Induction of Labour
Can I go home during the induction process?
What is induction of labour?
Induction of labour means helping labour to start using medicines or other methods when giving birth may be safer than continuing the pregnancy. This may be recommended if continuing the pregnancy could carry more risk for you or your baby than giving birth. It is common. Around 1 in 4 women have their labour induced.
Every pregnancy is different. Your midwife or doctor will explain why induction is being offered, discuss your options, and support you to make the decision that is right for you.
Why induction may be offered
You may be offered induction for several reasons, including:
- pregnancy reaching 41 weeks or beyond
- waters breaking without labour starting
- diabetes
- high blood pressure
- reduced baby's growth
- concerns about your baby's wellbeing
- medical conditions affecting you or your baby.
Is induction my choice?
Yes Induction is your choice. Your care team will explain:
- why induction is being recommended
- the benefits
- the possible risks
- any alternatives
- what may happen if you choose to wait
You can ask questions at any point before making your decision.
Before your induction
From around 34 weeks, your midwife or doctor will start discussing your birth plan with you.
Before induction you may be offered:
- membrane sweep(s)
- an examination of your cervix (Bishop score)
- discussion about whether your induction will take place in hospital or partly at home
- information about the different methods available
- an induction date is booked
Membrane sweep
A membrane sweep is a vaginal examination. Your midwife or doctor gently separates the membranes around your baby from the cervix.
This may help labour start naturally and can shorten the induction process by making your cervix more favourable. It is usually offered from 39 weeks onwards.
Induction of labour timeline:
What happens on the day
On the day of your induction, please call Katherine Ward at 8am: 01895 279462
We will give you a time to come to the hospital. Katherine ward is on the first floor in the Maternity Building.
When you arrive, we will:
✔ check your observations
✔ monitor your baby's heartbeat
✔ assess your cervix
✔ discuss the next steps with you
Your induction plan will then begin.
Can I go home during the induction process
If you are being induced after 41 weeks and your pregnancy has been straightforward, you may be able to spend part of the induction process at home. This is called outpatient induction.
Outpatient induction is only offered when specific safety criteria are met. Your midwife will explain whether this is suitable for you.
How is labour induced?
There are several ways to help labour start. Your midwife or doctor will recommend the safest option for you and your baby.
1. Hormone medication
Prostaglandin medicines help soften and open the cervix. Options may include:
- Oral misoprostol (Angusta®) A small tablet taken by mouth.
- Propess® pessary A small pessary placed in the vagina, usually for up to 24 hours.
- Prostin® gel A gel placed in the vagina to help soften the cervix. It is usually given every 6 hours, up to a maximum of 2 to 3 doses.
Your clinician will explain which option is recommended for you. At Hillingdon Hospital, many women are now offered oral misoprostol (Angusta®) as the first method of induction when it is suitable.
Research shows oral misoprostol may:
- shorten the overall induction process
- increase the chance of giving birth within 24 hours
- reduce the need for an oxytocin drip
- reduce the number of vaginal examinations for some women, especially if the waters have already broken
Oral misoprostol is not suitable for everyone. Your doctor or midwife will discuss whether it is appropriate for you.
2. Balloon catheter
A small balloon is gently placed through the cervix and inflated. This helps the cervix open without hormone medication. A balloon catheter may be recommended if you have had a previous caesarean birth, or if hormone medication is not the best option for you.
Breaking your waters
This is also called artificial rupture of membranes or ARM and is done on Labour Ward.
Once your cervix is open enough, your midwife or doctor may break your waters. This involves an internal examination and a small opening being made in the membranes using a slim plastic instrument with a tiny hook. Breaking your waters can help contractions become stronger and more effective. If your waters have already broken, the clinician will check whether any membranes remain in front of your baby's head and break them if needed.
Oxytocin drip
If your contractions do not start ,or are not strong enough after your waters have been broken, we may recommend an oxytocin drip. Oxytocin is given through a cannula in your hand or arm to help your womb contract regularly. Your baby's heart will need to be monitored continuously while you are on the drip. This is done on Labour Ward.
Pain relief during induction
Every labour is different. Some women find induced contractions stronger or more frequent than spontaneous labour. Others find them similar. Our team will support you and help you choose the pain relief that is right for you.
Before established labour
While your cervix is softening and opening, simple pain relief may be enough.
You may choose:
- Movement and different positions: Walking, standing, sitting on a birth ball or changing position can help you stay comfortable and encourage labour to progress.
- Warm bath or shower, where available: Warm water can help relieve discomfort and promote relaxation.
- TENS machine: A TENS (Transcutaneous Electrical Nerve Stimulation) machine delivers gentle electrical impulses through pads placed on your back. Many women find this helpful in early labour.
- Entonox, also called gas and air: A mixture of oxygen and nitrous oxide that you breathe through a mouthpiece during contractions. It works quickly and wears off quickly.
- Opioid injections: Medicines such as diamorphine or morphine (depending on hospital practice) can reduce pain and help you relax. They may make you feel sleepy and are usually used before labour is well established.
During established labour
As labour becomes stronger, more pain relief options are available.
- Entonox ("Gas and Air"): Many women continue using gas and air throughout labour.
- Remifentanil patient-controlled analgesia (PCA): Remifentanil is a strong, short-acting opioid pain medicine given through a drip in your arm. You control each dose by pressing a button just before a contraction starts. The pump is programmed for safety, so you cannot give yourself too much medicine.
Benefits
- Provides stronger pain relief than opioid injections.
- Works very quickly (within about a minute).
- Wears off quickly between contractions.
- Can be a good option if you do not want, or cannot have, an epidural.
Things to be aware of
- It does not remove all pain, though can be used together with Entonox.
- It can make you sleepy and slow your breathing, therefore you will be given supplemental oxygen throughout.
- You and your baby will be monitored continuously while using it, and your midwife will remain with you throughout.
- Whilst not specifically licensed for use in the UK, use of Remifentanil PCA in labour is supported by NICE guidelines from 36 weeks of pregnancy onwards.
- It may not be suitable if you have certain cardiac or respiratory conditions.
- Epidural: An epidural is the most effective form of pain relief during labour. An anaesthetist places a small tube into your lower back. Pain-relieving medicine is then given around the nerves that supply the womb and birth canal. It provides excellent pain relief while allowing you to stay awake and involved in the birth. Your anaesthetist will discuss the benefits and risks with you before the epidural is inserted.
For more information:
https://thh.nhs.uk/pain-relief-options
How long does induction take?
This is one of the most common questions. There is no single answer.
For some women, labour begins within a few hours. For others, it can take a few days, especially if this is your first baby and your cervix is not yet ready. We understand that waiting can feel difficult. Sometimes there may also be a delay in transferring you to Labour Ward, because one-to-one care is needed there. If this happens, staff will keep you updated and support you throughout.
Risks of induction
Like any medical treatment, induction has benefits and risks.
Possible risks include:
- induction not working
- longer hospital stay
- needing more interventions
- assisted birth (ventouse or forceps)
- emergency caesarean section
- contractions becoming too frequent (rare)
Your individual risks depend on why induction is being recommended. Your midwife or doctor will discuss this with you.
Frequently asked questions
Can I eat?
Usually, yes. You can normally eat and drink during the early stages of induction unless your care team advises otherwise. If your plan changes, or if there is a medical reason to avoid food or drink, your midwife or doctor will explain this to you. We tend to ask you not to eat, once you are on the oxytocin drip.
Can I walk around?
Yes. We encourage you to stay mobile where possible, as walking, standing, using a birth ball or changing position can help you stay comfortable and may support labour to progress. Your midwife will let you know if monitoring or treatment means you need to stay close to the bed or ward area.
Can my partner or support person stay?
We encourage women to have a partner or support person with them during induction. Visiting arrangements can vary depending on where you are being cared for and what stage of induction you are in. The team will explain the current arrangements when you attend.
Will my induction happen on the booked date?
We will always try to start your induction on the booked date. However, the timing may change if Labour Ward is very busy or if emergencies need to be prioritised.
If there is a delay, we will keep you informed and continue to check that you and your baby remain safe while you wait. We understand that delays can feel frustrating or worrying, and staff will support you throughout.
What should I bring with me?
Please bring your maternity notes, any medicines you take regularly, comfortable clothes, toiletries, phone charger, snacks and drinks, and items for your baby. Because induction can take time, you may also want to bring something to help you pass the time, such as a book, headphones or a tablet.
How long will I be in hospital?
This varies from person to person. Some women go into labour within a few hours, while for others induction can take a few days. How long you stay will depend on how your body responds, your baby's wellbeing and whether you are suitable for outpatient induction.
What happens if induction does not work?
If induction does not start labour, your doctor or midwife will review your care with you. They may discuss trying another method, waiting a little longer if it is safe to do so, or recommending a caesarean birth. The plan will depend on your individual circumstances and your baby's wellbeing.
Will my baby be monitored?
Yes. Your baby's heartbeat will be checked during induction. The type and frequency of monitoring will depend on the induction method being used, your pregnancy history and how labour is progressing. If you need an oxytocin drip, your baby's heart will be monitored continuously.
Can I change my mind?
Yes. Induction is your choice. You can ask questions, take time to think, and discuss alternatives with your midwife or doctor. Your care team will explain the benefits and risks of each option so you can make an informed decision.
Any questions we have not answered?
Every pregnancy is different. If you have questions about why induction has been recommended for you, or whether another option may be suitable or any other queries, please speak to your midwife or obstetrician. We want you to feel informed, supported and involved in every decision about your care.
Contact us
If you have questions before your induction, or you think you are in labour, please contact:
Maternity Triage
Telephone: 01895 279054
Available 24 hours a day.