Induction of labour

Introduction

What is induction of labour?

Benefits and potential risks of induction of labour

When might I be offered induction of labour?

Can I choose not to be induced? 

Introduction

What is induction of labour?

Labour is a complex interaction of chemicals and hormones between the mother and baby. There is very little evidence to pinpoint exactly what happens to start labour, but we do know that several things need to happen for labour to take place. In order for a baby to be born the cervix (the neck or opening to the womb) has to shorten, soften and open.  Your womb has a powerful muscular wall that tightens and then relaxes, known as ‘contractions’ which gradually open your cervix. In most pregnancies this starts naturally between 37 – 42 weeks and is called ‘spontaneous labour’.  Induction of labour is a process used to encourage labour to start artificially. There are several chemical and mechanical methods we can offer you to initiate labour. Your individual circumstances, and that of your body, will determine the best course of action offered to you.

Benefits and potential risks of induction of labour

The main benefit of induction of labour is the reduction of known issues/risks that continuing the pregnancy further can incur. These may be medical or non-medical in nature. It may also be the reduction of the risk of potential issues occurring, before they start or worsen. We aim to ensure that all the reasons induction of labour is offered are evidence based.

There are a number of risks known to be linked to induction of labour, these include:

• Increased risk of further intervention – you are more likely to need an epidural, further induction methods or instrumental/assisted delivery of your baby with induction of labour. 
  
• Increased levels of pain – there is some evidence to suggest that induction of labour is slightly more painful than spontaneous labour, but this is disputed
  
• Labour lasts longer when induced – there is evidence to suggest that for some women the length of labour is longer with induction of labour, but this is impossible to predict. 
  
• There is an increased chance of distress to mum, baby or both. Due to the nature of induction of labour and the increased intervention and monitoring required, there is an increased chance that mum, baby or both may find the process distressing, which in itself leads to further interventions.
  
• It may fail. There is a small chance that the induction process may not work at all. In this case there are two options that will be discussed with you, but these will be dependent on the wellbeing of mum and baby, and the reason induction was offered in the first place. You may be offered a short rest and then to commence the process again, or you may be offered a caesarean section. These options will be discussed with you in the rare event that induction of labour does not work for you.

When might I be offered induction of labour?

There are three main reasons why induction of labour (IOL) is offered:

Prolonged pregnancy – pregnancy that continues after 41 weeks.  After 41 weeks there is some evidence to suggest that for some babies the placenta, the organ which has been nurturing your baby inside the womb, may start to deteriorate, causing a slight increase in the potential for your baby to develop problems. There are no tests currently available to accurately determine which babies are affected by this potential problem. Induction of labour is therefore recommended between 41 and 42 weeks.  At University Hospital of Leicester NHS Trust we offer IOL at 12 days over your expected date of delivery (due date), which has been determined by your initial dating scan.

Pre-labour rupture of membranes – (the waters around the baby breaking). There is evidence to suggest that the majority of women will go into spontaneous labour within 24-48 hours, however this also comes with an increased risk of infection transferring to the baby. To reduce this potential risk, it is suggested that induction (or augmentation) of labour is commenced as near to 24 hours as possible. If this is not imminent, then extra monitoring of the health and wellbeing of mum/baby is suggested.

Medical reasons – There are a number of medical conditions, either pregnancy related or conditions that are there prior to pregnancy, that can increase the potential for wellbeing issues of either mum or baby. If these conditions are worsening, then it may be felt that ending the pregnancy using induction of labour is the best course of action. Your specialist midwife or doctor can explain this further.

Can I choose not to be induced?

Induction of labour is a significant intervention, so it is important that we have your fully informed consent. After considering all the facts around IOL, if you decide you do not want to be induced, you should tell your midwife. Your decision will be respected. You will be offered an appointment to attend hospital to check that you and your baby are well, and you will have the opportunity to discuss with a midwife or doctor your decision not to be induced. An alternative management plan is important at this point, to ensure you are making the right decision for you and your baby and we can support you properly to ensure the best outcome for your pregnancy based on your decisions.

How often you come to the hospital for checks depends on your situation.  The midwife or doctor will discuss this with you.

> Find out more on Methods of Induction of Labour

> Find out more on Induction of labour – the process

More information (Maternity Leaflets / Information):

Induction of Labour

Foley Ballon Catheter Induction of Labour