When your pregnancy is induced

Your due date has come and gone, and your midwife’s started talking about induction. So what exactly does it involve, and is it ever better to let nature to take its course?

The last weeks of pregnancy can feel like one long waiting game. But some babies are in no rush to be born, and with your due date disappearing into history, your consultant may decide to induce labour – in other words, start it off artificially.

‘There is no such thing as a textbook induction, and it’s difficult to predict how things will go,‘ explains Lesley Regan, professor of obstetrics and gynaecology at St Mary’s Hospital, London, and author of Your pregnancy week by week (£18.99, Dorling Kindersley). ‘This is why most midwives and doctors are hesitant to recommend induction without a good reason.’

That means, then, that you can’t sweet-talk your consultant into kick-starting your labour just because you’re fed up of being pregnant. But according to the latest stats, almost 20 per cent of mums-to-be do end up being induced.

Why might I be induced?

The most common reason for induction is if your pregnancy continues beyond 41 weeks, although the exact point at which it’s offered depends on your hospital.

Sometimes, even before your due date, there may be indications that your baby would be better off outside the womb. ‘Induction may be recommended if his growth has slowed down or stopped, or if there are signs that he is distressed, such as a reduction in his movements or in the amount of amniotic fluid,’ explains Professor Regan. ‘This usually suggests that the placenta is no longer functioning properly.’ 

You may also be offered induction if there are concerns about your own health. Conditions such as pre-eclampsia or gestational diabetes often worsen as pregnancy progresses, meaning it’s best to deliver sooner rather than later. Induction might also be offered if you have a pre-existing condition such as heart, liver or kidney disease.

You’d be forgiven for thinking that if your waters break, you’re well on the way to giving birth, and indeed, 90 per cent of women do go into labour within 24 hours. But if you don’t, you and your baby are at risk of infection, so induction is often recommended, especially if nothing has happened after four days.

How does it work?

Before you’re booked in for induction, you’re likely to be offered a membrane sweep. ‘Your doctor or midwife will gently insert one or two fingers through the cervix and lightly sweep them around,’ Professor Regan explains. ‘This often helps to start contractions, because it releases prostaglandins from the cervix.’

If the sweep doesn’t work, in most cases the first step is to use prostaglandin gel or pessaries, which are placed in your vagina and ripen your cervix, ready to start contracting.

‘A second dose may be needed about six hours after the first, and some women require further doses,’ says Professor Regan. After each dose, your baby will be monitored for 30 minutes to make sure he’s coping.

Prostaglandins work for 40 to 50 per cent of women, but if they don’t, or if your waters have already broken, you may be given Syntocinon, an artificial form of the hormone that triggers contractions, which is administered by drip.

‘The starting dose is always small, and is gradually increased until effective contractions have been established,’ says Professor Regan.

Once you’re 2-3cm dilated, it’s usually possible to artificially break your waters using a long plastic hook. ‘This releases more prostaglandins to help establish regular contractions,’ explains Professor Regan. ‘In some inductions, no further intervention is required after artificially rupturing the membranes.’

What are the risks?

Although there are benefits to induction, it’s not a risk-free procedure. ‘Induced labour may feel more painful, because you don’t experience the gradual increase in contractions that you would have with a spontaneous labour,’ explains Professor Regan. ‘Most maternity units recommend you have an epidural if you’re induced.’

Induction with Syntocinon can also increase the risk of your baby becoming distressed. ‘This is because the contractions can be strong and start suddenly, before the baby has got used to more gentle uterine activity,’ explains Professor Regan. ‘For this reason, you will need to be monitored continuously.’

The combination of artificially induced contractions, epidural and continuous monitoring means that you’re more likely to need assistance to deliver your baby. ‘Overall, 70 to 80 per cent of inductions result in a vaginal delivery, but they do increase the risk of needing forceps or ventouse extraction,’ says Professor Regan.

There’s also some evidence that induced labours are more likely to end in a caesarean. Although an induction performed simply because you’re overdue is just as likely as a spontaneous labour to end in a vaginal delivery, if you’re induced for a medical reason, for example because your baby isn’t growing properly, he may become distressed by the intensity of labour and need to be delivered by caesarean.

Bear in mind, too, that induction doesn’t always work. ‘It can take days to encourage an unwilling body into labour,’ explains independent midwife Virginia Howes (kentmidwiferypractice.co.uk). And there’s no going back – if induction doesn’t succeed, your only remaining option is a caesarean.

Can I refuse?

Although sometimes, induction is strongly advised for medical reasons, you’re not obliged to accept, especially not simply because you’re overdue. ‘Post-term induction shouldn’t be seen as routine,’ says Virginia. ‘In fact, in a healthy pregnancy, you needn’t give it a second thought until you’re two weeks past your due date, as a normal, full-term pregnancy lasts between 37 and 42 weeks.’

If you decline induction, you should be offered twice-weekly monitoring to check your baby’s wellbeing once you reach 41 weeks, and a scan to check the volume of amniotic fluid and the blood flow through the cord. These checks will help to establish your baby’s wellbeing, and if he’s still thriving, there’s no need to be induced.

‘If you think you’ll find it difficult to resist the pressure to be induced, you can ask your community midwife if she’ll do your post-term checks, rather than having them at the hospital,’ advises Virginia. And bear in mind that although declining induction can feel like you’re just prolonging the wait, only eight to 10 per cent of women fail to go into labour naturally by 42 weeks, so the end is in sight – honest.

‘I wanted to be active, not stuck on a drip’

Kate Fever, 22, is a customer service assistant from Tiverton and mum to Gemma, 15 months

I wanted a natural birth, and I felt that if my baby came when she was ready, I’d be less likely to need interventions. So when I went overdue, I decided against being induced. My community midwife supported my decision. I had an extra scan, and was monitored every couple of days.

I tried everything to kickstart labour, from curries to long walks. I also had a membrane sweep. But eventually, labour started naturally, 12 days overdue. It was great to be able to walk around, have baths and use my birth ball, rather than being stuck on a drip.

Unfortunately, after 22 hours, Gemma became distressed and I ended up with a caesarean. I was gutted, but I was still glad I resisted induction. The first part of my labour was fantastic, and although Gemma needed some help to be born, she decided when the time was right.

‘Induction was the best thing for my baby’

Julia Davis, 38, is a full-time mum to Ffion, three months, and lives in Abergowrie

I had pre-eclampsia from 31 weeks, but two days before my due date, my symptoms became a lot worse, with severe headaches and visual disturbances. My consultant felt the risks to me and my baby justified inducing labour with prostaglandin gel.

After the first dose, I began to get cramps, but I didn’t dilate. But the second, six hours later, took effect very quickly, and within a few hours I was fully dilated. Ffion was born naturally after just half an hour of pushing.

Although my labour was quicker than I’d expected and very painful, I was pleased I pushed Ffion out by myself. I’d have preferred to go into labour naturally, but induction was definitely best for me and my baby.