The induction of labour: what happens when you're induced

If you've reached your due date or gone overdue without so much as a niggle or a twinge, you may need to have an induced labour – one that's started artificially to get things moving. Find out what it involves and why you might need one.

Nearing your due date, or even gone past it without so much as an acne, pang or a spasm ? Then it's worth making sure you know about the ins and outs of being induced.

Although labour normally happens naturally before you reach 42 weeks of gestation, some women may need a helping hand to get things started. This is often more the case if you're giving birth to your first child. That's where an induction of labour can help.

Usually performed when you're late term, at about 41 weeks pregnant, this artificial process is designed to get your baby out safely when things aren't happening naturally.

Your midwife will probably discuss the management of this with you at your 38-week antenatal appointment, if not before.

Induction is offered to all women who don't go into labour naturally by 42 weeks, as there's a higher risk of stillbirth or problems for the baby if you do go over 42 weeks pregnant.

The NHS offers a handy guide to the induction of labour compared with staying pregnant here.

Unfortunately, induced labours do get a bad press, with the reputation that they're painful, longer and can require intervention.

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However, thousands of expectant women are induced safely every year.

According to the NHS:

'[Being induced] is fairly common. Every year, 1 in 5 labours are induced in the UK.'

It also doesn't affect your chances of having a natural birth, according to NHS research (see below).

Of course, it'll always be your choice whether to have one or not so before you decide, here's what you need to know about being induced.

• Why is labour induced?
• How labour is induced
• Does being induced hurt?
• How long does it take?
• Are there any side-effects?
• Is there anything I can do to start labour naturally?
• The pros of being induced
• The cons of being induced
• Can I request an induction?
• Can I refuse to be induced?

Induced labour is actually pretty common. According to the NHS, 1 in every 5 births in the UK are induced.

Aside from the obvious reason – to help get your baby out – there are a number of different reasons for being induced. According to the NHS, you might need to be induced if:

• you're overdue (past 42 weeks pregnant)
• your waters have broken (but labour hasn't started naturally)
• you or your baby have a health problem (such as diabetes, intrahepatic cholestasis of pregnancy (ICP) or pre-eclampsia).

You won't always be induced in these instances – it's possible that with close monitoring you'll be able to await things starting naturally, if your pregnancy is considered low-risk.

However, due to the health risks and complications associated with being pregnant past 42 weeks, it'll probably be recommended to you.

Sadly, if you go over 42 weeks pregnant, the risk of stillbirth is slightly increased (though it remains low). You also have a slightly higher risk of heavy blood loss after the birth. That's why most healthcare professionals recommend routine induction for women who go overdue.

Induction of labour is usually planned in advance, so you'll have plenty of chances to talk over any queries or concerns with your midwife.

Induction of labour is usually not recommended if:

• your baby is breech
• your baby has severe fetal growth restriction
• you're having a big baby (macrosomia), unless there are also other reasons for induction

If you've had a C-section before and are going for a VBAC, you may still be able to have a prostaglandin induction (see below for more info on different types of induction), but it will depend on your circumstances. Your midwife or doctor should discuss the risks and benefits with you to help you decide.

There are usually three parts to an induced labour:

1. having a sweep
2. having a gel pessary inserted
3. having a hormone drip

If step one doesn't work, you'll move onto step two, and so on.

Here's more about each of these key stages:

Stage one: the sweep

Before you're induced, you'll probably be advised to have a membrane sweep. Also known as a 'membrane sweep', 'stretch and sweep' or simply a 'sweep', this uncomfortable and slightly unpleasant procedure aims to get things moving before you'll need to be induced.

For that reason it's worth a go.

Your midwife or obstetrician will insert a gloved finger into your vagina, using a sweeping action around your cervix. This is to try to release the hormones needed to get labour started.

Read a step-by-step account of having a sweep.

If nothing happens after 24-48 hours then you can ask for another sweep, or to go ahead and be induced.

Stage two: the pessary

Once you've given the go ahead, here's roughly what'll happen.

You'll be admitted to the antenatal ward where you'll be examined and the baby's heartbeat will be monitored.

Then you'll have a tablet, pessary or gel containing hormones called prostaglandins inserted into your vagina to soften your cervix. This can take between 6-24 hours to work, and you may be sent home until contractions start.

Stage three: the drip

If the pessary isn't doing anything, or to help speed things up, you'll be hooked up to a hormone drip on the labour ward (a needle in your arm). This contains syntocinon, an artificial form of the hormone oxytocin, which kickstarts labour.

Before this stage your midwife or doctor will probably recommend that you have an epidural. That's because the drip can produce particularly strong contractions that can come on quickly. Having the epidural in place will mean you'll be ready to control the pain once it starts. You can still opt for other forms of pain relief though.

Your contractions will be closely monitored until it's time to push that baby out.

Can I eat if I'm having an induced labour?

If you're having a membrane sweep or induction using prostaglandins (tablet, pessary or gel), it's fine to eat and drink as normal. In fact, it's a good idea to have plenty of snacks on hand, to give you slow-release energy to get through your labour. Sandwiches, nuts, fruit and crackers are all good options.

If you're having a syntocinon drip, you'll usually be advised to stop eating after it's been put in. You should still be able to drink water though, and perhaps an isotonic drink to keep your energy levels up.

It depends which type or stage of induction you're talking about:

• A membrane sweep shouldn't hurt, though it can be uncomfortable and unpleasant. Staying as relaxed as you can may help, so it's a perfect chance to practice those breathing exercises!
• Having a pessary, tablet or gel inserted can also be uncomfortable, and for some women it also causes vaginal pain, backache or diarrhoea. Walking around may help to ease any pain, or you could try a warm bath, TENS machine or paracetamol (don't take ibuprofen or aspirin though; they're not safe for your baby).
• Having a syntocinon drip involves a needle in your hand or arm, which can be a little painful. The contractions are also often much stronger than contractions which start naturally, and they come on more quickly. That's why women being induced via a drip are often advised to have an epidural set up first. You'll also need extra monitoring to check that your baby is coping with the strong contractions.

Whichever type of induction you choose, you should still be able to have any of the regular pain relief methods for labour. Learn more about your pain relief options.

As ever when it comes to questions about how long labour lasts, the answer is unfortunately: it depends!

If a membrane sweep is successful, you'll usually go into labour within 48 hours. If it doesn't work, you may be offered more sweeps over the coming days. According to the NHS, 60%-70% of low-risk women who have a membrane sweep go into labour before they're 42 weeks pregnant.

If you have a tablet or gel inserted, contractions usually start within about six hours. If not, you may be offered another tablet or gel.

If you have pessary inserted, that can take 24 hours to work. If not, you may be offered another dose.

Similarly, a hormone drip can take 24-48 hours to get labour going.

While that gives you some idea of when your labour might start, it doesn't say much about when the actual delivery and birth will happen.

On average, for all women (no matter how their labour started):

• The first stage of labour (where the cervix is dilating and contractions are getting progressively stronger) lasts about 8-18 hours for first-time mums and 5-12 hours for women who've had a baby before.
• The pushing stage lasts about 3 hours for first-time mums and 2 hours for women who've had a baby before.

When labour is induced using medication, it can lead to stronger and faster contractions. So once labour has started, it may progress more quickly than labour that started naturally. But it still depends on a number of factors, including whether you've given birth before, and how ready your cervix is for giving birth.

If you have an induced labour, you have a higher chance of needing labour interventions compared to women whose labour starts naturally.

When labour is induced using medication:

• less than two-thirds of women give birth without further intervention
• about 15% have instrumental (assisted) births, such as forceps or ventouse
• 22% had emergency caesarean sections

This compares to an average rate of about 12.5% for instrumental births and about 15% for emergency C-section.

That means that, if you're induced, you're still more likely than not to give birth without any need for forceps, ventouse or C-section. But your risk is higher than average.

Aside from that, the main side-effect is that your contractions may be stronger and more painful. You may also develop diarrhoea. Some women taking prostaglandins have prolonged contractions that can affect the baby's heartbeat, so you'll need extra monitoring during labour to make sure your baby is safe.

Fortunately, serious side-effects from induction medication are very rare.

Although you may have heard that there are things you can try doing to start labour naturally, here's what the NHS has to say:

'There are no proven ways of starting your labour yourself at home.

'You may have heard that certain things can trigger labour, such as herbal supplements, eating spicy food and having sex, but there's no evidence that these work.

'Other methods that aren't supported by scientific evidence include acupuncture, homeopathy, hot baths, castor oil, and enemas.'

Commonly recommended by mums to other mums is having sex, which does have some science behind it. The NHS advises that:

'Having sex won't cause harm, but you should avoid having sex if your waters have broken as there's an increased risk of infection.'

Read the truth about 'natural' ways of starting labour here.

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Here are some of the advantages of being induced:

• The main advantage is that it gets your baby out safely. Sadly, the longer you go overdue after 42 weeks, the higher your risk of having a stillbirth or health problems for your baby.
• If you have a medical condition such as pre-eclampsia, the only way to cure it is to give birth to your baby, so induction can help to protect you from further medical problems.
• It also can relieve your anxiety – if you're uncomfortable and anxious about when the baby will arrive, being induced can play an important role in starting labour so you can meet your baby, at last!

Being induced does come with some negative aspects depending on how you look at it. Here are some of the downsides:

• It can be a long process – it can be 48 hours before you start labour, by which point you may not have had much sleep and will have been poked and prodded a fair bit already.
• It can be more painful – as above, artificially starting labour can cause contractions to be more painful than if things start naturally. However, you'll still be able to have the pain relief you choose to counter this.
• It doesn't always work – you may need the process repeating, or to have a C-section if it doesn't.
• Your labour is more likely to be assisted – according to the NHS, 'women who are induced are also more likely to have an assisted delivery, where forceps or ventouse suction are used to help the baby out.'
• You may still need to have a C-section, regardless, if this is what your midwife deems is the best choice for you and your baby.

Not usually. The National Institute for Health and Care Excellence (NICE) says that this is only considered in exceptional circumstances, 'for example, if the woman's partner is soon to be posted abroad with the armed forces'.

If you have a particular reason for wanting an induction, talk it over with your midwife.

Absolutely. Here's what the NHS says about choosing to being induced:

'It's your choice whether to have your labour induced or not.

'Most women go into labour naturally (spontaneously) by the time they're 42 weeks pregnant.

'If your pregnancy lasts longer than 42 weeks and you decide not to have your labour induced, you should be offered increased monitoring to check your baby's wellbeing.' (This is known as 'expectant management'.)

So there are options besides being induced. But, bear in mind that your midwife team just wants your baby out as safely and quickly as possible, which is something this process is designed to do.

NICE guidelines recommend you ask your midwife the following questions regarding any concerns about being induced:

• Why am I being induced?
• What are the benefits?
• What are the risks?
• Can I be induced at home?
• How is an induced labour different to a normal one?
• What pain relief is available?
• What happens if I choose not to be induced?
  
  The Positive Birth Book: A New Approach to Pregnancy, Birth and the Early Weeks by Milli Hill is a must-read for expectant parents. See more details here at Amazon.

In the meantime, why not chat to other mums who've been induced in our chat forum. Or join the chat below in our thread...

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