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 hospital visit a positive experience by providing you with the necessary information.
The following information aims to provide you with the knowledge to help you understand the process of Outpatient induction of labour, what to expect and why it is recommended for you.
What is Outpatient Induction of Labour?
Induction of Labour (IOL) is the process of artificially starting labour. Outpatient IOL is offered to low risk women who wish to be at home during some of their induction process.
Why are you being offered Outpatient Induction of Labour?
If you have had an uncomplicated pregnancy, with midwife led care, and you are suitable for the Birth Centre, you are likely to be suitable for Outpatient IOL.
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 between 10 - 12 days overdue. Research has shown that, for some women, the placenta (afterbirth) does not work as effectively after 42 weeks, therefore IOL is recommended.
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 ‘sweep’. This is an internal examination whereby your midwife or doctor sweeps their fingers around your cervix. 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 heartbeat 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.
At 7am, on the morning of the induction, you need to attend Maternity Assessment Unit (Tambootie) 01322 428280 / 428278. It is important that you bring your pregnancy notes with you and your hospital bag (in case you are admitted).
- On arrival to the ward you will meet a midwife.
- 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 listen to the baby’s heartbeat for at least 30 minutes and monitor any contractions (if you are having them).
- If the CTG monitoring is normal, the midwife will begin the IOL.
All outpatient inductions begin with Propess. This is a thin pessary, like a tampon, which contains a hormonal medicine 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, the prostaglandin hormone is slowly released.
After the Propess has been inserted the baby’s heartbeat will be monitored for 60 minutes, then you will attend the ultrasound department for a scan. This is to confirm that everything is normal with your baby and you are safe to return home (sometimes this scan can be performed the day before your IOL if your IOL is booked at the weekend).
Following the scan, you can return home. Once at home you can continue as normal. 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.
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 call the midwife on Tambootie (MAU) and return to the hospital where she can put it back in for you.
It is important for you to contact the hospital if you have any concerns or experience any of the following:
- Regular, strong contractions, at least 3-4 in 10 minutes.
- Any bleeding.
- If your waters break.
- If your baby’s movements are reduced.
- If the Propess falls out.
- If you have nausea / vomiting and diarrhoea.
- Or if you have any other concerns or questions.
If you go into labour at any point during this 24-hour period, you can go to either the Birth Centre or Delivery Suite for labour care.
You will need to come back to Tambootie (MAU) 12 hours after the Propess has been inserted to be reassessed. The midwife will check your blood pressure, pulse and temperature and feel your abdomen. You will also have a CTG monitor for at least 30 minutes to ensure the wellbeing of your baby. If all is well and it is safe to do so, you can return home again.
You then will need to come into Cedar ward 12 hours later for the Propess to be removed, this will be 24 hours after the Propess was first inserted.
On arrival onto Cedar ward, the midwife will introduce themselves and take your blood pressure, pulse and temperature. The baby’s heartbeat will be checked using the CTG monitor and you will be examined internally. If 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 your cervix has not changed enough, 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 the Prostin and at least an hour following the Prostin.
After this time, you can continue as normal again and eat, drink, shower or bath and leave the ward for short periods if you want to. However, you will not be able to return home.
You and the baby will be checked regularly using the CTG monitor and after 6 hours you will be assessed internally again. If your cervix is unchanged you can have another Prostin gel.
If your cervix has dilated enough to enable us to break your waters, you will be transferred to Delivery Suite. However, there may be a delay whilst a bed is made available for you. Once you are on Delivery Suite, the midwife 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 via 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 your labour. There are also a range of pain relief options available to you that you can discuss with your midwife.
Yes, if you don’t want to be induced at the time when the doctor or midwife is suggesting, you can talk through your options with them. The doctor or midwife will answer any questions you have and give you information for you to make an informed decision.
For some women IOL can take several days. 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.
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.
Can I shower or bath with Propess / Prostin in?
Can someone stay with me in the hospital?
Due to the recent pandemic and change of visiting policy, please discuss with the midwife booking your induction.
Can I still go to the Birth Centre?
The Birth Centre is only suitable for women who have had an uncomplicated pregnancy. If you were planning to have your baby on ‘The Birth Centre’ but have now been advised that you need to have an Induction of Labour, it is unlikely that the Birth Centre will be suitable for you.
This is because of how your baby is monitored in labour. On The Birth Centre babies are monitored using intermittent auscultation which is only suitable in uncomplicated pregnancies. If you are being induced for any other reason than postdates it is because we have concerns for your health or your babies. This means your baby needs to be continuously monitored once you are in established labour which can only be undertaken on Delivery Suite. This also means that a waterbirth is no longer suitable for you.
If the only reason you are being induced is because you are overdue this can be an inpatient or outpatient induction. You will still be suitable to come to The Birth Centre once you are in established labour if you go into labour in the 24 hours following the insertion of the Propess. If the induction of labour requires further intervention then you will be transferred to Delivery suite.
Will the examination hurt?
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.
During the early stages of your induction, techniques such as mobilising, relaxation techniques and birth partner support can help you[. The ward also have birthing balls and baths. If you have a TENS machines now is the time to use it.
Oral analgesia such a Paracetamol and Dihydrocodeine can be given. If this does not work following a discussion with your midwife, Pethidine which is a stronger injection can be given for pain relief.
Epidurals cannot be given on the antenatal ward and are only given once you are in established labour.
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.