Info Centre - Induction and acceleration (augmentation)

Induction means starting labour off by artificial means and may be offered for babies who are ‘post-term’, where the pregnancy has lasted for longer than 41-42 weeks. Although most babies born after this point are fine, a small number seem less able to deal with normal labour and birth, which is why doctors and midwives may strongly recommend induction at this point.

What is induction of labour?

Rather than waiting until you go into labour naturally, it may be started or ‘induced’ when:

There is a problem with you or your baby and an early birth is advisable
Your baby is ‘overdue’ (41+ plus)
Your waters have broken, but labour has not started.

If you are being offered induction, make sure you fully understand the reasons why it’s being suggested. You can choose whether or not to accept the offer – induction of labour is a major intervention and best used only when medically indicated. A common reason why a woman with an otherwise normal pregnancy is offered induction is that her baby is ‘overdue’, or post-term. Many doctors are unwilling to let a woman carry on beyond ten days after her due date, while others are happy for the pregnancy to continue for up to 21 days beyond the 40 weeks.

If your waters have broken and you are more than 37 weeks pregnant, but you have not gone into labour after, at most, four days, induction is strongly recommended. This is because there’s an increased risk of group B streptococcus infection.

What the disadvantages of induction?

Your labour can be induced in several ways:

Sweeping the membranes

This is done as a first stage. During a vaginal examination, the membranes are separated from the uterus around the cervix. This procedure, which can be done at an antenatal appointment, can trigger contractions. If labour does not start within a few days, then the following would be offered:

Cervical ripening

A prostaglandin pessary is inserted into the vagina. This is usually done in hospital and can be enough to start labour.

Breaking the waters (amniotomy)

Here your membranes are ruptured using a special plastic hook. It can only be done if the cervix has started dilating.

Synthetic oxytocin (syntocinon)

This is an artificial form of oxytocin given via a drip into a vein in your arm. The syntocinon makes the uterus contract. Electronic fetal monitoring is always recommended to ensure that the baby is coping well with your contractions.

There are disadvantages however to each of these methods:

Sweeping the membranes increases the chance of labour starting naturally within 48 hours, but there is a risk that your waters could be accidentally broken. If this happens, there is no turning back, and because of the risk of infection, there will be a need to get labour going and for the baby to be born within the next few days.
Very occasionally women react to prostaglandin pessaries used for ‘cervical ripening’ by having very strong, painful contractions. These can be difficult to cope with, which can affect your baby’s heartbeat.
Breaking your waters can cause discomfort, and the contractions following it tend to be stronger and more painful.
A syntocinon drip can increase the strength, length, and frequency of contractions. For this reason, women who are induced in this way are more likely to have an epidural to cope with the pain and will also need electronic fetal monitoring. This means, in turn, that there’s a greater risk of the labour ending in a ventouse or forceps delivery, or even a caesarean. This is an example of the ‘cascade of intervention’.

Can I still have a home birth?

Apart from sweeping the membranes, all other methods of induction need to be carried out in hospital. Therefore accepting an offer of induction will mean putting aside your plans for a home birth.

What are the alternatives?

If, after 42 weeks gestation, an induction has been suggested, you should also be offered, as an alternative, twice-weekly monitoring of your baby’s heartbeat, and an ultrasound scan to check the depth of amniotic fluid surrounding your baby.

What will happen if I am not induced?

In an uncomplicated pregnancy, there is a small but definite increased risk of your baby developing health problems after 42 weeks. In situations where your waters have broken but labour has not started at term, 91 per cent of women go into labour naturally within 48 hours. Induction is strongly recommended if labour has not started after four days. You can try other methods of induction following your due date, however the evidence for these methods is largely anecdotal.

To avoid induction try:

Sex – semen is rich in prostaglandins; kissing, nipple-stimulation, and orgasm can all increase your natural oxytocin levels
Eating spicy food or fresh pineapple
Complementary therapies such as acupuncture, homeopathy, reflexology, or aromatherapy (go to a registered practitioner).
Gentle exercise
A vigorous walk

What is acceleration of labour?

This is sometimes called augmentation. It is a process designed to strengthen contractions and speed up the dilation of your cervix. It is achieved in similar ways to induction – by breaking the waters (amniotomy) and using a syntocinon drip. If you do choose to accelerate your labour, remember that the benefits of a faster labour in terms of not getting so tired and seeing your baby sooner have to be weighed against the disadvantages of acceleration.

What are the disadvantages of acceleration?

These are similar to the disadvantages of induction – sudden, painful contractions that can be difficult to cope with and you may need epidural anaesthesia. In addition you are also likely to be continuously monitored. All these factors will reduce your ability to move around and adopt comfortable positions. If you do accept syntocinon and are finding the contractions too hard to cope with, you can ask for the drip to be turned down.

What are the alternatives?

Any alternatives to acceleration usually focus on helping your body to produce its own oxytocin so that you don’t need an artificial supplement. The labour hormone oxytocin is produced in the absence of stress, in other words when you feel safe, nurtured, and relaxed. Natural stimulation of oxytocin can take some time, so you may need to request being left in private for a while.

To avoid acceleration of labour try:

Getting yourself into a comfortable upright position
Moving around between contractions – even pace up and down the room if you feel like it
Improving your environment – make it dark and cosy
Relaxation techniques
Requesting privacy – ask extra people in the room to leave
Asking your birth partner for lots of positive support: ‘You can do it!’ ‘You’re doing great!’
Focusing on your baby
Keeping your energy and fluid levels up
Kissing and nipple stimulation, which encourages the release of oxytocin
Staying calm. Don’t worry about your labour being slow; it is fine as long as you and baby are coping well.

Page lasted updated 2007.