What is an induction?
If doctors or midwives are concerned about the health of either you or your unborn baby, they may intervene to trigger labour artificially. This is called ‘inducing a birth’, and it may be advised for several reasons including:
- If your baby is at 42 weeks gestation, overdue and at increased risk of stillbirth
- If you have been diagnosed with pre-eclampsia
- If your waters broke more than 24 hours ago but your labour hasn’t begun naturally and there is a risk of infection to you and your baby
- If you have gestational diabetes, your baby is big and at 38 weeks gestation.
Labour can be helped along or induced in several ways. For example, your midwife could give you an internal sweep, insert a prostaglandin gel pessary or you could have intravenous Syntocinon added to your bloodstream via a canula.
What is a sweep?
A sweep is usually the first attempt at inducing labour and it’s often recommended if you are 41 weeks pregnant and overdue. During a sweep, the midwife inserts her fingers into your vagina and if your cervix is already slightly dilated, she uses her finger to gently separate the membranes of the amniotic sac from your cervix. However, if you are not at all dilated, she may gently massage and open the cervix instead. Women sometimes have to have around three sweeps before labour is induced.
Induction by use of prostaglandins
Your midwife can insert a prostaglandin gel into the vagina to hormonally stimulate the cervix to soften and open. You will be asked to lie down for a while immediately afterwards so that the gel can work on the cervix before going home. It can take around six hours for labour to begin.
Induction by rupturing the membranes
If gels and sweeps haven’t worked, your midwife may suggest that she artificially rupture the membranes (ARM) of the amniotic sac. This is also called ‘breaking your waters’ and involves inserting a plastic pointed ‘needle’ into the vagina, through the cervix and then breaking through the membranes. It works better if your cervix is already dilating.
It can be an uncomfortable procedure so for this reason you may be offered gas and air to help you manage the pain. There is a danger of infection once the membranes have been ruptured so it’s usually only recommended when you’re already in early labour.
Induction using IV Syntocinon
This is an artificial form of oxytocin, a hormone naturally produced by the pituitary gland, and which triggers the uterus to contract in a rhythmic way. It is generally used after other forms of induction haven’t worked and your baby will need to be continually monitored to assess if the induction is stressing the baby.
The Department of Health have reported that around one fifth of births in the UK are induced. Some of these births were started with Syntocinon. Of these inductions:
- 63% were able to deliver vaginally without an assisted delivery
- 15% had an assisted delivery (eg forceps or ventouse cup)
- 22% needed emergency Caesarean sections
Syntocinon is not recommended for women who have previously had a Caesarean section as it can increase the chances of a rupture of the uterus along the scar.
What are the risks and downsides of induction?
Common side-effects of Syntocinon for the mother include headache, nausea and vomiting and changes in heart rate. The drug also can make contractions more painful because it can produce stronger, less rhythmic, more frequent and more painful contractions than if your labour was proceeding naturally.
As you need constant monitoring and are attached to a Syntocinon drip, you are less mobile, which can make it harder to get into active birthing positions to help you cope with the contractions and encourage labour along.
For these reasons, women are more likely to ask for an epidural when being induced because of the increased intensity and frequency of pain during contractions.
Induced births are statistically more likely to end up needing assisted delivery, for example a forceps or ventouse delivery. But it’s hard to know if this is due to the induction itself or because those labours that require induction are themselves more likely to need assistance at both the start of labour and when it comes to a safe birth.
What is a Bishop’s Score?
This is a way of rating the readiness of your body to respond to induction. The score looks at things like the position of your baby’s head, position and ripeness of your cervix etc.
If your score is less than six out of 10, your cervix is considered ‘unripe’ and at this point, 15% of inductions will not progress to labour.
Pain relief in induced birth
As labour that has been induced with IV Syntocinon tends to feel more intense, it’s a good idea to be open-minded about pain relief – especially if you were hoping to rely on alternative methods to ease your contractions, like wallowing in water, pacing or leaning on a Swiss ball.
Make sure you discuss any concerns over with your midwife.