Understanding why an induction by pessary, gel or hormone drip might be advised, plus the alternatives to having your labour started artificially, can help you make informed decisions about your care.
What is induction of labour?
An induction is when your labour is started artificially through the use of a pessary, gel, hormone drip or breaking of your waters.
A quarter of all pregnant women are induced in England, and the numbers are increasing year by year, according to NHS maternity statistics.
Inductions are started in the hospital, and if you’ve been induced you’re likely to be admitted as a patient until you give birth, on the labour ward.
This is so health professionals can make sure both you and your baby are doing OK throughout the process and have access to extra medical help, should you need it.
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Why might I be offered an induction?
Labour can be induced for many reasons, but the most common are:
- You’re more than 41 weeks pregnant. Your baby is at a slightly higher risk of stillbirth or other problems if you are pregnant for more than 42 weeks, so as a precaution the recommendation is to induce labour at 41 weeks.
- Your waters have broken but contractions have not started. You’re at higher risk of infection the longer your waters are broken without your baby being born, so the official advice is to offer an induction 24 hours after your waters break if you’re full-term.
- Giving birth is safer than letting the pregnancy continue. This can be due to a number of reasons, for either you or your baby’s safety. For example, it’s common to be offered an induction if you have been diagnosed with pre-eclampsia or gestational diabetes, or if your baby seems to have stopped growing.
“I had a planned induction at 38 weeks as I was very anxious. I had an amazing midwife and an epidural which made labour very comfortable and a lot more relaxing, and my beautiful girl was born after only five hours.”
How long will the induction take?
The time it takes for labour to begin after induction will depend on how ready your body is to go into labour, the methods used and how your body responds to them. It can take hours or up to a week depending on your situation.
If this isn’t your first baby and you have gone into labour naturally before, your body will generally react faster after being induced than if this is your first baby.
Before the induction, your health professional will do a vaginal examination to check how ready your body is to give birth by feeling your cervix. They’ll give what is known as your bishop’s score which will determine which method of induction you’ll be recommended.
If your cervix has already started to efface and dilate, the induction is likely to go faster than if your body hasn’t started this process.
“The days-long induction process was really frustrating and tiring. Every time I had a check-up I thought: ‘Right, it has to be working now’ and yet every time they examined me I hadn’t dilated.” Read Sheila’s birth story
Methods of induction
There are several different ways to start labour, and which one you’ll be recommended depends on your pregnancy, health and any previous births you’ve been through.
It’s not unusual to start with one method of induction and move on to another method later if the first doesn’t bring on labour on its own.
A soft silicone tube with a balloon near the tip is inserted into your cervix. The balloon is filled with a sterile salt water fluid.
Over 24 hours, the balloon gently puts pressure on your cervix to soften and open enough to start labour, or for your midwife or doctor to be able to break your waters.
Pessary or gel
A small almond-shaped tablet or gel is inserted into your vagina to slowly release a substance that should soften your cervix and encourage contractions.
You may be offered to have the pessary inserted as an outpatient, and come back to the hospital once you’re in labour, or you may be asked to stay on the antenatal ward till labour starts.
Breaking your waters
Your waters may be broken by your midwife inserting a hook through your cervix to pierce the membrane sack to get contractions started. This is also known as ‘artificial rupture of membranes’.
Your waters can only be broken if your cervix has already started to efface and dilate.
A cannula is inserted into your hand which gives you an artificial oxytocin drip to get your contractions started.
You’ll need to be monitored continuously while receiving the drip to make sure your baby’s coping with the contractions.
Are there any problems caused by being induced?
Yes, there are specific considerations that it’s good to be aware of when deciding whether to accept an offer of induction.
Higher chance of emergency c-section
Women who are induced are twice as likely to have an emergency caesarean section as women whose labour starts spontaneously.
NHS maternity statistics show that 18-22% of women in England who are induced end up needing an emergency c-section (the numbers vary slightly depending on the method of induction), while 10% of women who go into labour naturally have an emergency c-section.
You can have a look at the induction rates of your local units by using our Birth Choice tool.
“I was induced at 12 days overdue, but after several days I’d only reached 6cm dilation and was whisked down the corridor for an emergency c-section. My healthy baby boy was born just fine and I made a speedy recovery.”
Labour may be more painful
If your labour is induced, the contractions experienced are often different, stronger and possibly more painful than contractions that start naturally.
This may lead to you needing pain relief such as an epidural, which may not have been something you originally planned for.
“Half an hour after the pessary was inserted, the contractions had gone from zero to ten. That pain was worse than when I was pushing later on because it intensified so quickly.” Read Laura’s birth story
Can I say no to being induced?
Yes, it’s your choice whether to have an induction or not. If you decide that you don’t want to be induced, your wish has to be respected.
You should always have the opportunity to discuss things with your health professionals before making a decision, including the reasons why an induction is being recommended and what is in the best interest of you and your baby.
It’s a good idea to ask your midwife or consultant for the specific risks and benefits of an induction in your situation. Every pregnancy and birth is unique, so it’s important that you’re able to make a decision that’s right for you.
For example, if you’re told your baby’s at higher risk of stillbirth if you’re not induced as you’re over the age of 40, ask for specific numbers of how much the risk is increased by not being induced – then compare that to the statistical risks of induction.
“At a routine antenatal appointment I broke down in tears over my scheduled induction. A really nice midwife talked to me and made me feel a lot more reassured. That was more valuable than all the literature we’d been given by the consultant.” Read Victoria’s birth story
What are the alternatives to induction?
There are two main options to having an induction:
If you’ve been recommended to be induced because you’re more than 42 weeks pregnant (overdue), you should be offered increased monitoring as an alternative if you don’t want to be induced.
The charity AIMS has a useful list of facts to consider when deciding whether or not to have an induction or membrane sweep.
What is augmentation of labour?
If you’re in labour but the progress is slow, or stops altogether, you may be advised to have your labour sped up (augmented) through a hormone drip.
If you’re at home or in a birth centre, you’ll need to be transferred to the labour ward to receive a hormone drip to stimulate labour.
What is a membrane sweep?
A membrane sweep, or ‘stretch and sweep’, is when your midwife inserts a finger into the opening of your cervix and moves their finger around in the hope of stimulating labour.
Membrane sweeps are usually offered once you’re past your due date. They can be carried out during a normal antenatal appointment in your own home or antenatal clinic – there’s no need to go to the hospital to have this done.
The sweep increases the chances of you going into labour within 48 hours, but it’s not a guarantee. You can choose not to have stretch-and-sweeps, and instead wait for labour to start naturally.
More from Which?
- Top ten birth statistics: statistics can help you understand what might happen during labour – we cover the key information to look out for.
- Monitoring during labour: Monitoring helps midwives and doctors know how your baby is coping with the contractions.
- Your rights during pregnancy and birth: Understand your legal rights to receive the maternity care and choose the birth that you want.
These are the sources of information used in this article:
Health and Social Care Information Centre, Hospital Maternity Activity 2015-16