Induction of Labour (IOL)
Patient Information
Darent Valley Hospital
Darenth Wood Road
Dartford
Kent
DA2 8DA
Antenatal Clinic: 01322 428190
Tambootie Maternity Assessment: 01322 828280 / 428278
Community Midwives office: 01322 428753
Cedar Ward: 01322 428936
Delivery Suite 01322 428100 ext. 4313
www.dvh.nhs.uk
Authors: M. Penny, K. Woolway, G. Rustrick
Review date: April 2017, next review April 2020
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We understand that coming into hospital is a nervous time for anyone, especially
when you are coming in to have your baby. We hope to make your visit a positive
experience by providing you with the necessary information.
This leaflet aims to provide you with the knowledge to help you understand the
process of induction of labour, what to expect and why it is recommended for you.
What is Induction of Labour?
Induction of Labour (IOL) is the process of artificially starting labour.
Why are you being offered Induction of Labour?
IOL is offered to women for many reasons, including:
 If you are overdue.
 If your waters have broken and your labour hasn’t started.
 If you or the baby have health problems.
Most women’s pregnancies last between 37-42 weeks and spontaneous labour
occurs for most women between these dates. For some women, their labour does
not start spontaneously and IOL is offered at 12 days overdue. Research has shown
that, for some women, the placenta (afterbirth) does not work as effectively after 42
weeks.
Before you are induced.
As you reach 40 weeks pregnant, you will see your Midwife or Doctor for an
appointment and they will discuss with you the option of having a ‘membrane
sweep’. This is an internal examination whereby your Midwife or Doctor sweep their
fingers around your cervix (neck of the womb). This action should separate the
membranes (bag of waters) from your cervix. The separation releases hormones
(prostaglandins) which may encourage your labour to start. The baby’s heart beat
will be listened to before and after the procedure. It does not hurt the baby, but it can
cause mild discomfort for you and it can cause a small amount of bleeding or your
‘show’ to come away. If there is any heavy bleeding, you must contact your midwife
or the hospital for advice.
A sweep can be performed again at your 41-week appointment. Your Midwife or
Doctor will book your IOL at this appointment too. However, you do not have to have
a sweep if you do not want one.
What happens during induction?
At 10am, on the morning of the induction, you need to call Cedar ward on 01322
428936 or Delivery Suite 01322 428100 ext. 4313 (depending on the reason for
induction) and they will give you a time to come in. It is important that you bring
your pregnancy notes with you and your hospital bag.
For most women, the IOL has several stages:
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On arrival to the ward you will meet your Midwife and be shown around the
ward.
You will have your blood pressure, temperature and pulse checked and the
Midwife will feel your abdomen and listen to the baby’s heartbeat.
The Midwife will use a CTG machine to monitor the baby’s heartbeat for at
least 30 minutes and any contractions (if you are having them).
If the CTG monitoring is normal the Midwife will begin the IOL.
Propess
The majority of inductions begin with Propess. This is a thin pessary, like a tampon,
which has a hormone in it called prostaglandin. When you go into labour your body
releases a natural prostaglandin which causes changes to your cervix and allows the
body to go into labour. The Propess works in a similar way.
The Midwife will insert it close to your cervix and it stays inside the vagina for 24
hours. During this time, it slowly releases the prostaglandin hormone. The baby’s
heartbeat will be monitored for at least an hour after the Propess has gone in using
the CTG monitor. During the next 24 hours, you may experience some cramping
(like period pains), contractions, or your waters may break. It is possible for you to go
into labour with just the Propess.
During the time you have the Propess in; you can eat and drink normally, you can
leave the ward for short periods and walk around the hospital.
You have to be careful not to pull the Propess string when you go to the toilet or
have a shower or bath. If the Propess does come out, you must tell the midwife and
she can put it back in for you.
Some women can develop unwanted side effects from the Propess, including:
 Vaginal bleeding
 Diarrhoea / vomiting
 Contractions too close together (hyper stimulation).
If this happens, please let your Midwife know as she may need to remove the
Propess.
During this 24-hour period, your baby will be assessed regularly, using the CTG
monitor. You will also have regular observations performed to ensure your wellbeing.
You will be offered paracetamol and Dihydrocodeine for pain relief during this stage
if you require it.
At the end of the 24 hours, the Propess will be removed and the next part of the
induction will start.
Will I definitely need Propess?
Occasionally, on the first examination, your cervix may have already started to
change and the midwife will easily be able to feel the waters around your baby’s
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head. If this is the case, you will not receive Propess; instead you will be transferred
to Delivery Suite once there is a bed available.
If your waters have broken at home, prior to labour and your contractions have not
started, you will be booked in for IOL for the next day. You will not have Propess;
your induction will start with Prostin gel or a Syntocinon intravenous infusion.
Prostin Gel
If, after the Propess, your cervix has changed enough for you to have your waters
broken, you will be transferred to Delivery Suite when there is a bed available for
you. If there are no significant changes, you will have Prostin gel.
The Prostin gel has the same hormone as the Propess but it works slightly
differently. The gel is inserted close to your cervix using an applicator. Your baby’s
heart beat will be monitored for 30 minutes before Prostin and at least an hour
following the Prostin.
After this time, you can continue to eat and drink normally. You may shower or bathe
and you can leave the ward for short periods if you wish to. Your baby will be
monitored using the CTG machine and after 6 hours you will be assessed internally
again. If your cervix is still unchanged, you can have another Prostin gel. If, after the
second Prostin, your cervix is still closed, a doctor will come and discuss your
options. They may suggest waiting for 24 hours to see if labour begins or trying a
third Prostin. They will be able to answer any questions you may have and they will
explain everything in detail for you.
How long will it take to go into labour?
The induction process can take from a few hours up to a few days. It depends on the
reason for the induction and also the gestation at which you are being induced. We
need to ensure that you and your baby are safe; it may be that if Delivery Suite is
busy they may not be able to accept you to break your waters. Please be patient,
nature cannot be rushed.
Transferring to Delivery Suite
If your cervix has dilated enough to enable us to break your waters, you will be
transferred to Delivery Suite. Once you are on Delivery Suite a Midwife or Doctor will
break your waters using an Amnihook. This procedure can be uncomfortable for you
but is not harmful to your baby.
If your contractions have not started after 1-2 hours then you will have an
intravenous infusion (IV) called Syntocinon. This IV contains hormones that
artificially start contractions. It is administered through a pump and during this time
your baby will be continuously monitored on the CTG machine. Although this may
limit your ability to mobilise, you can still alter your position to aid your comfort and
promote the progress of labour. There are a range of pain relief options available to
you that you can discuss with your Midwife.
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Can I choose not to be induced?
Yes, if you do not want to be induced at the time when the Doctor or Midwife is
suggesting, you can talk through your options. The Doctor or Midwife will answer any
questions you have and give you information for you to make an informed decision.
More information
If you are being induced because your baby is overdue and you are otherwise low
risk and suitable for the Birth Centre, you can still go there if you go into labour using
Propess alone.
As IOL can take several days for some women, it is important to arrange child care
for your other children should this happen.
It is possible for you to have one person staying with you throughout the induction
process. Your birth partner can sleep on a recliner chair next to your bed. It is
advisable to bring a pillow and change of clothes for them. All other visitors and your
second birth partner are welcome between 2pm and 8pm whilst you are on Cedar
Ward. There is no visiting for anyone under 14; unless they are siblings of the new
baby.
There is no visiting on Delivery Suite except for Grandparents immediately following
the birth of their grandchild.
All of your meals and drinks will be provided for you, but your birth partner will have
to bring their own.
Car parking fees are not controlled by the hospital, any queries regarding parking
should be directed to the car parking kiosk in the main car park.
Commonly asked questions:
Can I shower or bath with Propess / Prostin in?
Yes
Can someone stay with me in the hospital?
Yes
Can I still go to the Birth Centre?
If you were previously suitable for the Birth Centre and Propess is enough to
bring about established labour then yes, you can still go to the Birth Centre.
Will the examination hurt?
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It can be uncomfortable during the insertion of the Propess / Prostin as it is
important for it to be in the right place. This will ease once the examination has
finished.
How long will induction take?
This depends on how quickly your body responds to the Propess / Prostin- but
for many women it can take between 24-72 hours.
Useful positions during induction and / or labour
Keeping
walking.
active
&
Leaning against a wall.
Leaning over
bean bag.
Leaning
against
Use of birthing ball –
back of chair.
a circulating hips and
moving side to side /
front
to
back
motions.
Keeping upright, your Birth
partner
Leaning
against arms on you birth keeping
you
back of bed.
partner’s shoulders mentally focused.
and gentle rocking /
swaying.
References:
National Institute for Health and Clinical Excellence (NICE) (2008) Inducing Labour.
Available
at:
https://www.nice.org.uk/guidance/CG70/chapter/1-Guidance.
(Accessed: 8.2.17).
National Institute for Health and Clinical Excellence (NICE) (2008) Induction of
Labour. Available at: https://www.nice.org.uk/guidance/CG70/ifp/chapter/About-thisinformation. (Accessed: 22.2.17).
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Use this space to make a note of any questions you have and they can be answered
prior to the start of your induction.
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