Induction of LabourInduction of labour is offered to women with normal, uncomplicated pregnancies between 10-14 days past their estimated due date (EDD). However, the decision will

Information for patients

For more information about our Trust and the services we provide please visit our website: www.nlg.nhs.uk

Induction of Labour Name: _______________________________ Who to contact and how: _______________________________ Notes: _______________________________ _______________________________ _______________________________ _______________________________ Diana, Princess of Wales Hospital Scartho Road Grimsby DN33 2BA

03033 306999 www.nlg.nhs.uk

Scunthorpe General Hospital Cliff Gardens Scunthorpe DN15 7BH


Goole & District Hospital Woodland Avenue Goole DN14 6RX




Introduction In most pregnancies labour starts naturally between 37 and 42 weeks, leading to the birth of the baby. Sometimes an induction of labour is required; Induction is a process designed to start labour artificially.

When is induction recommended? When it is felt that yours and your baby’s health is likely to benefit, the doctor may offer or recommend induction of labour.

There are a number of reasons why induction may be offered and recommended. For example, if you have diabetes or pre-eclampsia (high blood pressure).

If you are healthy and have had a trouble free pregnancy induction of labour will be offered if:

• Your pregnancy is more than 40 weeks and 10 days

• Your waters break before labour starts

When induction of labour is being considered your doctor or midwife will fully discuss your options with you before any decision is reached.

This will include explaining the procedures and care that will be involved and whether there are any risks to you or your baby. Induction of labour is offered to women with normal, uncomplicated pregnancies between 10-14 days past their estimated due date (EDD).

However, the decision will be reached after consultation between you and the doctor / midwife in attendance at your final clinical appointment.

What if I would rather wait? If you decide not to be induced and prefer to wait longer than 14 days beyond your due date, then you will be required to attend the hospital more frequently so that your baby can be monitored more closely. This may include:

• Monitoring your baby’s heartbeat, using a cardiotocograph machine (CTG)

• An ultrasound scan and Doppler (measuring the blood flow from the placenta to and from your baby)

How is labour started? There are a variety of methods that can be used to induce labour. You may be offered one or all of the methods described, depending on your individual circumstances.

Sometimes the ward and Central Delivery Suite are very busy, and this can delay your induction 24-48 hours or ask you to come at a later time in the day. It might also delay parts of your induction. If you have questions surrounding this, please ask to speak with a senior midwife or obstetrician on duty.



Membrane Sweeping

This has been shown to increase the chances of starting labour naturally within 48 hours following this procedure and can reduce the need for other methods of labour induction. Membrane sweeping involves your midwife or doctor performing an internal examination and placing a finger just inside your cervix, making a circular sweeping movement to separate the membrane from the cervix.

If you have agreed to induction of labour, you may be offered a membrane sweep before other methods are used.

The procedure may cause some discomfort or bleeding, but will not cause any harm to your baby, and will not increase the chance of you or your baby getting an infection. Membrane sweeping is not recommended if your membranes have ruptured (waters have broken).

Cervical Ripening Balloon Catheter

This method has minimal side effects and does not need you to be monitored closely compared to using medications. A soft silicon tube (catheter) is inserted into your neck of the womb and the balloon at its tip is filled with salt water (saline). This stays in place for 24 hours and balloon exerts gentle pressure on the cervix softening and opening your cervix enough to break your waters. The procedure may be uncomfortable but not painful. It may fall off on its own or will be removed by midwife the next day. This method will be particularly recommended if you have had a caesarean section in the past as it is very safe and unlike the drugs will not have a risk of weakening your scar in the womb.

Using Prostaglandins

These are drugs which help to induce labour by encouraging the cervix to soften and shorten (ripen). This allows the cervix to open and contractions to start.

Prostaglandins are usually given as a tablet or controlled-release pessary that is inserted into the vagina. This is always done in hospital. More than one dose may be needed. Doses are



given every 6-8 hours if given Prostin (tablet), or every 24 hours if given Propess (controlled-release pessary), both inserted into the vagina.

If your membranes have not yet ruptured, prostaglandins are the recommended method of induction. This is the case whether this is your first pregnancy or not, and whether your cervix has ripened or not.

Before giving prostaglandins your midwife will check your baby’s heartbeat using a CTG. After being given your prostaglandin you will be asked to rest on your bed for at least 30 minutes.

A record of your baby’s heartbeat will again be recorded using the CTG for approximately 30 minutes. Once it is established that all is well, the CTG will be discontinued and you will be able to move around.

The prostaglandins may cause period type pains (which may be strong) and backache, and may lead to one of the three outcomes:

• Nothing happens

• If induction fails, the subsequent management options include:

− Further attempt to induce labour (the timing should depend on the clinical situation and the woman’s wishes)

− Caesarean section

• Your cervix may start to soften and open slowly

• You may go into labour

If when the midwife carries out an internal vaginal examination, she finds your cervix has started to dilate and that it would be possible to break your waters, you will be transferred to the labour ward as soon as possible for this procedure (if in Scunthorpe).

If it wouldn’t be possible to break your waters the team may offer you another dose of prostaglandins. In some circumstances you may be offered a Caesarean section

Breaking your waters

If your waters have not broken a procedure called an amniotomy may be recommended. This is when your midwife or doctor makes a hole in your membrane to release (break) the waters. This procedure is done through your vagina and cervix using a small instrument. This will cause no harm to the baby, but the vaginal examination needed to perform this procedure may cause you discomfort.

Once you have had your waters broken, you usually start to have contractions, which may be painful. However, if this does not happen or your contractions are not strong enough to contract your uterus, it may be necessary to start a drip that contains a drug to stimulate contractions.



Using oxytocin

This drug encourages contractions. Oxytocin is given through a drip and enters through a tiny tube inserted into a vein in the arm. Once contractions have begun, the rate of the drip can be adjusted so that your contractions occur regularly until your baby is born.

If your membranes have ruptured (waters broken) prostaglandins and oxytocin are shown to be equally effective methods of inducing labour. This is the case whether this is your first pregnancy or not and whether your cervix has ripened or not.

Whilst you are being given the oxytocin the midwife will monitor your baby’s heartbeat continuously.

Women who have oxytocin are more likely to ask for an epidural to help with the pain. An epidural is a pain relief injection given into your back.

Oxytocin is given through a drip and being attached to this will limit your ability to move around.

Very occasionally oxytocin can cause the uterus to contract too much which may affect the pattern of your baby’s heartbeat. If this happens your midwife will take the appropriate action, which may include asking you to lie on your left hand side, and the drip will be turned down or off to lessen the contractions.

When do I go to the Labour Ward? At Scunthorpe General Hospital you will be taken to the labour ward when the following occur:

• You are in established labour

• You require pain relief which cannot be administered on the ward, i.e. an epidural

• When your waters are ready to be broken

• If complications arise with you or your baby

At Diana Princess of Wales Hospital you will remain in the same room for all of your care

What can I do to help? You can help by bringing in with you on the day of your admission:

• All the maternity records you have

• A urine sample

• Everything you may need for yourself and your baby

• It may be useful to bring something to keep you occupied in the early stages of labour

Can my partner / support person be there? As it may take a few days to induce your labour, it may not be practical for your partner to stay with you all the time. Nevertheless, flexible visiting for your partner / support person is encouraged. However, at times there may be a need to be sensitive to the needs of other



women in the ward area. The ward staff will be happy to advise you should you have any enquiries.

All other visitors are asked to keep to the visiting times.

Advice for Partners Facilities are available for partners to stay overnight at Diana Princess of Wales Hospital. However, at present there are no facilities that allow you to stay overnight at Scunthorpe General Hospital.

Admission of your partner for induction is not the ideal time to book longer stretches of time off work. It may be better to arrange to have only a day or two off work at the time of the delivery. It is often better to take the rest of your leave when your partner returns home with the baby, as this is when she will need you most.

Enquiries It helps the staff if enquires are kept to a minimum. Therefore, we suggest you or your partner keep relatives / friends informed of any progress.

If you have any further questions, please do not hesitate to ask your midwife or doctor.

Contact Telephone Numbers For Diana Princess of Wales Hospital:

Honeysuckle Team 03033 304794

Blueberry Team 03033 304789

Holly Team 03033 304790

Jasmine Team 03033 304787

Antenatal Day Unit 03033 304797

Acorn Women’s Outpatient Suite 03033 304800

For Scunthorpe General Hospital:

Ward 26 03033 302227

Central Delivery Suite 03033 302270

Any Comments, Compliments, Concerns or Complaints If you have any other concerns please talk to your nurse, therapist or doctor. Our Patient Advice and Liaison Service (PALS) are available on 03033 306518 (Grimsby, Scunthorpe and Goole). You can also contact [email protected]

As a Trust we value equality of access to our information and services, therefore alternative formats available on request at [email protected]



Date of Issue: July, 2019

Review Period: July, 2022

Author: Operational Matron

IFP-0558 v1.3

© NLGFT 2019

Documents

Induction of LabourInduction of labour is offered to women with normal, uncomplicated pregnancies between 10-14 days past their estimated due date (EDD). However, the decision will