In an ideal world, your baby will stay safely in the warmth of your womb right up until he’s good and ready when you might opt for a vaginal or 'natural' birth. But if we know anything about pregnancy and labour here at Mother&Baby, it’s that things don’t _always g_o to plan. In fact, rarely so!
If you’ve been offered an induction due to complications, or because your baby is overdue and natural ways to induce labour haven't worked, chances are you’ll be feeling a little apprehensive, and asking yourself (and anyone else who will listen!) all sorts of questions about induction of labour. Can you still have pain relief? Will it end in a c-section? Will labour be slower – or fast and furious? The first step in easing your anxiety is knowing that you’re not alone in needing a helping hand to kickstart your labour.
According to the latest figures from NHS Digital, over 31 per cent of labours were induced between 2017 and 2018. And, in general, one in five mums are induced every year, says the NHS.
If you’ve run through the risks and benefits, explored other options and have decided an induction is best for you and your baby, rather than viewing it as a negative, reframe your induction: ‘Think about why you’re having it,’ says midwife Marie Louise. ‘Consider the benefits, and the fact you’ve got a team of people to support you and keep you and your baby safe. In some countries it’s not an option for women, so we’re very lucky here in the UK.’ Reframing induction as a positive thing that you’re doing for all the right reasons can really help in removing some of your anxiety as your induction date draws nearer.
Why might I need to be induced?
There are lots of reasons your midwife or doctor might offer you an induction. ‘The most common reasons are being overdue,’ says Marie. ‘In the UK, we consider a normal length of pregnancy between 37 and 42 weeks. Generally, we would encourage women to have an induction at 41 weeks plus five days pregnant.’
Other reasons include your waters breaking and labour not starting, or any health issues like hypertension in pregnancy or gestational diabetes. ‘Sometimes, if your baby is particularly big or small, you may also be offered an induction,’ adds Marie.
Why might I not be offered an induction?
If your baby is breech and you plan on delivering vaginally, induction doesn't tend to be recommended as labour needs to progress steadily.
If your baby is large for their gestational age, you won't be induced purely for this reason as accurately assessing your baby's weight is difficult.
How do I decide if I want an induction?
It is completely your choice if you decide to have an induction but your doctor or midwife should give you more information to help you make the decision. This will include:
Why you're being offered an induction
When, where and how it will be carried out
What support and pain relief will be available to you
What the risks and benefits are
What other options are available
What your choices are if the induction doesn't work
How is labour induced?
Wondering what happens when you get induced? Well, knowledge is power! Here’s your step-by-step guide to being induced...
Phase one: Membrane sweep
‘There are a few phases to being induced,’ says Marie. ‘If your waters haven’t broken, we’ll usually start by offering a ‘stretch and sweep’. This can be done at home or during your normal antenatal appointment with your midwife.’
During a stretch and sweep your midwife will sweep her finger around your cervix. The aim is to separate the sac surrounding your baby from the cervix, and kickstart your labour. A second stretch and sweep can be carried out 48 hours later if the first doesn’t work. You can go home after a sweep – there’s no need to go into the hospital.
‘If this hasn’t encouraged the body to go into labour we would then advise we continue on along the medical route,’ says Marie.
Phase two: Prostaglandin pessary or gel
If the membrane sweep doesn’t trigger labour, the next step is going into hospital and having a prostaglandin pessary or gel. This works to soften the cervix. ‘The aim is to open the cervix up a bit and get the uterus to react,’ says Marie. ‘Some women don’t need anything else and this will start their labour.’
You’ll be on an antenatal ward for up to 24 hours to give the gel or pessary time to work. ‘You and your baby will both be monitored during this time. You can also have pain relief if you need it, so chat through your options with your midwife.’ If this doesn’t work, you’ll move on to phase three...
Phase three: Breaking your waters
From this point, you’ll be transferred up to the delivery suite. ‘If you don’t labour off the prostaglandin, you’ll move onto one-to-one care with a midwife,’ says Marie. She’ll offer to break your waters with an amnihook. ‘The prostaglandins should hopefully soften and open your cervix enough for your water to be broken. However, this isn’t always possible. It will feel a bit like a stretch and sweep, which can be uncomfortable, but you shouldn’t feel any pain from the breaking of your waters.’
Depending on your hospital, they’ll either wait an hour to see if your labourstarts or they might recommend you start on phase four…
Phase four: Hormone drip
The last step of induced labour is having a hormone drip containing syntocinon, an artificial version of the ‘happy hormone’ oxytocin. ‘You’ll need a cannula into a vein in your hand, and we’ll start the drip off slowly before gradually increasing it,’ says Marie. ‘That’s how things usually progress in spontaneous labour. You can have an epidural before the hormone drip is started.’
For some mums, contractions start quite quickly, but for others it can take a bit of time. You and your baby will be monitored throughout. If you’ve had a c-section before, you may be offered a balloon catheter instead of the drip. ‘Your doctor will be able to advise you on this, the process, and why this is recommended for you,’ says Marie.
How long will it take to be induced?
Many women mistakenly believe the date of their induction will be the day they meet their baby. But being induced can take a long time and it may be two or three days before labour gets properly started. The pessary stage can often take up to 24 hours before a woman is either given a drip or has her waters broken.
Midwife Evony Lynch, who is based in West Cornwall, says: “The process can be quite a long one, especially if it is your first baby. Bring all the stuff you need to make that space your own. You might want to bring your birth ball, your TENS machine, hypnobirthing CDs and some relaxing music to listen to. If you can concentrate, use the time to watch a film or read a book.
“Bring lots of snacks and anything that makes you feel more comfortable as there can be a lot of waiting around.”
Is being induced more painful?
Although the dose of Syntocinon is given gradually, the contractions you will feel during induction are likely to be stronger and more intense than if you had gone into labour naturally.
“If it is your first baby, it can be quite hard-going,” says Evony. “Your body is having contractions before it is ready so you don’t have your own endorphins to help you deal with the pain.
“If you are finding your contractions too strong and painful, don’t be frightened to ask for an epidural or other pain relief. You will have stronger contractions in a shorter space of time so an epidural might help you to cope better.”
What if the induction doesn't work?
If you don't go into labour following an induction, your medical professional will speak with you about your options. This could be another induction or a caesarean section.
Will I have any control over my birth plan?
One of the big fears for women facing an induction is that they won’t have any control over their birth experience.
But Evony says: “If you go into labour from the pessary or from your waters being broken, there is no reason you can’t give birth as you planned. If you are given a drip, you will be more restricted as you will have a cannula in your hand but this doesn’t mean you can’t move around. You can still kneel or sit on a birth ball.
“Even with an epidural, you should be able to move onto your side so you are not lying on your back, which is a difficult position to give birth in. You can make the experience seem more natural by turning the lights down low. You can even ask for the volume of the monitoring equipment to be turned down so it isn’t so intrusive.
“If you go into labour from the pessary or from your waters being broken, there is no reason you can’t give birth as you planned. If everything goes well and you have a normal vaginal birth, you can still decide things like who cuts the cord and whether you pick up your baby yourself.”
Induction myths busted!
Myth 1: You’ll have your baby on the day you’re induced
‘This is one of the biggest myths around being induced, and it can cause quite a lot of disappointment!’ says Marie. ‘Women will come in at 8am and think they’ll be at home with their baby by 8pm. But it’s a lengthy process, so bring in your favourite snacks and books.’
Myth 2: An induction is more likely to end in a c-section
‘There’s a misconception that if you have an induction you are more likely to need an emergency c-section,’ says Marie. ‘But the majority of women come in because they are overdue. That means their bodies are all ready to give birth and quite often they labour really well.’
Myth 3: You can’t move off the bed during induced labour
Just because you’re being monitored doesn’t mean you’re stuck on the bed. ‘You can still stand up, sit on a birthing ball, and be active,’ says Marie. ‘Yes, we’re monitoring, but that doesn’t mean you have to sit in a certain way. We work around you.’
Myth 4: You’re not in control
Repeat after us: you are! ‘I find, especially with mums who’ve had very low-risk pregnancies and then go overdue and are offered an induction, they feel their plans and choices have gone out the window,’ says Marie. ‘But I always explain that they are still in control. And they don’t have to do anything they don’t want. Even on the day, you can change your mind at any time before the induction process is started.’
Myth 5: Induced labour is more painful
You have lots of pain-relief optionsduring an induced labour, just as you do with spontaneous labour. ‘The contractions from the hormone drip can be quite intense, but you can have all the pain relief you want,’ says Marie. ‘Your midwife is there to support and guide you. If you’re concerned about anything, ask your midwife and they’ll help you.’
9 ways to have a positive induction
Even with an induced labour, you still have plenty of options …
Make an informed decision
The first step is to find out all the facts. ‘Ask your midwife why they are recommending an induction and what it will involve,’ says Marie, ‘and talk through any specific concerns you have. This will help you make your decision based on evidence.’
Read positive induction stories
There are lots of myths surrounding induced labour. Marie suggests doing a ‘fear-dumping’ exercise. ‘If someone has told you a bad birth story, write it down, talk it through with your midwife or a friend, and then dump it. In other words, get rid of those negative thoughts and then fill that space in your mind with positive induction stories.’
Boost your oxytocin
Your body produces oxytocin to help with labour. So give it a helping hand by creating your own oxytocin boost. ‘I always tell mums that what got the baby in gets the baby out. And I don’t mean sex! Instead,
recreate that intimate feeling: privacy, low lighting, and a sense of safety,’ says Marie.
Create your own endorphins
Endorphins are another powerful hormone that can help during labour. ‘Endorphins are a natural pain relief,’ says Marie. ‘Oxytocin helps with your contractions, and endorphins work alongside them to relieve the pain. It’s like a hormone cocktail.’
A great way to boost your endorphins is by getting a massage from your birth partner. ‘Massage and touch are really effective during labour,’ adds Marie.
Rest when you can
An induced labour can last a while. So Marie recommends pacing yourself. ‘Take things as slowly as possible. If you fancy going out for a walk after your sweep, or when you’re on the ward, then that’s absolutely fine. But don’t overstretch yourself or you’ll be exhausted by the time you’re in labour.’
Fuel your body
After your sweep and the pessary or gel, make sure you eat and drink regularly to boost your energy and keep your blood sugar levels up. ‘When you have the hormone drip, we advise you don’t eat, so get that fuel in while you can,’ says Marie. Dehydration can slow down labour, so keep a water bottle on hand for regular sips.
Stay in the moment
Feeling overwhelmed at the thought of being induced? Marie recommends taking it a step at a time and using mindfulness techniques to be in the moment. ‘Rather than focusing on everything you feel, try to be as calm as possible and just go with it. Have a walk, have a bath. Don’t focus on every little twinge.’ She suggests using breathing and relaxation exercises to keep yourself as relaxed as possible.
Bring home comforts
You could be on the antenatal ward for up to 24 hours after the prostaglandins, so create a comforting environment for yourself. ‘Bring your pillow or pillowcase, and some photos. Some mums bring little affirmations on Post-It notes to really empower themselves.’
Work with your midwife
Remember: you’re not on your own. Instead, you have a top team alongside you while you’re being induced. ‘It’s all about communication. If you need something, tell your midwife and they’ll help you. If you’re worried about something during your induction, talk it through with them. We’re not there to tell you what to do – we’re there to help you in any way we can.’
Real mum experiences
‘I was induced in at 39+5 for reduced foetal movement but had a really positive experience. Even though the thought of induction was scary, and meant my birth plan had gone out the window, it all went smoothly, and ensured my baby was out when he needed to be!” - Claire Cronan, 24, from West Lothian, is mum to Aiden, seven months
‘I was dreading being induced as you hear horror stories of it taking days. I even put it back, hoping my daughter would come naturally. But she was having none of it, so I went in at 14 days overdue. But within an hour of the hormone drip, I went from being 1cm to 9cm dilated!’ - Kelly Macdonald, 35, from Cleethorpes, is a mum of six.
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