Having your labour induced is fairly common – about one in five babies are born following an induced labour. You’ll usually be offered an induction if you or you baby’s health is at risk, or because your baby is late.

What is induction?

Induction is when your labour is started artificially. This can be done using a membrane sweep or synthetic hormones.

Why might I need to be induced?

You’re most likely to be offered and induction if:

• your waters have broken – you’ll be offered an induction if you are more than 34 weeks pregnant and your waters have broken, but you haven’t gone into labour after 24 hours. This is to avoid the risk of infection.
• your baby needs to be delivered for medical reasons – if you are showing signs of pre-eclampsia, for example, or you have gestational diabetes and your baby is getting quite big.
• your pregnancy goes beyond40 weeks – this is the most common reason for induction. This is because, after 41 weeks, your placenta may not work as well and the risks to your baby increase.

How is it done?

Your midwife or doctor will explain why you are being offered induction, and tell you about the risks and benefits. There are several ways to induce labour:

Membrane sweep

If you are still pregnant at 40 (for first-time mums) or 41 weeks, you will be offered a ‘membrane sweep’. Your midwife or doctor will do an internal exam and sweep their finger around the inside of the cervix to loosen it from the membranes around your baby. This releases hormones called prostaglandins, which may start labour off.

About half of women who have a membrane sweep go into labour within 48 hours. It won’t increase your risk of infection but it may feel uncomfortable and you may notice some slight bleeding afterwards. It can be done in hospital or at your routine antenatal appointment, and you can go home afterwards to wait for labour to begin.

If it doesn’t work the first time, you can request a second or even a third one.

Prostaglandins

If you don’t go into labour following membrane sweeping, you will be offered an induction using prostaglandins. These synthetic hormones help to start labour by encouraging the cervix to soften and shorten, allowing it to open and contractions to begin.

Prostaglandins are given as a tablet, gel or pessary inserted into your vagina. This is done in hospital, but you may be able to go home and wait for contractions to start. Most women will go into labour, although more than one dose may be needed. When contractions start, your baby will be monitored using an electronic fetal monitor. If your baby is fine, the monitor can be removed and your midwife will use a small hand-held monitor for the rest of your labour.

Oxytocin

This is a synthetic form of the hormone your body produces naturally to start labour off. You will only be offered it if prostaglandins don’t work. Oxytocin is given through a drip, which is attached to a needle (canula) inserted into your arm. Once the drip is set up, your baby will be monitored continuously with an electronic fetal monitor. If your waters haven’t broken already, your midwife may suggest breaking them artificially. This is not usually painful but some women find it a bit uncomfortable. Many women find labour induced with a drip more painful than normal labour, and more women choose to have an epidural for pain relief.

Can I say no to induction?

Yes, you can. Your doctor or midwife will discuss all the benefits and risks with you so that you can make an informed decision. If you go beyond 42 weeks, you will be offered regular monitoring and a scan to check how well your placenta is working and how your baby is doing.

Will induction harm my baby?

If you have your membranes broken artificially there's a small risk that your baby's cord will become prolapsed, but your midwife or doctor will examine you carefully to make sure your risk of prolapse is low before carrying out the procedure. There's also a small risk that your uterus may rupture if you have an induced labour after a previous caesarean delivery.

On the other hand, an induced labour may well benefit your baby if there are medical reasons to deliver him or if he is very overdue as the risk of complications increases after week 41.

Are there any alternatives?

Some women like to try natural forms of induction or complementary therapies to kickstart labour. While there isn't much evidence to support them, these methods may be worth trying.

• Sex – some people believe the prostaglandins in sperm can help to start labour.
• Nipple stimulation is also supposed to help labour begin, but you do have to do it for quite a while!
• Some women believe that complementary therapies, such as acupuncture and homeopathy, can help get things started. Make sure you discuss it with your midwife first, though, and choose a qualified practitioner.

How to cope with an induction

First, make sure that you understand why you are being offered an induction. How will it be carried out, and what will the likely course of your labour be? Ask whether you may need other interventions during labour.

Remember that you don't have to give up on all the self-help techniques you've learned for labour just because you are having an induction. Talk with your midwife about how you can move around, change position and use breathing and relaxation to help you cope with the pain, even if you have a drip.

Keep an open mind about pain relief and choose what is best for you when, and if, you decide you need some help.

A mum says...

"I was given the gel and pessary first. It did start mild tightening but that stopped overnight. I was given the drip at 9am the next day. You cannot move as your baby has to be monitored through the whole labour. You have very limited space in which you can stand or walk. The actual canula in your hand isn't that bad. It soon gets forgotten about when contractions start!"