Induction Of Labour

You will be given a date and time to attend the hospital. After an assessment of you and your baby, the doctor or midwife will recommend the most suitable medication.

Propess pessary

• A small, tampon‑like pessary placed behind the cervix.

• Releases medication slowly over 24 hours.

• A string remains at the vaginal opening.

• You and your baby will be monitored regularly.

Prostin gel

• A gel inserted into the vagina to soften the cervix.

• You will rest for 30–60 minutes after insertion.

• If labour does not begin, a repeat dose may be given after 6 hours.

• If labour begins, you will be transferred to the Delivery Suite when a space is available.

A call bell will be provided to you so you can alert your midwife if you experience any pain, contractions, bleeding or rupture of membranes.

Following this you are encouraged to move around and eat and drink as normal.

Your midwife will monitor you and your baby’s wellbeing while you are waiting to go into labour.

If there are signs of labour i.e. strong, regular contractions and/or your membranes rupture (waters break), your midwife will assess. If you are in labour, the Propess pessary will be removed. You will be transferred to the Labour Ward as soon as a space becomes available.

If labour has not started within 24 hours you will be reviewed by the doctor. The doctor will examine you to assess if your cervix has ripened and if you are suitable for amniotomy.

If you are not suitable for amniotomy, a decision may be made to administer Prostin gel, to further assist successful induction. Your midwife will continue to monitor you and your baby’s wellbeing. You will be reassessed vaginally 6 hours later.

If Prostin gel is the initial medication of choice, similar to Propess, you and your baby are monitored. If labour starts, you will be transferred to the Labour Ward as soon as a space becomes available. If after six hours, there are no signs of labour, you will be examined by the doctor and a further dose of Prostin medication may be inserted, with the aim of softening the cervix.

Mechanical methods soften and open the cervix without medication. They are suitable for many women, including some who cannot receive prostaglandins. A small number of women who are considered normal risk may be offered the option to go home after a balloon catheter or Dilapan‑S dilators are placed (often called outpatient cervical ripening). This is not suitable for everyone. When this becomes available, your midwife or doctor will discuss whether it is an option for you, what monitoring you and your baby will need, and when to return to the hospital. You will also be given clear advice on when to phone or return sooner if you have any concerns.

Mechanical options include:

• Balloon catheter

• Dilapan‑S rods

Balloon catheter

• A thin tube with one or two small balloons is inserted through the cervix.

• The balloons are filled with sterile water.

• Pressure helps the cervix soften and open.

• Usually stays in place for 12–24 hours.

• May cause period‑like cramps or pressure.

• You can mobilise, eat, and drink as normal.

• Avoid sexual intercourse while the catheter is in place.

• When the cervix has opened enough, the balloon falls out or is removed.

Dilapan‑S rods

• A few thin, matchstick‑like dilators are placed in the cervix to help it soften and open.

• They slowly absorb moisture and expand, which helps the cervix to open.

• They are usually left in place for up to 12–24 hours.

• You can mobilise, eat, and drink as normal.

• You should avoid having a bath, but you can have a shower.

• You may feel period‑like cramps or pressure.

• Avoid sexual intercourse while the dilators are in place.

• When the cervix has opened enough, the dilators fall out or are removed before the next step of induction.

When your cervix is open, your waters can be broken.

• A midwife or doctor performs a vaginal examination.

• A small plastic instrument is used to make a tiny opening in the membranes.

• This may be enough to start contractions, or you may need an oxytocin drip.

If labour does not start after your waters are broken, you may need oxytocin, a synthetic form of the hormone that helps your womb contract.

• Given through a drip in your arm.

• The dose is adjusted using an infusion pump.

• Your baby will be monitored continuously using cardiotocography (CTG).

If you are being induced with Propess and/or Prostin, your partner will be able to stay with you on the antenatal ward during regular visiting hours.

However, once you are transferred to the Labour Ward your partner can stay with you at all times.

• Some babies may not tolerate induction methods, so you and your baby will be monitored closely.

• Induction may not always be successful; if labour does not progress, a caesarean section may be recommended.

• Medication‑based methods can occasionally cause contractions that are too frequent (hyperstimulation).

• Mechanical methods (balloon catheter or Dilapan‑S) have a lower risk of hyperstimulation.