Induction of Labour: Your Body, Your Decisions

With induction rates running at around 40% in some Trusts, chances are that as you reach the end of your pregnancy you’ll be offered an induction for one reason or another. The law says that the only person who can make the decision about whether or not to accept induction is the person whose body it is, so knowing more about your choices means that you can, if necessary, be ready to make an informed decision.

What are the stages of induction?

  • Stretch and sweep

During a stretch and sweep a midwife will insert her fingers into your vagina and attempt to put a finger through your cervix. If it’s open enough to allow this, she will sweep her finger in a circle, attempting to separate the membrane around your baby from the top of your cervix. She may also try to slightly stretch your cervix to open it a little. This can trigger the release of hormones which in some women and people starts labour.

  • Opening your cervix

Opening the cervix is necessary to start the process of induced labour and this can be done with drugs called prostaglandins, administered on a gel or pessary which is inserted into your vagina. Alternatively, a type of balloon may be inserted through your cervix and then gently expanded. The pressure that this puts on your cervix may help to open it, and it may also release natural prostaglandins.

  • Breaking your waters. (Also known as releasing the water around baby)

If your cervix opens sufficiently, it is likely that the next step that you are offered will be to have your waters artificially broken. This involves the midwife inserting a hook device into your vagina and through your cervix to reach the membranes around your baby. The hook ruptures the membranes, and this allows your baby’s head to press more firmly on your cervix, which in turn may help it to trigger contractions. It is very unlikely you will feel the hook as it is passed up between the midwife’s fingers.

To do this, sometimes your midwife will ask you; when you are lying down, to pop your hands under your bottom to help tilt your pelvis and your cervix to make it easier. We would suggest that instead of this, you take a towel into hospital with you so you can roll it up and pop it under your bottom, this does exactly the same thing, plus you are not then lying on your own arms!

However, if you are having regular tightenings or surges after the first stage of the induction process, it may be worth considering if releasing the water around baby is something that needs to be done at this point. It may be worth chatting to your antenatal midwife to discuss these options so you feel more prepared on the day. More about this a bit further down in your choices.

  • Syntocinon drip

If labour hasn’t started with these interventions, you will be offered a drug called Syntocinon which is given to you in a drip. Syntocinon is an artificial version of the hormone oxytocin which the body uses to create uterine tightenings.

In the UK this intervention will more likely happen in an obstetric ward, not a birth centre or a midwifery led unit.

Syntocinon is a drip that will go directly into your blood through your veins. This means that you will have to have a cannula (a thin plastic tube). Because they are putting something that is artificial into your body to work, you will now be monitored in more ways, more closely.

This will mean that you will be encouraged to have continuous monitoring of you and your baby. Baby’s heart will be monitored and so will the tightenings you are having.

This is likely to mean that you are attached to a machine, unless the hospital has a wireless monitor, however, you can still move around and we have developed several ways for you to work with, during a more medicalised birth.

Benefits and risks of induction

Each of these steps of induction has its own benefits and risks. For every form of induction other than a stretch and sweep it will be recommended that your baby’s heart is monitored, as each of them can cause your baby to become distressed, which may lead to the need to have a caesarean birth, or, if your cervix is fully opened, assistance with forceps or ventouse.

There are many benefits and risks of induction, far more than we can cover here, but you can read all about them in the AIMS book, The AIMS Guide to Induction of Labour”.

What choices do I have about how I’m induced?

Firstly, it’s really important to know that you have choices, and that you are the one who makes the decisions about those choices, even if you do not feel it’s not put across to you like that.

You can decide whether you accept induction or decline it. If you decline it and then change your mind, that’s fine too.

If you start on the induction pathway, you still have choices. For instance, if you have the pessary to start to open your cervix, if it doesn’t work you can have another, or you can decide to wait. Maybe go for a walk, move around, take a bath, relax. You could go home for a few hours, or a day (or more!) and then come back and try again. Some hospitals start an induced labour with the pessary, then if that is enough to start active labour they support the woman or person going home for a home birth. Of course, you can go home at any time – hospital isn’t a prison!

If the pessary (or gel, or balloon) works and labour seems to be starting, you can decline having your waters broken if you want. Keeping your waters intact will lower your risk of infection, and some women and people find labour becomes a lot more intense after they are released, so if you want to just wait and see, you can decide to do so. Again, if you change your mind and decide to have them broken, you will be able to.

If your waters are broken, your risk of an infection in your uterus will increase, and this risk increases the more vaginal examinations you have. Therefore, reducing or avoiding vaginal examinations might be something you want to consider.

If the Syntocinon drip is offered you can accept it, or wait a while and see whether labour becomes established without it. Once it’s started, it can be hard to stop it because the artificial oxytocin can over-ride your body’s own oxytocin production, so your body may not take over again if the drip is reduced or taken down.

You do still have the right to stop it, or reduce it, if you want to, and if the tightenings that it creates are more than you can bear, this may be an option that’s right for you. Naturally produced oxytocin helps to trigger natural pain killers called endorphins, but Syntocinon doesn’t have the same effect on our body’s, which is one reason why an induced labour can feel more painful than a natural one.

During all of these steps, it’s really important to know that you can stop any of them at any time. You can decide to not move onto the next step, but instead wait, relax and regroup, giving your body a chance to go into labour naturally.

Importantly, you also have the option to go to a caesarean at any point in this process. If there is no obvious medical need for it this might take some negotiating, and you may need to wait for a space in theatre. However, if you are being induced it’s because it’s important for your baby to be born sooner rather than later. Therefore, if the induction pathway becomes a choice you have decided no longer works for you, the reason why your baby should be born before spontaneous labour starts is still there, and that should be enough to justify a caesarean birth.

In summary

Induction is a serious medical intervention, but that doesn’t mean that the doctors and the hospital take over your body and your rights to decide. At all times during an induction the decisions are yours, so know what options you have so that you feel confident in making them!