Outpatient Induction of Labour

You will need to call Cedar Ward at 9am on the day of your induction. You will be asked to attend between 5pm and 6pm, this time will be confirmed when you call. It is important that you bring your pregnancy notes including your scan reports with you and your hospital bag (in case you are admitted, this can stay in the car while we assess you).

Please watch the IOL video prior to your arrival so you understand the processes. The video is available on our webiste or via the QR code on the Outpatient IOL leaflet.

• On arrival to the ward, you will meet a midwife who will discuss the IOL process and answer any questions you might have
• You will be assessed to ensure you are still suitable for an outpatient IOL

• You will have your blood pressure, temperature and pulse checked
• The midwife will feel your tummy to check the position of your baby, listen to the baby’s heartbeat using a CTG machine 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.

Examination

If all the above assessments are normal the midwife will ask for your permission to perform a vaginal examination to check your cervix. This is similar to the process of having a sweep. During this examination you will be offered gas and air as this is available on Cedar Ward. Dependent on the findings, the midwife will then proceed to insert either Propess or Dilapan.

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. After the Propess has been inserted the baby’s heartbeat will be monitored for 60 minutes. This is to confirm that everything is normal and you are safe to return home.

During the 24 hours, the prostaglandin hormone is slowly released. You may experience some cramping (period like pains), contractions or your waters may break. It is possible for you to go to labour with just the Propess.

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 be asked to return to Tambootie Ward (MAU) 12 hours after the Propess has been inserted. The midwife will check your blood pressure, pulse and temperature and feel your tummy again. You will also have a CTG monitor for at least 30 minutes to ensure the wellbeing of your baby. You will not require a vaginal examination at this point, unless it is indicated. If all is well and it is safe to do so, you can return home again.

You then will need to return to Cedar ward a further 12 hours later for the Propess to be removed, this will be 24 hours after the Propess was first inserted.

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.

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 be asked to return to Tambootie Maternity Assessment Unit 12 hours after the Propess has been inserted. The midwife will check your blood pressure, pulse and temperature and feel your tummy again. You will also have a CTG monitor for at least 30 minutes to ensure the wellbeing of your baby. You will not require a vaginal examination at this point, unless it is indicated. If all is well and it is safe to do so, you can return home again.

You then will need to return to Cedar ward a further 12 hours later for the Propess to be removed, this will be 24 hours after the Propess was first inserted.

Dilapan

Dilapan is a small rod that gradually absorbs fluid from the cervix, the rods increase in size and therefore stretch to open the cervix. This is a mechanical way of induction as the rods do not contain any hormones or drugs.

The midwife will need to insert 3-4 Dilapan rods into your cervix which will remain in place for up to 15 hours. It is not unusual to have a small amount of bleeding following the examination.

After the Dilapan is inserted your baby’s heartbeat will be monitored with a CTG machine for 30 minutes. If all is well, you will then be allowed home and advised to return to Cedar Ward between 12-14 hours after insertion. This time will be given to you before leave.

When we can break your waters

On some occasions your cervix may be open enough for your waters to be broken. In this circumstance you would not need Propess or Dilapan. Your waters will need to be broken on Delivery Suite, where you can be provided with 1 to 1 care and close monitoring. There is often a wait for a Delivery Suite bed. If you are confirmed to be low risk and all is well, you may be able to go home to wait for a bed to be available.

Whilst at home

· Continue your normal day to day activities

· Stay as active and mobilise as much as possible

· Eat and drink as normal

· You may take paracetamol if required for pain relief

· Monitor your baby’s movements

· Do not attempt to remove Dilapan your self

· Do not remove Propess unless directed by a Midwife

Avoid bathing while the Dilapan is in place

· Avoid sexual intercourse

Contat Tambootie Maternity Assessment Unit Immediately on 01322 428280 if you experience any of the following

· Regular, strong contractions, at least 3-4 in 10 minutes

· Any abnormal vaginal bleeding

· You think your waters have broken

· You are worried about your baby’s movements

· The Propess /Dilapan falls out (please bring with you if this happens)

· If you have episodes of nausea / vomiting and diarrhoea

· Or if you have any other concerns or questions

IOL Video

For further information about the Induction of Labour process please watch the Induction of labour availalbe on our website. This video discusses the Inpatient processes but details all the methods used and covers what to expect when you are admitted.

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, 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?

Yes

Can someone stay with me in the hospital?

Yes, you may have 1 named birth partner to support you throughout your entire induction process.

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 / Dilapan as it is important for it to be in the right place. This will ease once the examination has finished.

Pain relief

During the early stages of your induction, techniques such as mobilising, relaxation techniques and birth partner support can help you. You may find comfort using a birthing ball or taking a warm bath. If you have a TENS machine, 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 but you will need to be admitted an an inpatient.

Epidurals cannot be given on the antenatal ward and are only given once you are in established labour on Delivery Suite.

How long will induction take?

This depends on how quickly your body responds to the Propess / Dilapan- but for many, it can take between 24-72 hours.