5th August 2021
Sometimes, extra help may be recommended by your midwife or doctor so you can give birth 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, so you can feel prepared for different scenarios.
Remember, you can always talk to your midwife at one of your if you are feeling worried or have any questions, and it can be a good idea to include some information about your preferences if you are recommended interventions in your .
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.
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.
Labour can be induced for many reasons, but the most common are:
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.
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 it's your first.
Yes, there are specific considerations that it’s good to be aware of when deciding whether to accept an offer of induction.
Yes, it’s your choice whether to have an induction or not. If you decide that you don’t want to be induced, your wishes have 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's 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.
There are two main alternatives 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.
When instruments like forceps or ventouse are used during the second stage of a vaginal birth, it’s known as an assisted delivery. One in eight babies in England are born with the help of forceps or ventouse.
Having an assisted birth is no-one’s first choice, but being aware of why and how assisted births happen can help you feel more prepared and able to make informed decisions when you go into labour.
Forceps are a surgical instrument that looks like large tongs. They come in two halves; each half is carefully placed around your baby’s head while it is in the birth canal, and the two handles fit together.
The doctor pulls the forceps at the same time as you push to help deliver your baby.
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 it’s kept in place using suction.
The ventouse is then pulled by a doctor or midwife during contractions to help the baby be born, while you’re pushing at the same time.
Source: 2017 Maternity Survey, Care Quality Commission.
These are some of the reasons why you may be recommended to have an assisted delivery:
Both forceps and the ventouse cap can be used during the second stage of labour. The decision about which to use will depend on the circumstances of your birth and the clinical judgement of the midwives or doctors involved.
Generally speaking, a forceps birth is more likely to be successful in allowing the baby to be born without need for a c-section, but a ventouse is gentler and less likely to lead to a severe tear for the woman in labour.
Like all birth intervention, an assisted birth comes with some potential complications for both you and your baby.
There are some risks of injury to the baby with forceps and ventouse cap, but they’re usually only temporary. You may notice:
With an assisted birth, you’re more likely to experience severe tearing and blood clots, as well as urinary and anal incontinence, compared to if you have a straightforward vaginal birth.
1% of women who have an unassisted birth suffer severe tearing, compared to 8-12% who have a forceps birth.
In other cases, the baby is already so far down the birth canal that it would be very difficult to even have a c-section at that point.
Birth is unpredictable and complications can occur in any situation. However, where and how you plan to give birth can affect your likelihood of needing interventions like forceps or ventouse.
Low risk, first-time mothers planning to give birth in a were almost twice as likely to have a forceps or ventouse delivery compared to those opting to have their baby at home or in a freestanding birth centre.
For women who’d had a baby in the past, the difference was even more pronounced: low-risk women who planned to give birth in the labour ward were more than four times more likely to have an assisted birth compared to those who were planning to have a home birth.
Use our if you’re still weighing up your options for where to have your baby. The tool lets you put in your personal circumstances and preferences to see whether giving birth at home, in a birth centre or in the labour ward might be the best option for you.
Beyond choosing where to have your baby, there are other things you can do to reduce the likelihood of an assisted birth, although not all of them are within your control.
Here are some of the things that have been shown to reduce the likelihood of having an assisted birth:
If you’re giving birth at home or in a birth centre, you’ll be recommended to transfer to the nearest labour ward if your midwife is concerned for you or your baby’s health, or if you request stronger pain relief which can only be given in the hospital.
You may be transferred to hospital if:
It can be comforting to know that most transfers are precautions rather than emergencies.
Once the decision to transfer has been made, your midwife will call an ambulance to take you to the hospital, although in some cases you may be able to go in your own car. If you’re in an alongside , you can go to the labour ward in a wheelchair.
You won’t have to travel in the ambulance on your own – your midwife and birth partner will come with you. Once you’ve arrived at the hospital, your midwife may be able to stay with you, or your care will be handed over to a midwife who works on the labour ward and is more experienced in hospital births.
If you or your baby need more help after the birth, you’ll travel together to the hospital by ambulance. If you need to be admitted to the for overnight care, your baby will stay with you the whole time.
In this video, a consultant midwife explains what being transferred means in practice:
Regardless of where you plan to give birth, you’re more likely to need to be transferred to the labour ward if you’re having your first baby, compared to women who have given birth before.
You have a good chance of not needing to be transferred from your planned place of birth if you’re at low risk of complications and have had a baby before.
Just one in ten mothers who have had at least one baby previously have to be moved from a birth centre or their home during labour or shortly after the birth, according to The Birthplace Study.
The same study found that you have a fairly high chance of having to go the hospital at some point during the birth if you’re pregnant with your first baby.
A caesarean section 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.
As it stands, if you have suspected or confirmed coronavirus infection, there is currently no evidence to suggest you can't give birth vaginally or that you must have a caesarean.
However, one thing that has changed during the pandemic is whether you can have your birth partner with you if you need to be induced.
If you're in a single room (e.g. on a maternity suite) they should be able to stay with you, providing they don't have coronavirus symptoms.
If your induction takes place on a bay on a main ward, however, they might not be able to be with you because it may not be possible to maintain necessary social distancing measures.
Even if they aren't able to be with you during induction, they can still be with you during active labour and birth, unless they are unwell with symptoms of COVID-19 or have had a positive test.