Induction of labour and augmentation Guide

• Why are inductions needed?

  Induction of labour (IOL) is a relatively common procedure.

  The IOL rate in Queensland is about 22%.

  IOL is a procedure used to stimulate contractions, before labour begins on its own. It includes the use of medication or other methods to bring on (induce) labour.

  The reasons that an induction could be recommended include:

  • your pregnancy is overdue
  • multiple pregnancy
  • your baby is small for their age
  • your membranes have ruptured (waters have broken) and labour has not started
  • certain medical conditions such as diabetes, high blood pressure or cholestasis.

  Your doctor or midwife will discuss the reason for your induction at your antenatal visit.

  More information: Queensland Clinical Guidelines parent information – Induction of labour

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• Frequently asked questions – inductions

  What is a Bishop score?

  It is a score used by doctors and midwives to determine how ‘ready’ your cervix is for labour. It is a combination of how soft, open and thin your cervix is, and where your baby is positioned in your pelvis. The score assists in deciding which method of induction will be most successful for you.

  What is ‘cervical ripening’?

  Ripening the cervix is a process that helps the cervix soften and thin out in preparation for labour. Medications or devices may be used to soften the cervix so it will stretch (dilate) for labour.

  How will I be induced?

  The method of induction will depend on:

  • the condition of your baby
  • your condition
  • the progress of labour
  • dilation of the cervix
  • how far down in your pelvis the baby has gone
  • the position of the baby's head
  • your comfort and choice.
  • Transcervical catheter ‘balloon catheter’.
  • Prostaglandins, a ‘gel’ or pessary (Cervidil).
  • Artificial Rupture of Membranes (ARM) ‘breaking your waters’.
  • Syntocinon (oxytocin), sometimes called ‘the drip’.

  What are some of the different methods of induction?

  How long do inductions take?

  There are lots of factors involved. Some women go into labour and deliver within a few hours after induction. Others take one or two days to start labour.

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• Questions to ask about induction of labour

  Your midwife or doctor should discuss the pros and cons of any intervention so you can make an informed decision.

  You should ask your doctor or midwife whether induction will:

  • hurt?
  • affect my recovery?
  • affect my ability to breastfeed?
  • affect any future pregnancies?

  You should also ask questions such as:

  • why would I need this intervention?
  • what are the risks and benefits to me and my baby?
  • are there any alternatives?
  • is it likely to increase my need for more interventions?
  • can I do anything while I’m pregnant to decrease my chances of needing the intervention?
  • what is the hospital’s policy on this intervention and the evidence to support this?

  More information:

  • Queensland Clinical Guidelines parent information – Induction of labour
  • Pregnancy, Birth and Baby – Induced labour

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• Methods of induction

  Balloon catheter

  A cervical ripening balloon catheter

  This is a thin tube or catheter with balloons on the end. The catheter is inserted into your cervix and the balloons are inflated with saline (salty water).

  Once inflated, the balloons apply pressure to the cervix. The pressure should soften and open your cervix.

  What happens next will vary for each woman – some might need an Artificial Rupture of Membranes (ARM) to break their waters. Some women might need oxytocin to stimulate the contractions.

  What do I need to know?

  When the catheter is in place, you will need to stay in hospital, but you can move around normally. At about fifteen hours after the catheter has been inserted or when it falls out, you will be re-examined (vaginal examination).

  More information: Queensland Clinical Guidelines parent information – Induction of labour

  Prostaglandins (‘gel’)

  What is a prostaglandin induction?

  Prostaglandin is a hormone that prepares your body for labour. A synthetic version of this hormone is inserted into your vagina, behind your cervix, using a syringe (see image).

  When the prostaglandin takes effect, your cervix will soften and open.

  • you may need up to three doses (given every six to eight hours) over 12 to 24 hours
  • some women may need an ARM to break their waters
  • the gel may start your labour but you may still require other methods of induction, such as an ARM and/or a Syntocinon infusion.

  What do I need to know?

  A ‘gel’ induction can be a lengthy process, sometimes one to two days. If the process is started in the evening, you will need to rest while the gel is working. Your support person is advised to go home as there are no facilities to accommodate them overnight.

  More information: Queensland Clinical Guidelines parent information – Induction of labour

  Cervidil induction

  What is Cervidil induction?

  Cervidil is a tape that contains prostaglandin which is used to ripen (soften), shorten and open the cervix.

  A vaginal examination is performed to assess the cervix and the tape is inserted behind the cervix.

  • the end of the tape will be visible at the opening of the vagina similar to a tampon string
  • your baby will be monitored by a CTG machine for a minimum of 20 minutes (monitors strapped to your abdomen)
  • the Cervidil tape remains in for up to 24hrs
  • this may cause backache or ‘period-like’ pains.

  What do I need to know?

  • once the induction process has started you will need to remain in hospital
  • some women will react to the Cervidil and have nausea, vomiting or diarrhoea, or facial flushing (this is rare)
  • the Cervidil may start your labour but you may still require other methods of induction, ARM and/or a Syntocinon infusion.

  More information: Queensland Clinical Guidelines parent information – Induction of labour

  Syntocinon (oxytocin) infusion

  What is a Syntocinon induction?

  Oxytocin is the hormone that causes contractions. A synthetic version (Syntocinon) can be given to start the induction process.

  Syntocinon is given through a drip, usually in your hand or arm. Once contractions begin, the rate of the drip is adjusted so that contractions occur regularly until your baby is born.

  This process can take several hours.

  Your baby's heart rate will be monitored throughout labour using a CTG machine.

  What do I need to know?

  • you are attached to a drip and the CTG monitor which can affect your ability to move around during labour
  • sometimes oxytocin can cause the uterus to contract too frequently, which may affect the pattern of your baby's heartbeat. If this happens, you may be asked to lie on your side and the drip will be slowed to reduce the number and strength of your contractions

  the Syntocinon drip is only an option after your waters have broken.

  More information: Queensland Clinical Guidelines parent information – Induction of labour

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• Risks of induction

  • Your chance of needing extra pain relief is higher, because the contractions are often more painful.
  • Your chance of having a caesarean birth is higher, if your labour is induced for a reason other than pregnancy lasting longer than 41 weeks, or it’s your first baby.
  • Sometimes an induction doesn’t work in getting your body to go into labour (failed induction).
  • As your baby’s heartbeat will be monitored with special equipment during your labour, it can be harder for you to move around and use the bath or shower for pain relief.
  • Overstimulation of the uterus: this may require medications to reverse the effects of the over-stimulation or an emergency caesarean birth.
  • Cord prolapse: this is extremely rare. When the waters are broken there is a very small risk of the umbilical cord slipping below the baby’s head with the fluid. This requires an immediate caesarean birth.

  More information: Queensland Clinical Guidelines parent information – Induction of labour

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• Augmentation of labour

  A labour that's progressing slowly can be augmented, which means certain techniques are used to speed it along.

  If your cervix is opening slowly, or the contractions have slowed down or stopped, your midwife or doctor may suggest medications or techniques to speed up labour. This is known as augmentation of labour.

  Methods include:

  • amniotomy – breaking the waters or ‘ARM’
  • oxytocin – this hormone is administered via an intravenous drip to stimulate uterine contractions.

  It is important to note that both induction of labour and augmentation require extra fetal monitoring.

  What else can I do if my labour is progressing slowly?

  Your midwife may suggest changing your position, walking around, taking a warm shower or bath, or having a massage to encourage the contractions. If you’re tired or uncomfortable, you may want to ask about options for pain relief.

  Next section: Assisted birth and caesarean birth

Induction of labour and augmentation, 23 Mar 2023, [https://oss-uat.clients.squiz.net/health/children/pregnancy/antenatal-information/induction-of-labour-and-augmentation]

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