Induction of Labour
There are 2 methods of induction used at Wirral Women and Children’s Hospital, depending on clinical examination and cervical assessment
Prostaglandin Vaginal Pessaries/Tampons
If the Bishop’s score is below 8 points, prostaglandin pessaries are the induction method of choice. Individual condition determines which is more suitable.
- Prostin tampon is inserted and left for up to 24 hours or until labour begins or
- Pessary is placed behind the cervix, at the top of the vagina where it dissolves
- Hormones in the pessary cause the cervix to soften and the uterus to contract
- If labour has not begun 6 hours later, the process is repeated
- A 3rd pessary is sometimes given the following day, if indicated
Artificial Rupture of Membranes and Syntocinon
If the Bishop’s score is 8 or above, artificial rupture of membranes (ARM) can be performed. This should be no more uncomfortable than any other vaginal examination.
- Small, slim instrument is used to nick the bag of membranes, releasing some of the water.
- Often this is sufficient stimulation for the uterus to start contracting and labour begins
- An intravenous infusion of a hormone called syntocinon can be used to stimulate the uterus to begin contracting.
People who are Rhesus positive (Rh pos) have a substance known as 'D antigen' on their red blood cells, whereas Rhesus negative (Rh neg) people do not.
If an Rh neg woman carries an Rh pos baby, there is a slight risk that a small amount of the baby’s blood could enter the mother’s bloodstream.
This could cause an immune response to the D antigen and her body will produce antibodies against it, which stay in her blood forever.
This doesn’t usually affect the existing pregnancy but can cause difficulties in subsequent pregnancies.
The antibodies in the mother’s blood can cross the placenta and attach to the D antigen on the baby’s red blood cells. This can harm the baby and cause anaemia and jaundice.
Anti-D Immunoglobulin - Wirral Women and Children’s Hospital advises all Rhesus negative women to accept a prophylactic Anti-D injection at certain times:
- Should there be any bleeding during the pregnancy
- Following miscarriage and amniocentesis
- Routinely at 28 weeks gestation
- Following birth, if the baby is Rhesus positive
- For further information, visit www.nice.org.uk/TA156.
Routine blood tests taken at booking include:
- Blood group and Rhesus factor
- Full Blood Count test for anaemia and Thalassaemia
- Virology tests for Hepatitis B, Syphilis, HIV and Rubella (German Measles)
The results of these are filed in your notes at the 20-week scan visit.
Should any need to be repeated, the community midwife will do this at a clinic.
- At 15-16 weeks the Quadruple screen for Down’s and Spina Bifida risk, is offered and is entirely optional.
- At 28 weeks the Full Blood Count and Rhesus factor tests are repeated
- At 36 weeks the Full Blood Count is repeated, to detect and treat possible anaemia prior to delivery
- After delivery, a Kleihaur test offered to all Rhesus Negative women and a Full Blood Count may be indicated
The Maternity Ward
Some women need care in hospital during the antenatal period. Care is provided on the Maternity Ward on the first floor of the Wirral Women and Children’s hospital.
There are 26 individual rooms for newly delivered mothers and pregnant women, each with en-suite bathrooms. Your partner may be able to stay on the ward with you. Please speak to the midwife caring for you.
There is a six bedded Post Operative Care Bay (pictured) where higher dependency care can be delivered around the clock.
The Postnatal ward also has four “Transitional Care” rooms that are used when babies require additional support that can be provided outside the Neonatal Unit.
The Midwifery-led Unit (MLU)
The MLU has five home-from-home rooms and two poolrooms for water births. Women with low risk pregnancies are encouraged to labour here if they do not want to give birth at home. This area is totally staffed by midwives and is a centre for normality in childbirth.
Delivery Suite/Labour Ward
The delivery suite is where anyone who isn’t low risk will be give birth, this is also where care is given to ladies who are high risk and requiring additional care in the antenatal, intrapartum or postnatal period.
Who isn’t low risk? - Anyone who is being induced, less than 37 weeks pregnant, has a high risk obstetric or medical condition, unwell or with a fetal well-being concern.
8 Delivery rooms – 7 are ensuite
High risk pool room (Use subject to criteria & availability)
2 High Dependency rooms
Emergency maternity theatre and recovery room
Level 3 Neonatal Unit in immediate vicinity
There are two designated Maternity Theatres directly linked to the Delivery Suite and MLU which are staffed 24 hours per day for elective and emergency surgery
A new Induction of Labour suite is also in the process of being developed on delivery suite
Staff – Who’s who and their Uniform?
Midwives – Royal Blue Scrubs
Delivery Suite Sisters – Navy Blue Scrubs
Delivery Suite Manager – Navy Blue Tunic with red trim
Advanced Midwifery Practitioner – Lilac scrub top
Matron – Red Tunic
Student Midwives – Grey Tunic
Obstetricians, Anaesthetists, Neonatologists – Maybe in their normal clothes or theatre Scrubs which are light blue
Support Staff, Clinical Support Worker and Theatre Staff – Light blue theatre scrubs
Domestic Assistants – Dark Purple tunics
On duty through the day and night we have ...
- At least one Delivery Suite Sister
- A team of Midwives who provide one to one care
- Obstetric, Anaesthetic and Neonatal teams who are always on call
- We also have a team of midwives dedicated to high risk care and bereavement care
- During your stay on delivery suite you are likely to meet the whole team on routine ward rounds