Induction of Labour
Induction of labour means starting a labour artificially rather than allowing it to naturally start on its own. Most labours start on their own between 37 weeks and 41 weeks and 5 days (term +12). If the labour does not start on its own, your midwife or doctor will talk to you about being induced. Sometimes, because of your health or that of your baby, your doctor may discuss inducing the labour rather than waiting for it to start on its own. Some examples of this include Diabetes, high blood pressure or concerns about the baby’s size or growth on the scan.
Most women will be asked to come into the antenatal ward, Ward 65, for the midwife to start the induction. Some inductions of labour are carried out on the Delivery Unit. Induction of Labour is undertaken in single rooms. You should expect to be an in-patient on Ward 65 for several days before you are ready to be transferred to the Delivery Unit for the next stage of the induction process. During this time it is usually best to keep vaginal examinations to the minimum.
The induction process uses different methods. Your induction may use one or more of these methods, depending on individual circumstances:
Prostaglandin
Prostaglandins are substances that prepare the neck of the womb (cervix) for labour by making it soften, shorten or open. They are given into the vagina as either a gel (Prostin) or a pessary (Propess). The gel takes 6 hours to work, after which you may need at least 1 or 2 more doses. The pessary is given once and is left in place for 24 hours. In some women, the prostaglandin makes the labour start on its own, but for most women, it opens the neck of the womb enough to enable the waters to be broken. For some women, prostaglandin is not necessary as the neck of the womb is open enough to begin with.
Cervical ripening balloon
Your doctor may suggest the use of a cervical ripening balloon rather than the use of prostaglandin to soften and open the cervix enough to break the waters. For example, this might be because you have had a Caesarean section before. This small balloon is gently pushed through the neck of the womb by the doctor and is inserted using a speculum. This is a bit like having a cervical smear taken. The balloon is left in place for 12 hours after which it is removed. The physical pressure on the neck of the womb leads to the natural release of prostaglandins. At this stage, the neck of the womb should be open enough to enable the waters to be broken.
Artificially rupturing the membranes (breaking the waters)
Breaking the waters, or artificial rupture of the membranes, is done when the neck of the womb has opened up slightly. You may hear doctors or midwives refer to this as an ‘ARM’ which is short for Artificial Rupture of the Membranes. During a vaginal examination the waters are broken in front of the baby’s head. This helps to stimulate the contractions to start. This is performed on the Delivery Unit.
Oxytocin Drip (Syntocinon)
After the waters are broken, the midwife will put a drip into your vein containing a drug called oxytocin. This is a synthetic version of the hormone your own body produces to start the contractions. The contractions and your baby’s heart rate will be closely monitored while this is happening.
Delays in the induction process
Due to the unpredictable nature of maternity care, there are occasions when there is a delay in the induction process. If the Delivery Unit is busy with emergencies, or if it is expected that your baby will need a cot on the Newborn Intensive Care Unit, it may be necessary for you to wait on the antenatal ward before being transferred to the Delivery Unit. Under these circumstances, transfers to the Delivery Unit occur in order of clinical priority. We will do our best to keep you informed about any delays, and how long we expect this to take but this can be difficult and unpredictable.
You can read more about the processes of induction here:
http://www.nhs.uk/conditions/pregnancy-and-baby/pages/induction-labour.aspx#close
Instrumental Delivery
About 1 woman in 8 will need to have an instrumental delivery, using either forceps or a ventouse suction cup to help to deliver the baby’s head. The commonest reasons for this are because there are worries about the baby’s heart rate or because it is taking a long time for the baby to be pushed out (more common where an epidural has been used for pain relief).
The aim is to mimic a natural birth with the minimum risk to mum and baby. Sometimes it is safest to conduct these deliveries in the obstetric theatre rather than in a delivery room. Often, the doctor will need to perform an episiotomy in order to deliver the baby’s head if the baby is born using forceps or ventouse. You can read more about instrumental delivery here.
Caesarean Section
Even if you have your heart set on a vaginal delivery, 1 in 3 women end up requiring a Caesarean section. There are a number of reasons your doctor might schedule one: chronic conditions (like heart disease) that make vaginal delivery dangerous, a pregnancy complication (like placental problems or pre-eclampsia), the size of your baby, your weight or age, carrying multiples, or having a baby in breech position. A planned Caesarean section is usually performed 1 week before the due date (39 weeks). This is major abdominal surgery, therefore it is only performed when there is a clinical reason to do so.
If you are scheduled to give birth vaginally, your doctor may also perform an emergency Caesarean section during the birth process if labour doesn’t start or stalls, if your baby is in fetal distress, if you have a prolapsed umbilical cord or if you have uterine rupture.
Just remember: The best birth is always the one that’s the safest — and any delivery that finishes with a healthy baby in your arms is a success.
If you go into labour before your planned Caesarean section date, the doctor will talk to you about having a normal delivery instead. This will depend on the reason for the Caesarean section but for some women, a vaginal delivery can be a safer option for you and your baby.
The baby is delivered through a cut across the lower part of the abdomen, just above the bikini line. In the UK most Caesarean sections are done using either a spinal or epidural anaesthetic. These involve an injection into the back so that you are numb. This is much safer than a general anaesthetic and because you remain awake, your birth partner can stay with you and you can be awake to see your baby. It takes around 5-10 minutes to deliver the baby, and the whole operation takes around 45-60 minutes. The Caesarean section will be arranged by a doctor in the antenatal clinic who will explain the possible complications and ask you to sign a consent form.
Click here to find out more about what happens.
After the Caesarean section, you will feel uncomfortable as the cut in your tummy will be sore. You should take regular pain relief to keep on top of the pain. You will have a catheter, which is a tube into the bladder to drain the urine, for up to 24 hours, although in most women, we aim to take this out around 6 hours after the operation. You will also need to take an injection every day, called Heparin (either Fragmin or Tinzaparin), to thin the blood and prevent blood clots for at least 7 days. You will need to learn to give yourself this injection.
You should aim to be mobile as soon as possible after your Caesarean section as this is important in reducing the risk of blood clots and improving your recovery. Most women undergoing Caesarean section will be looked after as part of our enhanced recovery pathway. Enhanced recovery is a package of care that has been shown to improve recovery after major surgery, as it reduces some of the risks of infections and blood clots.