Induction Of Labour

INDUCTION OF LABOUR

Knowledge Base

What does induction of labour mean?

Induction of labour is starting a labour artificially. It may be recommended by your doctor or midwife if the benefits to you or your baby’s health are greater than the likely risks associated with the induction process.  Some of the reasons for thinking about induction are:

    • You have high blood pressure
    • Your are at least 10 days past your due date
    • Your have a health concern such as diabetes or kidney disease
    • Your baby’s growth is less than expected or the fluid around the baby is low without the waters having broken.
    • Your water sac breaks before labour starts. The longer the time between your water sac breaking (rupture of the membranes) and your baby’s birth, the increased risk of infection for both you and your baby

While induction of labour may take less time for some women, most often it is a longer process and may take several days. You may stay in hospital, or you may go back and forth from home to hospital, depending on the type of induction. Your doctor or midwife will discuss your choices, taking into account your and your baby’s health. Together you will decide which choices are best for you and your baby.

Be sure to ask any questions or raise any concerns. It is important for you to feel your choice is the best one for you and your baby.

How is labour induced?

The most common choices for inducing labour are:

Prostaglandin Gel
This drug is in a gel form and is placed in the vagina by your caregiver or the nurse. It helps to soften and shorten (ripen) your cervix. The gel may feel warm after it is inserted but this sensation will disappear in time. You will stay in hospital for at least one hour after the gel is inserted and you and your baby will be monitored during this time. This will mean that you will be in bed with the monitor attached to you. Most often you are able to go home after the hour. Someone must drive you home and stay with you. More that one dose of gel is often needed to start labour. Repeated doses of gel are given no less than six hours apart. Before you leave the hospital you will be given instructions on when to come back to the hospital. When you are at home continue to eat and drink as normal. Try to get as much rest as possible.

Cervidil
This drug is contained in a tampon that is placed in your vagina. There is a string attached so that it can be easily removed when necessary. The cervidal works in a similar way to the prostaglandin gel. It does not work immediately and it may take some hours before you notice any effect. In some cases you will remain in the hospital after the cervidal has been inserted so that you and your baby can be monitored. However, in most cases you will be sent home an hour after the cervidal has been inserted. Once at home you can continue with normal activity but you should avoid bathing (showering is fine). Do not pull on the string that is attached to the cervidal. If the drug falls out of the vagina do not panic but give us a call at 604 875 3070.

Oxytocin
Oxytocin is a naturally occurring drug that your body releases when you are in labour and when you breastfeed. This drug is given to you through an intravenous line. The amount of drug given is controlled with a pump, and adjusted until the contractions occur regularly. Once the oxytocin has been started you will be attached to the monitor so that the frequency of contractions as well as your baby’s response to these contractions can be monitored. This will mean that you will be confined to bed during the induction. Oxytocin is used if the cervix is soft and dilating or the other forms of induction of labour are not recommended for medical reasons. Patients who have had a previous caesarean section and who are attempting a trial of labour (VBAC) would usually be given oxytocin if they need to be induced.

Rupture of the Membranes (Breaking the Water Sac)
If your cervix has begun to open it may be helpful to break the water sac (membrane) that surrounds your baby. A small sterile tool is used to make a small hole in the water sac and the fluid (waters) will leak out. The process may be a bit uncomfortable, but is not painful, and does not harm the baby. If breaking the waters does not start the labour then other methods of induction might need to be used as well in order to get your labour going, such as the gel or oxytocin mentioned above.

Foley Catheter
This is a small rubber tube with a bulb on the end that can be placed in your cervix. The process may be uncomfortable but usually is not painful. The size of the bulb is increased by adding fluid, and the pressure of the bulb slowly and gently stretches your cervix. The tube of the catheter is then attached to your leg .The tube is usually pulled tight and taped to your leg. This form of induction is not used very often today.

What do I do while waiting for labour to start?

The process of induction can take a long time, depending on how ripe the cervix is and the type of medication used to induce you. Once the induction process has been started and you are at home waiting for the contractions to start, it is important to keep well hydrated and to keep eating .Eat and drink whatever you like, but don’t force yourself to eat if you feel nauseated. Do not drink any alcohol. It is also important to get rest, as once you are in labour you will need a lot of energy and you might not be able to rest once the labour is established. You may bathe or shower unless you are told not to.

When do I come back to the hospital?

Before leaving the hospital you will be given instructions on when to return to the hospital.

Come back to the hospital if you experience contractions that are strong enough to stop you from talking or walking. The contractions should also be at least 3 to 5 minutes between the start of one and the next, and the contractions should last at least 45 seconds long.

If your waters break and there is a lot of bleeding or if the waters are green in color come back to the hospital. Also if your waters break and you have tested positive for Group B Streptococcus come back to the hospital.

While you are at home please monitor the movements of your baby. A lot of babies move less before the start of labour .However babies should still move from time to time especially after you eat or drink. If you have not felt any movement in 3 hours and the baby has not moved after eating or drinking please come back to the hospital.

What do I do if my waters break before labour starts?

If your water breaks before your labour starts do not panic. Look at the colour of the water. The water is usually clear but may be pink or yellow. If the water is green make your way to the hospital. A little bit of bleeding is normal but if you notice heavy bleeding please make your way to the hospital. It is also important to know whether you are a carrier of Group B Streptococcus (GBS) in your birth canal. You will usually be tested for this at 36 weeks. If you have GBS then please come to the hospital if your water breaks as you will need to be started on antibiotics to prevent the bacteria getting to the baby which in some cases can cause an infection in the baby.

If you do not have Group B Strep and your water has broken you can wait up to 8 hours before coming to hospital as long as the water is clear and the baby is moving. If you have any concerns please call 604 875 3070 or come to the hospital.

Who do I call at the hospital before I come in?

604-875-2165 or
604-875-3070