What is induction of labour?
Induction of labour (IOL) is the process of starting labour artificially. Up to 35% of births in the UK are induced for various medical reasons.
IOL is suggested on an individual basis and we will discuss why it is suitable for you.
This discussion should include information about the benefits for your baby to be born sooner, rather than continuing your pregnancy.
Induction of labour is a process that can take time. Commonly your baby may not be born until at least the following day after you attend for induction of labour.
Common reasons for offering induction of labour include:
- Induction of labour us usually recommended when there is a complexity to your pregnancy.
Prolonged Pregnancy (Post Dates): As pregnancy continues beyond your due date there is an increased chance of still birth, neonatal death and baby needing admission to the Neonatal Intensive Care Unit. We usually offer induction of labour at 41 weeks unless you have any other risk factors in your pregnancy. Please see the Post dates Induction of Labour Tool kit for further information and statistics to help you decide.
Ruptured membranes – up to 70% of women will go into labour naturally within 24hours after their ‘waters go'; There is an increased risk of infection to you and your baby, the longer the time it takes from your waters breaking to your babys birth.
- Fetal (baby) reasons your baby's growth is dependent upon their placenta working well; if the growth of your baby is not as expected, IOL may be offered at an appropriate time to reduce the small risk of stillbirth.
Mother reasons or baby, including medical conditions can increase the risk to mother
- pre-eclampsia
- high blood pressure
- obstetric cholestasis
Induction of labour does involve more intervention than when labour starts by itself:
There may be more vaginal examinations
It can take time
Sometimes women request more pain relief, including being more likely to use an epidural
If oxytocin is needed (which is common) we would recommend continuously monitoring your baby's heartrate
Ventouse or forceps are more likely to be needed
Caesarean section is not more likely
Risks of Induction of Labour
Uterine hyperstimulation - if you begin to have very frequent contractions that are coming too close together, your team member will manage your symptoms in 2 or more ways. This could be to
- remove the Induction method
- reduce the amount of Oxytocin infusion or
- administer a drug which would encourage your uterus to relax.
Cord prolapse - cord prolapse is an emergency situation whereby your baby's umbilical cord exits the vagina prior to your baby. Your health professional will ensure your baby's head is secure in your pelvis prior to breaking your waters, to reduce this risk. If cord prolapse does occur you will be taken immediately for an emergency caesarean section.
Unsuccessful induction – this is defined as labour not establishing (cervix not dilating to 4cm). If induction is unsuccessful, healthcare professionals will discuss with you and your birth partner the options available. Options include further attempt to induce labour with an alternative method, or to opt for a caesarean section. Your entire situation will be fully discussed before you make a decision about the birth of your baby.
No progress in labour (First Stage of labour) – once labour is established, normal progress of labour is for your cervix to dilate at least 0.5cm per hour. Sometimes change may be slower than this. This can be because your contractions are not regular, or your baby may not be in the best position to cause progressive opening of the cervix.
Your team will discuss steps to help your labour to continue, which may include either starting or increasing the oxytocin drip. If no further opening of your cervix occurs, the team will discuss your options, which is likely to include having a caesarean section.
No progress in labour (Second Stage of labour) - once your cervix has
opened to 10cm, we would expect your baby to be born within the next 4 hours. If your baby is not born by this time, then the team will discuss your options, which may include having an assisted vaginal birth with either ventouse or forceps, or you may require a caesarean section.
Uterine rupture - This is a rare complication (0.2 in 1000 women overall), where the wall of the womb can develop a tear.
- This can be a serious emergency, particularly if the heart rate of baby is affected.
- If uterine rupture is suspected the baby should be delivered by emergency caesarean section.
First pregnancy – the chance of uterine rupture in a first pregnancy even when labour is induced is exceedingly rare.
2nd babies and after them– no previous caesarean section (or other uterine scar) – having previous babies does slightly increase the chance of uterine rupture when labour has been induced (or oxytocin used in labour).
2nd babies and after them- previous caesarean section - The scar on your uterus does have a risk of separating and/or tear (rupture). This can occur in 1 in 200 women with a previous caesarean section. This risk increases by 2 to 3 times if your labour is induced.