Most women will go into labour spontaneously between 37 and 42 weeks of pregnancy. Although most pregnancies continue safely beyond the estimated due date, research shows that certain risks gradually increase after 41 weeks of pregnancy. These risks remain small for most women but are important to consider when making decisions about ongoing care and the option of induction of labour.
As pregnancy continues beyond the due date, your midwife will discuss the options available to you, including ongoing monitoring and induction of labour, to help you make an informed decision about your care.
You may be offered a membrane sweep, which involves a vaginal examination during which a midwife or doctor gently sweeps a finger around the cervix. This can encourage the release of naturally occurring hormones (prostaglandins) that may help labour to start. Having a membrane sweep is optional, and your healthcare professional will explain the procedure, benefits, and potential discomforts before asking for your consent.
Induction of labour
Induction of labour is the process of artificially starting labour. It may be recommended when the benefits of giving birth are considered greater than the benefits of continuing the pregnancy.
Induction may be offered if:
- Pregnancy has continued beyond 41 weeks
- The waters have broken but labour has not started naturally
- There are concerns about the health or wellbeing of the mother or baby
Your midwife or obstetrician will discuss the reasons for recommending induction and explain the benefits, risks, and alternatives available to help you make an informed decision.
If you decide to proceed with an induction of labour, your midwife or obstetrician will arrange this during an antenatal appointment. The Birthing Suite will contact you within 72 hours to arrange a date and time for your induction and provide details about where to attend.
Occasionally, planned induction dates and times may need to be adjusted due to activity levels within the maternity unit and the needs of women requiring urgent care.
If you have not been contacted by the Birthing Suite within 72 hours, please telephone the Birthing Suite on 028 9442 4167.
Your maternity team will keep you informed of any changes and will be available to answer any questions you may have throughout the induction process.
How labour is induced
If induction of labour is recommended, your healthcare professional will discuss the most appropriate method based on your individual circumstances and how ready your cervix is for labour.
Methods of induction may include:
- Prostaglandin pessaries to help soften, shorten, and open the cervix.
- Balloon catheter insertion, a mechanical method used to help the cervix dilate.
- Artificial rupture of membranes (ARM), where the waters are broken to encourage labour to start or progress.
- Oxytocin infusion (hormone drip) to stimulate regular contractions.
For many women, the first stage of induction involves cervical ripening, which helps prepare the cervix for labour. This may involve prostaglandins or a balloon catheter.
It can take many hours, and sometimes longer than expected, for cervical ripening to occur. During this time, you will usually remain in the maternity unit, although some women may be suitable for outpatient (home) cervical ripening and can return home following assessment.
If labour does not start following cervical ripening, additional interventions may be recommended. These may include artificially breaking the waters (ARM) and/or starting an oxytocin infusion to encourage regular contractions.
When induction does not lead to labour
Occasionally, induction of labour is unsuccessful and labour does not begin despite treatment. If this happens, your obstetrician and midwife will review both your wellbeing and your baby’s wellbeing and discuss the options available to you.
Depending on your individual circumstances, these may include:
- Trying another method of induction
- Waiting and reassessing after a period of time
- Planning a caesarean birth
Your maternity team will discuss the benefits, risks, and alternatives of each option to help you make informed decisions about your care.
Resources
Overview: Inducing labour (NICE Guidance)
Inducing Labour: Reasons, methods and side effects (Tommy’s)
The Pregnancy Book (Chapter 9) | HSC Public Health Agency