Inducing Labour

What does ‘inducing labour’ mean?

Most women start labour naturally without any external intervention. However, some women find that their pregnancy continues long past their due date, in which case labour may be encouraged using a variety of methods such as synthetic hormones or artificially breaking the waters. Inducing labour means artificially starting the birth process.

Why would you need to be induced?

There are several reasons a woman may need an induction. Inductions are, in general, avoided unless they are medically necessary. For example, if the mother has a disease, such as pre-eclampsia, which threatens the safety of either the mother or the baby. Induced labour may be recommended if the waters have already broken but labour has not started, because the risk of infection is much greater when the waters have broken. If you are diabetic labour may be induced at 38 weeks (provided the baby is growing normally), whereas in most cases an induction would not be considered until after 40 weeks of pregnancy. Today, inductions are only thought to be worthwhile when the risks involved with continued pregnancy are greater than the risks of induction.

However, some women still request ‘social inductions’, which are done for personal reasons such as a partner being required to go abroad resulting in them missing the birth. These are assessed on an individual basis, but induced labour is generally not recommended in these cases because of the potential complications.

How is labour induced?

There are many methods of inducing labour. Some are scientific, proven methods and some are natural home remedies with little research but a host of anecdotal claims to back them up. You should discuss any method you try with your doctor or midwife before you attempt it. Some methods may need to be tried several times before they work.

Scientific Methods

• Membrane Sweep - This is a method which is now routinely offered to women who are overdue, and is proven to stimulate labour in most cases. It is performed by the doctor or midwife, who will gently separate the membranes surrounding your baby from the cervix during an internal examination. You can be offered two or three membrane sweeps before other methods of induction are attempted. However, there are no serious risks associated with this method, hence its popularity. You may experience some discomfort.

• Prostaglandin - This is a substance similar to a hormone which helps to stimulate contractions. It is generally tried after a membrane sweep, or if the cervix is ‘unripe’. Before labour the cervix should soften, shorten and dilate, allowing the baby to be born. If this does not happen naturally you are likely to be given prostaglandin to get the cervix ready for birth and encourage contractions.

Prostaglandin can be administered via a gel, tablet or pessary in the vagina. If your doctor uses a gel or tablet you may need more than one dose. There are few risks associated with prostaglandin and it has the advantage of reducing the number of caesarean sections associated with inductions. It also promotes a more natural birth. However, there is a possibility that your uterus will become hyperstimulated, which reduces the supply of oxygen to your baby. This can be controlled with drugs.

• ARM (Artificially Rupturing the Membranes) - This is also known as breaking the waters and is no longer recommended unless prostaglandin cannot be administered for any reason. It can be done during an internal examination using a tool called an amniohook. This looks a little like a crotchet hook, and it is used to make a small tear in the membranes around the baby. It does not always work, and once the waters have been broken the chance of infection is greatly increased. This is why it is no longer recommended.

• Syntocinon - This is a synthetic version of the hormone oxytocin, which is naturally released during labour. The synthetic version can be used to start contractions (particularly after ARM). You would only be offered syntocinon if all other methods had failed because of its numerous disadvantages. It is administered via an intravenous drip which means it can be well-controlled, and is absorbed straight into the bloodstream. It can cause very strong contractions and put the baby under stress, which means you are constantly monitored. Most women find the contractions with syntocinon more painful than without it, increasing the need for pain medication. As with prostaglandin there is a chance of hyperstimulation.

Natural Methods

There has been very little research done into the safety and effectiveness of natural methods of inducing labour, and even less conclusive proof. However, many mothers claim these methods work. You should always check with your doctor before trying these methods.

• Sex - There are many theories about why sex might work; oxytocin is released during orgasm, semen contains high levels of prostaglandin and orgasm can also stimulate the uterus. However, there is little to no evidence that it actually works, and in the final stages of pregnancy sex can be physically difficult. It is entirely safe until your waters have broken when the chance of infection rises.

• Nipple Stimulation - The idea is to imitate a baby feeding and therefore to release oxytocin thus inducing labour. You need to massage the whole nipple, including the areola, for fifteen minutes before moving onto the next one. There is no evidence to suggest this method is unsafe, but there is little evidence to suggest it works either.

• Castor Oil - This is an ancient method which is little understood, but many people believe that by stimulating the gut the oil also stimulates the uterus. Castor oil is a powerful laxative, and the most likely result is diarrhoea, which can lead to dehydration. For this reason it is not recommended. What’s more, you will also find it in our giving birth myth section.

• Eating Spicy Food - There is no scientific theory behind this method, except that perhaps the stimulation of the bowel also stimulates the uterus. It is not a good idea to start eating food a lot spicier than you are used to because they can irritate the bowel.

• Eating Pineapple - Pineapple contains bromelain which is thought to soften the cervix. However, you would have to eat seven pineapples to get enough bromelain to be effective, which is most likely to cause diarrhoea and possible dehydration.

• Walking - Aside from helping gravity, walking supposedly stimulates the release of oxytocin because of the pressure of the baby’s head on the cervix. There is no evidence for this theory, but walking is safe as long as you do not wear yourself out.

• Herbal and Homeopathic Methods - Homeopathy is completely safe but there is little evidence to suggest it is effective at all. Herbal remedies include black and blue cohosh. Both of these can be dangerous and increase complications during birth, so should be used with extreme caution and under professional guidance.

Is induced labour more painful?

Unfortunately there is little good evidence from studies on this topic. Contractions with syntocinon have commonly been reported as being more painful, but as for other methods, there currently seems to be no way of telling how the individual woman will respond with regards to pain.