several days; or not be successful and lead to the need for a caesarean section. Many things affect this, such as your gestation, how ready your body is to labour and whether you have had a baby before or not. Sometimes, regardless of our attempts, your body and your baby just aren’t ready.

The reasons you may be offered an induction

Starting with the most common:

• To avoid going more than 42 weeks’ gestation. Dr Sarah Wickham has a book on this called ‘In Your Own Time’ – it’s a fascinating read with an explanation on how due dates are calculated.
• If your waters have broken (membranes ruptured) but labour hasn’t started – usually within 24 hours, but this varies around the UK.
• Concerns over maternal wellbeing, usually due to pregnancy-related conditions such as pre-eclampsia.
• Concerns over fetal wellbeing – such as reduced fetal movement or growth.

Note: Most women go into labour between weeks 37 and 41 and usually within a week or two (either side) of their ‘due date’, and the vast majority of babies are born by 41+5 weeks. Only 5% of women give birth on their ‘due day’. I always recommend mums look at a due period for that reason, rather than get fixated on a specific date. There’s a 95% chance your baby will not be born on the due date you have been given.

Sweeps

You may be offered a ‘membrane sweep’ before a pharmaceutical induction. It’s important to remember that although no drugs are used, a sweep is still a form of intervention. There’s nothing wrong with that if that is what you want, but understanding the risks and benefits before consenting are key.

A sweep involves your midwife placing a finger into the cervix and making a circular ‘sweeping motion’ to separate the membranes surrounding your baby. There may be some discomfort or a small amount of bleeding. Some research suggests there’s a slight increased chance of you going into labour.

NICE updated their guidelines (2021) on offering sweeps at 39 weeks. For most women at 39 weeks’ gestation, your midwife will not be able to reach your cervix, let alone sweep it. This may cause unnecessary discomfort and leave you feeling disheartened, as though your body is not doing what it’s supposed to. At 39 weeks your body is doing exactly what it should be if your cervix is posterior and closed. This is a very normal finding. You do not have to consent to have a ‘membrane sweep’, it is your decision.

Booking your induction

Once you have consented to an induction, you will be offered a date and will be fully counselled on the process, including drugs used and time frames.

Induction methods

Localised drugs are usually used to begin with, such as a pessary or gel inserted into the vagina aimed at reaching your cervix. The aim is to soften your cervix, but for some women this is all they need and start contracting fairly quickly. For others this may not have any effect and they may need further doses or extended periods of time with the pessary in place.

Outpatient Induction of Labour: If you have had low risk pregnancy. You will possibly be able to go home with the localised drugs in place (at your cervix). Discuss this option with your birth team.

Inpatient Induction of Labour: You may be recommended to stay in hospital for the induction process – this could be due to the need for further monitoring or risk factors. Or perhaps the recommendation to break your waters first.

Using hypnobirthing techniques can be very beneficial, aiding feelings of calmness and in turn, supporting your body to labour by releasing your own oxytocin.

Pain relief options

• You will be offered the same support as you would if your labour had not been induced.
• TENS machine may be available to hire if you don’t have your own.
• You may be offered to use the baths available. Some women find great relief from water alone.
• Paracetamol
• Oramorph – oral morphine
• Diamorphine or Pethidine (muscular injection)

Oxytocin IV drip

If the induction process needs to continue (because your body has not laboured on the localised drugs mentioned above) then you may be advised to have a drip via a cannula in your arm or hand to deliver synthetic oxytocin and encourage your uterus to contract. This can only be administered on a labour ward and it is recommended you and your baby are monitored closely by a midwife or doctor.

Despite what some say, synthetic oxytocin does not cross the blood brain barrier so it does not have the same effect as natural oxytocin. Some women prefer to request an epidural before they start the hormone drip and others like to see how they go. It’s best to discuss this with your birth team at the time, so you can decide what is right for you.

How long does an induction take?

It’s difficult to predict as everyone is different. Some women labour within 24 hours and other women take a few days (especially if multiple hormone pessaries are needed). Sometimes there are delays in the logistics of the hospital – for example, if there isn’t space in the delivery suite. There needs to be a one-to-one basis of support from a midwife and a room available. This makes it difficult to predict when delays will occur and how long they might take.

You will be monitored and reviewed if you are delayed and you may be given the option to wait at home (based on your clinical assessment at that time). On rare occasions, your induction of labour process and service may be paused, which would be in the interest of safety of both you and your baby.

If you decide that you do not want to have an induction, you have other options, it’s not all or nothing. One option might be to have another scan and subsequent monitoring to check that you and your baby are well. If you have an induction booked and decide not to go ahead, you are advised to call the hospital and inform them of your change of plan so you can create a new plan together.