Safety and interventions

Inductions and interventions in labour

6 min read

Find out what to expect from medical interventions which can help you to give birth safely, such as inductions, forceps and ventouse delivery.

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Labour doesn’t always go smoothly, and extra help may be recommended so that you can give birth to your baby safely. You might hear this help referred to as ‘interventions’. Below we describe the different types of interventions in labour and why they might be needed.

Bringing on labour – being induced

If labour needs to be given a nudge it can be started off artificially. This is called an induction of labour. In 2015-16 about 28% of all women giving birth in England had their labour induced according to NHS maternity statistics.

Why might I need to be induced?

Labour can be induced for many reasons, but the most common are:

  • Your baby is overdue
  • Your waters have broken but contractions have not started
  • It would be safer for either you or your baby if your baby was born early, for example if you have pre-eclampsia.

How will I be induced?

Labour can be induced using a pessary which is a small almond-shaped tablet which is inserted in your vagina to slowly release a substance that should soften your cervix and encourage contractions.

In some cases, where things need to be moved on more quickly, your waters can be artificially broken, or you can be given an artificial hormone through a drip in your arm to get your contractions started.

Are there any problems caused by being induced?

If your labour is induced, often the contractions are stronger and 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 wanted. Inductions are usually planned in advance of labour, so you will have the opportunity to discuss the pros and cons with your midwife or doctor.

You can compare the induction rates of your local units using our helpful Birth Choice tool.

How long does induction of labour take?

The time it takes for labour to begin after induction will depend on the methods used and how your body responds to them. It can take hours or days 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 than if this was your first baby.

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 so you don’t have to go through an induction.

Membrane sweeps are usually offered once you’re past your due date and 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. If the sweep isn’t successful, you can have another one a few days later, if you want to and your midwife agrees.

Assisted birth – forceps and ventouse

Forceps and ventouse are two instruments that can be used to help you in delivering your baby. When these are used, it’s described as an assisted delivery or assisted birth.  In England, about 13% of babies are born by forceps or ventouse.

Forceps are a surgical instrument that comes in two halves and looks like large tongs. Each half is carefully put round your baby’s head while it is in the birth canal, and the two handles fit together. The doctor pulls at the same time as you push with a contraction, to assist you in pushing the baby out.

A ventouse is a silicone cap attached to a suction pump. The cap is fitted on your baby’s head while it is in the birth canal, and is kept in place using suction. The ventouse is then pulled, as for the forceps delivery, to help the baby be born.

Why might I need an assisted birth?

You might need help if you can’t push by yourself, perhaps because you’re very tired or if the baby is in an awkward position. In other cases, the baby’s heart rate might have dropped and so he or she needs to be born quickly. Forceps or ventouse can be used to help you give birth more quickly without the need for a caesarean.

How many women have assisted births?

Are there any problems caused by forceps or ventouse?

Using forceps is more likely to be successful than using a ventouse. However, there’s an increased risk of complications for the woman in labour such as tears to the perineum, which is the area between the vagina and the bottom. A ventouse is gentler on the woman in labour.

There are some risks of injury to the baby with both types of instrument, so the decision about which to use will depend on the individual circumstances of the birth and the clinical judgement of the midwives or doctors involved.

Use our unique Birth Choice tool to compare the intervention rates at your local units side by side.

Monitoring during birth

Babies’ heart rates are monitored closely throughout labour. A baby’s heart rate can be ‘monitored intermittently’, where it is checked from time to time, but in some cases you can be monitored throughout your labour and this is described as ‘continuous monitoring’.

Why is my baby’s heart rate being monitored?

During labour, the oxygen supply to your baby varies and this is a normal part of labour. Sometimes the baby may not get enough oxygen and, if this happens, the baby’s heart rate will change. Being monitored allows action to be taken quickly if any problems are detected.

What will happen when my baby is being monitored?

For a straightforward labour intermittent monitoring is all that is needed and recommended. With this type of monitoring, you’ll usually be free to move around.

If you’re at increased risk of complications during labour, or if your midwife is concerned about your baby’s heart rate you may be offered continuous monitoring. If you’re being continuously monitored, you may be less able to move around and may end up lying on a bed for long periods of time.

You can request continuous monitoring, but this isn’t usually recommended if you’re having a straightforward pregnancy.

Caesarean birth

A caesarean is an operation to allow your baby to be born without going through the birth canal, and instead they’re born through a cut in your abdomen.

Find out more about caesarean births and what to expect when you’re recovering from a c-section.

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References

These are the sources of information used in this article.

Health and Social Care Information Centre, Hospital Maternity Activity 2015-16, NHS

National Collaborating Centre for Women’s and Children’s Health, Intrapartum care: care of healthy women and their babies during childbirth. NICE Clinical Guideline 190, London: NICE

Care Quality Commission, Maternity Services Survey 2017 (2017)

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