Patient Information
Maternity Services
Women’s, Children’s & Sexual Health Directorate
INDUCTION OF LABOUR WITH
PROPESS
Name
Proposed Date of Induction of Labour with Propess
Time of Admission
Please come to
(Tel: 01245 362305)
Please telephone the Day Assessment Unit at 09:00 am on the morning of your admission
to confirm that a bed is available. You will be allocated a bed on either Day Assessment
Unit or Labour Ward, depending on your circumstances.
Due to the unpredictable nature of maternity care, the wards may be very busy. If so, it
may be necessary to re-schedule your induction, either for later in the day or on the
following day. This would be after a review of your case notes and according to medical
need.
INDUCING YOUR LABOUR
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This leaflet is to give you details about having your labour started artificially (being
induced). We appreciate that you may be disheartened about this, but we will do all
we can to meet your birth plan wishes as closely as is possible.
Please note that If you are being induced for an overdue baby you are no more likely
to need a caesarean section than if you go into labour spontaneously
Please do ask if you have any queries (please see the separate ‘Induction of Labour (IOL)’
leaflet – MEHT000281)
Unfortunately for most women being induced, a water birth is no longer an option.
PROVIDING WOMEN CENTRED CARE
Mid Essex Maternity Service aims to provide women centred care at all times. This
information leaflet is underpinned by that philosophy.
A planned induction of labour should take into account a women’s individual needs and
preferences. You will be given the opportunity to make informed decisions about your care
and treatment, in partnership with your healthcare professionals.
Maintaining good communication between yourself and the healthcare professionals who
are looking after you is essential. Our aim is to make sure you have received the
appropriate level of information to enable you to make informed decisions about your care.
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Patient Information
We encourage you to talk to the midwives if you feel you need more information or you still
have any outstanding questions or concerns.
REASONS WHY MY LABOUR IS BEING INDUCED?
Your individual circumstances should already have been discussed with you before your
labour is induced. Approximately one in five women need to have their labour started
artificially (this is called induction). The commonest reasons are:
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You are overdue – studies show that babies are at slightly more risk from developing
health problems during pregnancy and labour after 41 weeks gestation
(Only 4 out of 100 babies arrive on their expected date)
You have a medical problem such as high blood pressure or diabetes
Your baby is smaller or larger than expected
WHAT HAPPENS IN HOSPITAL?
On arrival to the Day Assessment Unit you will have a midwife allocated to look after you.
Your blood pressure, temperature, respirations and pulse will be checked and a urine
sample tested. We also take blood from you for a full blood count and a group and save; if
these have not been taken recently. Before starting your induction of labour, a
cardiotocograph (CTG) is performed; which is a tracing of your baby’s heartbeat pattern to
check his/her wellbeing. The midwife will then perform a vaginal examination to see if your
cervix is ripe. If it is not, we will attempt to ripen the cervix using a pessary called propess.
HOW WILL I BE INDUCED?
Depending on how favourable your cervix is; one or all of the following procedures may be
required:
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Propess Pessary
Artificial Rupture of Membranes
Oxytocin Drip
Initially your labour is usually induced with a propess pessary. The pessary looks like a
very small tampon which is inserted into the vagina. It contains prostaglandins which are
released slowly over 24 hours to ripen your cervix.
Once inserted into the vagina it will stay there for 24 hours. There is a string attached to
the pessary to allow us to remove it easily. The string will be placed inside the vagina.
ADVANTAGES OF INDUCTION
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To benefit your health if you have or are developing medical problems
To benefit the health of your baby
You will have a date to plan towards, but you could go into labour naturally in the
meantime
Prostaglandins increase the likelihood of a successful Induction of Labour, and
achieving a vaginal delivery within 12 to 72 hours
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Patient Information
DISADVANTAGES OF INDUCTION
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Women are likely to find induced labour to be more painful than spontaneous labour
You may wish to reconsider your choice of analgesia before you are induced.
In the early stages of labour some women may experience a sudden onset of regular
contractions that requires stronger pain relief. This can be because your body has not
had time to release the natural pain relief (known as endorphins). Women are
supported and encouraged to remain calm so they can feel in control during this time.
Women are also encouraged to stay mobile, and take a warm bath during the early
stages of their labour.
There can be a delay between the induction starting and your labour becoming
established, this can sometimes be over 24-48 hours
Occasionally once the induction process has been started there may be a need to
delay the on-going process for a period of time. If this happens your obstetrician/
midwife will explain the reasons for any delay in the process and discuss your ongoing plan of care
Rarely an induction using propess can cause hyper stimulation of the womb (no
breaks between your contractions). If this happens the Midwife/Doctor can remove the
propess if necessary
More internal examinations are needed during an induction of labour to assess your
progress and the need for further treatment. Some women find these uncomfortable
and/or painful
If you are being induced because you or your baby have a health problem, there is a
higher chance of needing a caesarean section
An instrumental delivery is more likely
An induction may not always be successful. Your care will be reviewed by a senior
obstetrician and your future plan of care discussed with you based on you individual
specific needs
PAIN RELIEF
Your Midwife will discuss with you the pain relief options that are available for you.
We will do our best to provide you with the pain relief appropriate to your pain. This can
range from simple analgesics to epidural analgesia. If an epidural cannot be provided
immediately an alternative form of pain relief will be provided.
WHAT YOU NEED TO BE AWARE OF ONCE THE PESSARY IS
IN PLACE
After the pessary has been inserted, you will be asked to remain on your bed for 30
minutes. This allows the pessary to absorb moisture from your vagina, which will make the
pessary swell and prevent it from falling out. During this time a further CTG will be
performed, and if normal you move around freely and mobilise within the hospital confines.
If the string from the pessary moves to the outside of your vagina you must be careful not
to pull or drag on it, as this may cause the pessary to come out.
A repeat CTG will be performed 6 hours later and if you are not in labour and the
assessment at that time is normal, you will be sent home. Occasionally, you will be kept in
the hospital if you have a medical condition which requires induction of labour in the
hospital.
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Patient Information
On being sent home you should be advised to contact the Labour Ward on 01245 362305
if you start contracting overnight; and if not the Day Assessment Unit (DAU) on 01245
362305 at 07:45 hours with a view to you returning at 08:30 hours the following morning
for a further review: dependent on when the propess pessary was inserted.
Please take special care
 When wiping yourself after going to the toilet
 After washing yourself
 Getting on and off the bed
In the unlikely event that the pessary should come out, please inform the midwife
immediately. The pessary will need to be reinserted.
Inform the midwife if:
 You experience regular contractions
 Your waters break
 If you experience reduced fetal movements
 If you are worried
 If labour should start, the pessary will be removed if your cervix is at least 3cms dilated
WHAT HAPPENS 24 HOURS AFTER THE PESSARY IS
INSERTED?
You will have an internal examination by the midwife. If your cervix is ripe, your waters will
be broken. You will then be transferred to the Labour Ward 2-4 hours later, as soon as a
bed is available for you, where a drip will be set up to stimulate your contractions. If your
cervix is not ripe the midwife will discuss further treatment with you at this time.
ARTIFICIAL RUPTURE OF THE MEMBRANES (ARM)
Artificial rupture of the membranes occurs when the water sac around the baby is broken
artificially. This procedure is part of the induction of labour process once the cervix has
begun to open.
An ARM will allow the following:
 It is performed before an oxytocin drip (see subsection below entitled ‘oxytocin’) is
used
 The procedure is performed during an internal examination so some women find it
uncomfortable; it does not hurt the baby
 It allows us to see the colour of the water (liquor), which is another guide to your
baby’s wellbeing
You will need to wear a sanitary pad as the waters continue to drain until your baby is
born. You will be encouraged to mobilise.
OXYTOCIN
This is a natural hormone that when manufactured synthetically is known as syntocinon. It
is given to establish your labour, or if the above methods have not achieved this stage in
your labour. It is also used if your waters have broken and your contractions have not
started within 24-48 hours.
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Patient Information
The following points describe the process for commencing syntocinon in general terms:
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Your waters should be broken first, either naturally or by an artificial rupture of the
membranes (ARM)
You will need to be transferred to the Labour Ward
You will need to have a drip placed into your arm
Your baby’s heartbeat pattern will need to be monitored continuously with the CTG
monitor
The syntocinon is increased slowly according to your contractions
It is still possible to be out of bed with the monitor and drip attached
If your waters are artificially broken (ARM), your midwife will monitor your baby’s heartbeat
for one hour on a CTG machine to check your baby is happy. A syntocinon hormone drip
will then be commenced after that hour, once your midwife has confirmed your baby’s
wellbeing. It has been shown that women with a syntocinon drip are more likely to need an
epidural for pain relief.
WHAT HAPPENS WHEN LABOUR STARTS?
If you are a ward attendee on the Day Assessment Unit you are encouraged to be up and
about, having warm baths, using the birthing ball and your TENS machine if you wish. A
midwife will check your contractions and the baby’s heartbeat. Dependent upon how
quickly your contractions become painful and regular you may wish to bring with you
things to distract you (e.g. music, magazines to read etc.) as labour may take up to two
days to become established.
When your labour becomes established i.e. your contractions are coming regularly and the
cervix is beginning to open up, you will be transferred to the Labour Ward. You will then be
allocated a midwife based on the Labour Ward to look after you. If you are already on the
Labour Ward, you are still encouraged to be up and about.
CAN I AVOID HAVING MY LABOUR INDUCED?
Before labour starts your cervix (neck of the womb) has to become softer and shorter.
There are several ways this can happen before you labour needs to be artificially induced
as follows:
Membrane Sweeping ‘Stretch and Sweep’
Before your induction date it is usually possible to have a ‘stretch and sweep.’ This
involves the midwife or obstetrician undertaking an internal examination placing a finger
just inside your cervix and making a circular sweeping movement to separate the
membranes from the cervix. This can be carried out at home, or at an outpatient
appointment or in hospital.
Stretch and sweeps are performed from 41 weeks of pregnancy and not before unless
authorised by an obstetrician.
A ‘stretch and sweep’:
 Has been shown to increase the chances of labour starting naturally within the next 48
hours and can reduce the need for other methods of induction of labour
 May be slightly uncomfortable
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Patient Information
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May cause some slight pains and a small amount of bleeding
Is not recommended if your membranes have ruptured (waters broken)
There is no increased chance of infection either to you or your baby.
NATURAL METHODS
The natural methods have not been fully researched or proven to work, but some women
find them useful: (please refer to Medicines Helpline on telephone number 01245 514822)
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Making love – this is thought to release hormones that prepare the cervix for labour. If
you have been told that you have a low-lying placenta or any bleeding this is best
avoided.
Complementary therapies – these should be used with advice from a specialist as they
can have side effects or complications
INFORMATION AND COMMUNICATION
At all stages you will be kept fully informed and your wishes will be taken into account.
Please do ask if you do not understand anything or wish for clarification.
CONTACTS / FURTHER INFORMATION
If you would like further information, regarding the evidence printed in this leaflet please
contact Day Assessment Unit on 01245 362305 and ask to speak to the DAU midwife or
refer to:
www.nice.org.uk
www.nhs.uk/Conditions/pregnancy-and-baby/pages/induction-labour.aspx
Please ask if you require this information in other languages, large print, easy read
accessible information, audio/visual, signing, pictorial and change picture bank forma via
the Patient Advisory Liaison Service (PALS) on (01245) 514235.
Mid Essex Hospital services NHS Trust is smoke-free. You cannot smoke on site.
For advice on quitting, contact your GP or the NHS smoking helpline free, 0800 169 0 169
Charitable donations can make a very real difference to the level of patient care at our
Trust. As well as contributing to new facilities, donations can be used to buy specialist
equipment and smaller items to make patient’s stay in hospital more comfortable. For
information about making a donation please contact the Charities Office on 01245 514559
or visit the website at: http://www.meht.nhs.uk/our-charity/
Document History
Department
Published/Review:
File name
Version/ref no
Maternity Services
October 2014 / September 2017
Induction of Labour with Propess
2.1 / MEHT000283
Induction of Labour with Propess
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