Induction of Labour

If you’ve been offered induction, make sure you understand why it’s being offered to you and what the risks of it are (including the risk of cascading interventions). You can always opt for a “watch and wait” approach and discuss this with your care providers (and in the rare situation where “watch and wait” isn’t appropriate for medical reasons, you can always opt for a planned c-section instead if you’d prefer - or change your mind and go for that at any stage in the induction process!).

There can be a tendency for HCPs to present induction as straightforward and low risk, but it comes with a lot of risks that you may feel do not justify its use in your case (even if you have other risk factors). Read up on any risk factors you may have, question HCPs, explore your options, and make absolutely sure that it’s the right choice for you.

If you could use some in-person support with this, you might consider booking a Power Hour (online) or an antenatal Doula session (in person) to discuss your options and get help making sense of all your thoughts.

Methods of Induction

Membrane Sweep: Yep, you read that right! A “stretch and sweep” is a form of induction, designed to start labour before your body would begin it naturally. The HCP inserts a finger into the cervix and “sweeps” it around, between your cervix and the amniotic sac. “This action should separate the membranes of the amniotic sac surrounding your baby from your cervix. This separation releases hormones (prostaglandins), which may start your labour. Some women find the procedure uncomfortable or painful. You may get some cramping and vaginal bleeding afterwards.” (NHS) It’s often presented as risk-free, but it isn’t, and some question if there’s even decent evidence about them (Wickham 2022). You can read more about that here to help you decide if a membrane sweep is right for you.

Prostaglandins: An artificial version of the natural hormone that prepares the cervix for labour, this is usually inserted as a pessary behind your cervix. Sometimes (and usually if your body was getting close naturally anyway), this will be enough to get contractions started. Sometimes, it won’t, and more doses may be suggested. They may also suggest breaking your waters. This can help as it allows baby’s head to make better contact with your cervix, which in needed for effective contractions, however it comes with risks such as infection. (For more information on artificially breaking the amniotic sac, here’s a great article by midwife Dr Rachel Reed.)

Syntocinon: An artificial version of one of the main birth hormones, oxytocin. Often given after breaking the waters or other induction methods have failed, it’s given via a drip in your arm. This comes with continuous fetal monitoring, so while technically you can be mobile in labour with the drips, the monitoring may restrict your movement. many women find the intensity of the synthetic contractions caused by syntocinon far more difficult to handle than natural contractions, so it’s something to bear in mind.

Dr Rachel Reed says: “Oxytocin (syntocinon/pitocin) administered via a drip is not released in waves [like natural contractions] and an individual woman’s oxytocin receptor response is unpredictable. This may result in contractions that are too powerful without an adequate gap between them leading to a hypoxic baby” - and a struggling birthing woman!

As always, you can decline; for example, if you were comfortable accepting pessary induction but it hasn’t worked, your HCPs may suggest a syntocinon drip. If you decline, discuss alternative options with them. Can you continue to watch and wait? What are the risks of that? Do you have a time limit on how long you would be comfortable with that? Would you prefer a c-section instead of the risks of syntocinon? Use the BRAIN acronym and work with your care providers to find the right choice for you.

Mechanical Method: This method doesn’t involve artificial hormones. A “balloon” is inserted into your cervix and slowly inflated (this is sometimes only suitable for women who have birthed before, as the cervix of a first-time birthing person may be too closed.) Benefits of this method include no artificial hormones (though they will be offered if the balloon doesn’t work), a reduced risk of hyper-stimulation of the uterus (which causes fetal distress), and reduced risk of scar rupture if you’ve had a previous belly birth.

This method is often used as part of a plan to break your waters after, and if it’s not successful you’ll be offered hormonal induction instead, so it’s important to think about this before accepting. It may be, for example, that you’re comfortable trying this but not hormonal methods. Discuss this with your HCPs and always plan for options that you feel comfortable with and informed about.

Oral Misoprostol Tablets: NICE guidelines say that one of the options that should be made available to women being offered induction is “low dose (25 microgram) oral misoprostol tablets” (NICE, 2021). Trials have shown this is at least as effective as vaginal pessaries and mechanical induction, and results in fewer abdominal births than use of synthetic oxytocin (Alfirevic et al, 2014, and Kerr et al, 2021). Though not commonly offered in local trusts, you may wish to discuss it as an option with your care providers if you’re considering accepting an offer of induction.

What happens if my induction doesn’t work?

“If you don’t go into labour after an induction your midwife and doctor will discuss the next steps with you and ensure that both you and your baby are safe. There may be several options but this will depend upon your individual circumstances. If your ‘waters’ have not broken it may be possible to stop the induction process and allow a period of rest. Alternatively, you may be offered further doses of prostaglandin. In some circumstances, a caesarean section may be recommended.”

- MKUH Induction Leaflet (2023)

If you decide to accept an induction, use your chosen coping tools and check in using BRAIN regularly to support you to feel in control, empowered, and positive about your birth.

Many women have positive induction experiences because they felt informed, empowered, and that they were in control of their choices and birth experience!