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Induction By Meghan Roe, Mother Fit Expert Midwife

Does induction always work? Sadly for some people the medications will not work to get the body into labour or to get the cervix dilated enough to birth baby vaginally and a caesarean section would be offered.

Michelle Baynham

21 Dec 2023
At what stage of pregnancy/labour will you be induced?

In 2020/21 records show that 34% of labours were induced (compared to 21% in 2010/11). One of the most common rationales for inducing labour in the UK is for women & birthing people who are still pregnant beyond their due date, some calling this 'overdue'. The NICE (National Institute for Health and Care Excellence) recommends induction of labour for straightforward pregnancies after 41 weeks of pregnancy, although ultimately the decision is down to the woman/birthing person/parents. You never 'have' to be induced, it's a choice. 

What's the earliest you will be induced?

We know that outcomes for babies are best when they are born after 39 weeks so induction before this time will only be offered if there is a risk to the woman/birthing person or the baby. People carrying multiple pregnancies (twins/triplets) would be offered induction earlier.

Are there any other scenarios in which you'll be induced?

Induction is most common for 'post-dates' pregnancy, but there are other reasons your medical team may offer induction. One reason is if the birthing person has a medical indication e.g. pre-eclampsia, Gestational Diabetes. Induction is also offered if there are concerns about the growth of the baby/babies. This can be picked up by scans. 
For about 10% of birthing people, their waters may break before labour starts, and NICE recommends offering induction of labour after 24hrs if labour hasn't already begun.

How exactly is labour induced- are there different forms of induction?

There are different methods of induction, and you will find that different hospitals have different guidelines so it's not completely universal. The medications used to induce labour are called prostaglandins, which promote cervical ripening and encourage the onset of labour. They are administered vaginally in the form of a pessary or a gel. You may receive one or both of the pessary/gel during your induction, and sometimes in several doses until you are in labour. Induction of labour is a process, and can take a long time to work. The aim is to kick start your body into labour, so that the contractions can dilate your cervix so you can give birth. Sometimes all you need are the prostaglandins, but sometimes you may need to move onto the next stage of induction if the prostaglandins alone do not help you into active labour. The next stage would be breaking your waters (if not already broken) and starting an artificial oxytocin drip to help the uterus to contract and the cervix to dilate. This stage of induction of labour would be on the Labour Ward under 1:1 care from a midwife and being continuously monitored. 

For people that have birthed before, either vaginally or by caesarean section, the balloon catheter method of induction may be offered. This is a mechanical form of induction of labour where a catheter is inserted inside the cervix and filled with saline solution, putting pressure on the cervix therefore hopefully encouraging the cervix to dilate. This can start labour or it can encourage the cervix to open enough to be able to break the water and start the oxytocin drip.

How long does it take to give birth after being induced?

This is a difficult question to answer as all women/birthing people will experience induction of labour differently. For some, the induction medications will work quickly to get the body to go into labour, but for some others it can take days and multiple attempts with different methods. It's also worth keeping in mind that maternity units can be very busy, and inductions can be delayed or paused if the unit is very busy or under staffed, which can add significant time onto induction experiences.

Are there things which will happen before induction if you're overdue- e.g. a sweep?

Under the NICE guidance, all women and birthing people can be offered a 'membrane sweep' after 39 weeks. A membrane sweep involves your midwife or doctor inserting their finger inside the cervix and making a circular 'sweeping' movement on the inside of the cervix to separate the baby's membrane sack from the cervix. Research shows this MAY reduce the need for formal induction but they do not overall lead to unassisted vaginal births. More research is needed to find out if membrane sweeps are truly beneficial. Make a list of the pros and cons of a membrane sweep to help you make your decision as to whether or not you would like a sweep if offered to you. 

What are the best natural ways to induce labour?

There is not enough research into 'natural' ways to induce labour. In my experience and opinion, it is most important to remain active, positive and calm as much as possible to enable your natural oxytocin hormones to develop. Old wives' tales such as curry/spice, pineapple and castor oil are not advised and will not get you into labour. Having sex may help you to relax and produce oxytocin but again there is no evidence it will work to get you into labour. 

How does being induced affect labour?

It is known that induced labour can be more painful than spontaneous labour, so the need for stronger methods of pain relief is more common. We also know from research that birthing people's experience of induced labour compared to spontaneous labour is very different. It may alter your options of place of birth, meaning you may not be able to give birth at home or on a Midwife-Led Unit, and the option of using a birthing pool may not be available.
An induced labour usually means a longer labour and hospital stay than with spontaneous labour, which can lead to exhaustion.
Induction of labour can lead to other interventions as it makes the labour and birth higher risk, which is why you are likely to be advised to give  birth on a Labour Ward with extra monitoring.
Sometimes the medications given to induce labour cause contractions that are too frequent, which can be painful but also put the baby under stress. This is why close monitoring is offered. This monitoring can restrict your movement so ask your midwife about wireless options if available to enable you to remain active (which is known to help with pain and shorten labour).
Despite the above, it's important to know that a positive induction of labour experience is absolutely possible, and preparation is key with this. The first step is to ensure you have all the information and evidence you need to make an informed decision that is right for you. Then prepare yourself for a longer hospital stay with items that will make you feel more relaxed and comfortable (e.g. home comforts, snacks, relaxing smells, music, TV, ear plugs and a TENS machine). Hypnobirthing tools are very useful for induction of labour to help remain calm, relaxed and getting those natural birthing hormones going to aid the induction process.

Does being induced increase the risk of forceps/c-section?


Evidence shows that induction of labour does increase the risk of an instrumental birth, but not a caesarean section. Although the National Maternity Statistics for England do suggest that induced labour increased the likelihood of instrumental birth and unplanned caesarean section compared to spontaneous labour. 

Does induction always work?

Sadly for some people the medications will not work to get the body into labour or to get the cervix dilated enough to birth baby vaginally and a caesarean section would be offered.

What questions should you ask your midwife/Dr before being induced?

It is so important to find out specifically why you are being offered induction and what the risks and benefits are for you as an individual. Find out how the intervention may benefit you and your baby, what risks it may entail and if there are any alternative options for you. Ask for the research/evidence to help you make your decision.
Other questions to ask are how your induction of labour can be tailored to your needs. Are you able to keep your birth preferences? For example: using a birth pool, wireless monitoring, staying active. Find out if you qualify for an 'Outpatient' induction of labour, where you are able to be at home for the first stage of induction.


Recommended Resources:
Books:
Sara Wickham 'In your Own Time'
Sara Wickham 'Inducing Labour: Making Informed Decisions'
Rachel Reed 'Why Induction Matters'

Websites:

Guidelines:
NICE Guideline: Inducing labour Inducing labour (nice.org.uk)

Podcasts:
The Midwives' Cauldron 
The Obs Pod
Evidence Based Birth