Induction of labour

What is the induction of labour?

In most pregnancies, labour starts naturally between 37-42 weeks, leading to the birth of a baby. When doctors and midwives encourage the process of labour to start artificially, it’s called induction of labour. In Australia, about 1 in 3 women have an induced labour.

Why is induction recommended?

The objective of induction is to decrease any risks of complications for both mother and baby. Some of the reasons for labour induction include:

• The pregnancy has gone longer than 41 weeks
• The mother has specific health conditions, such as diabetes, kidney problems, or high blood pressure
• Waters have broken but the contractions of labour have not started naturally
• The baby is not well or is not growing well
• Your baby is making fewer movements or showing changes in its rate
• There is a concern that the placenta is not working as it should
• You are giving birth to more than one baby

When is an induced labour not an option?

Not everyone can have an induced labour. It is not usually an option if you have had a caesarean section or major abdominal surgery before, if you have placenta praevia, or if your baby’s breech or lying sideways.

Are there any risks?

There are risks associated with induction, but there are also risks with continuing your pregnancy when an induction has been recommended. Some risks include that:

• it won’t work – in about 24 percent of cases, women go on to have a caesarean
• your baby won’t get enough oxygen and their heart rate is affected
• you or your baby get an infection
• your uterus tears
• you bleed a lot after the birth

Some women will choose not to be induced, and instead ‘wait and see’ to see if labour will start naturally (read our best tips to bring on labour naturally).

It’s important to speak to your obstetrician about any risks associated with induction specific to your situation and pregnancy.

What happens during induction of labour?

An induced labour experience is usually similar to a natural labour. In other words, pretty unpredictable!  Contractions are similarly painful, all the usual pain-relieving options are available and you’ll be able to push when you reach the final stage of labour.

Aside from medical emergencies, the general consensus is that elective induction should not be done prior to 39 weeks gestation for reasons of fetal maturation.

Before induction, your obstetrician will perform a pelvic examination to find out whether the cervix has dilated and by how much. This helps determine which induction method, or combination of methods is most suitable.

All induction methods aim to stimulate the onset of labour and contractions of the uterus.

How long will it take?

Like natural labour, you can’t predict the time of onset of labour or the length of time it will take. Induction isn’t a quick process; it may take more than 24 hours before you meet your baby. Once the induction has started, you can walk around but you can’t leave the hospital. Your cervix will be assessed regularly to check its progress.

Will it be more painful than natural labour?

For some women, an induced labour is more painful than a natural labour, but not for all. In an induced labour, contractions can start more quickly and stronger than a natural labour in which the contractions build up slowly. Every labour is different, and epidurals are usually available if needed. It’s not recommended that  you stop the induction process once started.

Will an induction always work?

Not always, so if you don’t go into labour and all safe options have been tried, you may need a caesarean.

What are the induction methods?

The method of induction you will need depends on how ready your cervix is for labour to begin. The different ways of inducing labour are:

Stripping of membranes or ‘stretch and sweep’ – your obstetrician uses a gloved and lubricated finger to gently separate the amniotic membrane from the cervix. This increases the body’s own prostaglandin levels and may help to dilate and soften the cervix. You don’t need to be admitted to hospital for this procedure and is often done in the doctor’s room. This can be enough to get labour started, so you may not need any other methods. Read more here.

However, if your cervix isn’t ready for labour, you may need ‘priming’, which can be done by either using a balloon catheter or prostaglandin. These priming methods help to prepare your cervix for labour, but don’t usually bring it on.

Prostaglandin – this is a natural hormone that softens the cervix. Your obstetrician or midwife will perform a vaginal examination and place the prostaglandin around the cervix. It may be inserted as a gel or pessary in the evening to dilate the cervix overnight. Sometimes two or three doses over 24 hours are required.

Balloon catheter – the doctor inserts a thin catheter into the cervix. Once in place, the little balloon at the end is inflated with water. The constant pressure exerted against the cervix may help it to dilate and soften.

Priming can take 6 to 48 hours. Once your cervix is open, you may need:

Artificial rupture of membranes – commonly known as breaking your waters, your obstetrician uses a slender instrument or a small hook on a gloved finger to break the amniotic membrane. This will not hurt but it may cause some discomfort during the process. It is rare for labour to start at this point, so it is best to use oxytocin soon after.

Oxytocin – during natural labour, the hormone oxytocin is secreted naturally from the pituitary gland in the brain. Oxytocin causes normal uterine contractions. In hospital, synthetic oxytocin can be administered through an intravenous drip inserted into the woman’s hand or arm. The dose is slowly increased until the uterus contracts efficiently. The length of time this takes differs for each woman.