Induction may be offered if there is a medical complication for you or your baby. Induction may also be offered because your pregnancy has continued past your due date. Why induction is recommended and any other options will be explained to you. This will help you decide what is right for you and your baby. 

Step 1 - Preparing the cervix (the lower part of the womb that connects to the vagina)

This first step of inducing labour is usually done on Pearl ward. At Medway Maritime Hospital we use two methods to soften and prepare the cervix ready for labour. These are the vaginal prostaglandins (given as a pessary or gel) or the cervical ripening balloon. The method used will depend on why you are being induced and how you have given birth previously. Sometimes if one method does not work, you may be offered the other. Sometimes you will not need this step and can move straight to step 2, if it is possible to break the waters without preparing the cervix.

1a) Prostaglandin pessary called 'Propess' is put into your vagina and slowly releases the medication over 24 hours. The pessary can cause contractions to start. It will be taken out after 24 hours, or sooner if labour starts or there are any concerns about you or your baby's health. Sometimes the Propess may not be enough to prepare your cervix and another method will be offered (such as the cervical ripening balloon - see below).

1b) Prostin gel may be used for induction of labour when your waters have already broken. The gel is put into your vagina after the midwife has assessed your cervix. The prostaglandin in the gel can help to make the cervix softer and ready for labour. The prostin gel can cause contractions to start. Only a single dose will be given after your waters have broken. 6 hours after the prostin gel is given, you can move onto 'step 3' - see below.

2) Cervical ripening balloon (CRB) is drug free and cannot cause your womb to contract too much. A soft silicone tube is placed into the opening of your womb (cervix) through your vagina. Two balloons (one in front and one behind your cervix) are then filled with water.

The CRB should soften and open your cervix enough for your waters to be broken. The CRB will stay in place for 24 hours or until it falls out (because it has worked and opened the cervix a little), whichever happens first.

Step 2 - Breaking your waters

 When your cervix is ready, your waters can be broken. This might be done on either Delivery Suite or The Birth Place (midwifery-led unit), depending on why you are being induced. Your midwife will use a small plastic hook to release the fluid around your baby. Breaking the waters helps your baby’s head to press onto your cervix and bring on contractions. You will usually be given some time after your waters have been broken to see if contractions start on their own. If you are not having contractions after a few hours you will be offered a hormone drip.

Step 3 - Oxytocin hormone drip

This drip is an artificial form of the hormone that causes your womb (uterus) to have contractions. The oxytocin is increased very slowly through a pump until you have strong and regular contractions. It is important to continuously monitor your baby’s heart rate while you are on this drip to check how your baby is coping with labour. The hormone drip can only be given on the Delivery Suite.

Q – Will induction limit my choices about where I give birth?

A – If your labour is induced you will usually give birth on the Delivery Suite. This is because some of the care you need during induction of labour cannot be given at home or in midwifery-led units (e.g. oxytocin hormone drip, continuous monitoring of the baby’s heart rate). Depending on why your labour is being induced, you may still be able to use The Birth Place if labour starts after step 1 or 2 of induction. Talk to your midwife or doctor about your individual situation and your wishes.

Q – Can I still use a birth pool in labour?

A – Whether the pool is suitable will depend on your reason for induction, your medical history and how your labour starts. If you want to use the birth pool you can discuss this with your midwife or doctor. You may be able to use the birth pool if labour starts after step 1 or 2 of induction. You cannot use the pool if you need the hormone drip.

Q – Will I be able to move around during labour if I am induced?

A - Yes you can still move around during labour that has been induced. This might include standing, kneeling, or using a birth ball. Birth balls are available on both Delivery Suite and The Birth Place to help you with this. Ask your midwife or doctor about using the wireless CTG monitor when you are in labour as this can make it easier for you to move around, change position and not feel restricted. The wireless monitor can also be used in the pool on Delivery Suite if this is suitable for you.

Q – Will my labour be more painful if it is induced?

A - Induced labour can be more painful than labour that starts on its own. You can talk to your midwife both before labour and during labour about the pain relief options available to you. These include using Gas & Air, pethidine or an epidural.

Q – Is induced labour be more stressful for my baby?

A - Using drugs to induce labour can sometimes cause the womb to contract too much or contractions last too long (hyperstimulation). This can cause changes in the baby’s heart rate pattern. Sometimes the hormone drip may need to be turned down or off for a while to give the baby a rest. If there are any worries about how your baby is coping with labour this will be discussed with you by the team caring for you.

Q – Is there a higher chance that I will need help to birth my baby compared to labour that starts on its own?

A - There may be a higher chance that you will need help to birth your baby (with forceps or ventouse). This can also increase the chance of more severe tears. If help is needed, the midwife and doctor caring for you will talk to you about this at the time.

Q – How long will I stay in hospital for?

A – The amount of time you will need to stay in hospital for can vary. Hospital stay is often longer with an induced labour compared to labour that starts on its own because of the time it takes to get labour started. You might want to think about things that you could bring with you to pass the time in the early stages of induction (e.g. books to read / games to play / things to watch or listen to on your devices). You may also need to make plans for other children that could cover several days.

Team Maia: How to contact us

Monday to Friday 8am-4pm

01634 969812 or 07775 004868

Email: medwayft.teammaia@nhs.net

Out of hours and weekends, please call Pearl Ward on 01634 825096

If you have any concerns while you are waiting for your induction of labour, please contact the ‘Call The Midwife’ phone line anytime 24/7 on 01634 825277. 

The Padlet includes information about:

• The induction of labour process

• What to expect / preparing for induction

• The most common reasons that induction may be recommended

• The possible benefits, risks and alternatives to induction for each reason

• Frequently asked questions

Some sections have links to extra information - just click on these to find out more

Scroll to the left to see all the columns

Scroll up/down in each column to see all the information

The method of induction may include the cervical ripening balloon, having your waters broken and using the hormone drip. We do not use Prostin gel for anyone who has had a previous caesarean section.

Induction of labour reduces the chance of successful VBAC and has a higher chance of scar rupture compared to spontaneous labour (chance of scar rupture around 1:200 for spontaneous labour after 1 x caesarean section, this is increased 2-3 times with induction of labour).

You can talk to your doctor or midwife to help you think about your options depending on the reason induction of labour has been recommended and the alternative risks / benefits of either having a planned caesarean section or awaiting spontaneous labour.

We do not offer induction of labour to women who had had 2 or more previous caesarean sections due to the additional risk of scar rupture in this situation.

• Induction of labour will reduce the risks linked to pregnancy continuing beyond 41 weeks.

• By 41 weeks your baby is fully developed and ready to be born.

  
  

Risks of declining induction of labour for prolonged pregnancy

• Continuing your pregnancy beyond 41 weeks carries some risks that may increase over time. These include:

  - An increased chance of stillbirth or neonatal death

  - An increased chance that your baby may need admission to the neonatal unit

  - An increased chance of caesarean birth

(please see link below for specific information about the chance of these outcomes)

Risks of having induction of labour for prolonged pregnancy

• Induction of labour is a medical intervention that may affect your birth options and experience. Where you can have your baby will be limited and your hospital stay may be longer than if labour that starts on its own. You will need additional interventions and monitoring during induced labour and may require more pain relief. (see ‘Frequently Asked Questions’ section).

• Induction of labour can sometimes make the contractions become too frequent (less than 60 seconds apart) or too long (lasting over 90 seconds). If this happens we may need to give you medication to reduce your contractions or turn off your oxytocin drip to give you and your baby a rest. The induction may be restarted after some time if it is considered safe for you and your baby. In some cases, a caesarean birth may be advised.

• If your labour is induced there may be an increased need for an assisted vaginal birth (with forceps or ventouse) which can also be linked to more severe perineal tears.

  
  

Alternatives to induction of labour for prolonged pregnancy

• You may choose to wait longer for labour to start on its own.

• You can choose an alternative date when you would like induction of labour to be booked for (e.g. 41+3 or 41+5 weeks).

• If you want to wait beyond 42+0 you can discuss this further with your doctor or midwife.

  
  

Intuition – Is induction of labour the right option for you?

• After considering the information provided and what is right for you, you can make a plan with your midwife or doctor. This plan should include your wishes if your labour starts before the date of a planned induction of labour, including your planned place of birth.

• Whatever you decide, we will support you in your choices. You can change your mind at any time. Speak with your midwife or doctor if you want to reconsider your options and plan.

  
  

What if you do nothing?

• If you choose not to be induced between 41-42 weeks you will be offered additional monitoring from 42 weeks. This may include twice weekly checks of your baby’s heart rate. The monitoring can provide reassurance about how the baby is at that moment. Scans and heartbeat checks cannot predict any changes that might happen after the monitoring ends. Stillbirth cannot be reliably predicted or prevented, even with a plan of additional monitoring.

• If you choose to wait for labour to start on its own after 42 weeks you will be advised to give birth on Delivery Suite. This is so that you can have continuous monitoring of your baby’s heartrate as your baby may be less able to cope with the stress of labour.

At Medway NHS Foundation Trust we offer induction of labour for prolonged pregnancy from 41+0 weeks and recommend induction takes place by 42+0 weeks. This is based on national guidance from NICE (National Institute for Health and Care Excellence). Your midwife will talk with you about whether you want to have induction of labour and when you would like to book this for.

The dating scan will be used to work out your estimated due date (EDD). This is more accurate than using the dates of your last menstrual period (LMP), providing the scan is done before 18 weeks of pregnancy. If your first scan was after 18 weeks of pregnancy, your LMP and measurements of the baby will be used to work out a due date that is as accurate as possible.

If you decide you do not want to be induced, you should discuss this with your midwife or doctor. They will talk with you about your individual situation, any worries that you may have and the alternative options.

This Padlet includes information about the benefits, risks and alternative options for the most common reasons for inducing labour. This will give you things to think about when making your choices. If the reason that you have been offered induction is not listed here, please speak to your midwife or doctor for further information.

When thinking about your options you may find it useful to use the 'BRAIN' tool (see below) to support your decision making.

Our midwives are available 24/7 through our ‘Call the Midwife’ service – 01634 825277

Please contact ‘Call the Midwife’ straight away if you are worried about your baby’s movements and they will arrange for you and your baby to be checked over.

For more information about baby movements in pregnancy please see the links below.

Reduced baby movements and stillbirth (baby dying before birth)

A baby moving less is not a cause of stillbirth but can be a sign that a baby is not getting enough food or oxygen through the placenta. If your baby is not moving as usual, your midwife or doctor will monitor your baby’s heartrate pattern and you might have a scan. They will check for any other risk factors such as whether your baby is small or if there are other signs that the placenta is not working properly.

If you are 39 weeks pregnant of more and have reduced baby movements you will be offered induction of labour.

• By 39 weeks you baby is fully developed and ready to be born.

• Induction of labour for reduced movements after 39 weeks does not seem to increase the chance of caesarean section or chance of complications for your baby.

• Induction of labour will reduce the chance of stillbirth happening after 39 weeks of pregnancy.

  
  

Risks of declining induction of labour for reduced fetal movements

• The chance of stillbirth might be increased if your baby’s reduced movements are linked to problems with the placenta. This may be more likely if you have had more than one episode of reduced movements.

• It is not always possible to predict which babies are most at risk of stillbirth.

Risks of having induction of labour for reduced fetal movements

• If your baby is now moving normally and there are no other concerns then inducing labour may not be necessary.

• Induction of labour is a medical intervention that may affect your birth options and experience. Where you can have your baby will be limited and your hospital stay may be longer than if labour that starts on its own. You will need additional interventions and monitoring during induced labour and may require more pain relief. (see ‘Frequently Asked Questions’ section).

• Induction of labour can sometimes make the contractions become too frequent (less than 60 seconds apart) or too long (lasting over 90 seconds). If this happens we may need to give you medication to reduce your contractions or turn off your oxytocin drip to give you and your baby a rest. The induction may be restarted after some time if it is considered safe for you and your baby. In some cases, a caesarean birth may be advised.

• If your labour is induced there may be an increased need for an assisted vaginal birth (with forceps or ventouse) which can also be linked to more severe perineal tears.

  
  

Alternatives to induction of labour for reduced fetal movements

• You may choose to wait for labour to start on its own. If you choose this option you should continue to monitor you baby’s movements and contact the maternity unit if you are worried about your baby’s movements again.

• If you are not happy with these options you can discuss this further with your doctor or midwife.

  
  

Intuition – Is induction of labour the right option for you?

• After considering the information provided and what is right for you, you can make a plan with your midwife or doctor.

• Whatever you decide, we will support you in your choices. You can change your mind at any time. Speak with your midwife or doctor if you want to reconsider your options and plan.

  
  

What if you do nothing?

• If you choose to wait for labour to start on its own you will be advised to give birth on Delivery Suite if you have recently had reduced fetal movements. This is so that you can have continuous monitoring of your baby’s heartrate during labour.

• If you choose not to be induced you will be offered induction of labour around 41 weeks if you have not given birth by then. (see ‘Prolonged pregnancy’ section).

In this Padlet we have provided more detailed information about our 6 most common reasons for induction of labour. Scroll across to see these reasons and scroll down in each column to find more information about the potential benefits, risks and alternatives of induction of labour for these reasons. You can discuss this further with your midwife and/or doctor. There are also links to where you can find more information.

If the reason that induction of labour has been recommended to you is not listed here, you should discuss your options with your midwife and/or doctor. You might find it helpful to use the BRAIN notes sheet in the section ‘Deciding whether induction of labour is right for you’. This can help you get all the information that you need to make an informed choice.

If there is anything that you are unsure about, please ask.

Your baby’s size may be 10-15% bigger or smaller than the scan measurements suggest.

If your baby is expected to be small you may have additional scans to monitor the baby’s growth, the amount of water around the baby and the blood flow to the baby.

Some babies are small because they are not growing as expected (growth restriction). This could be because the placenta is not working as well as it should, or there could be infection or other reasons for the growth restriction. If the baby’s estimated weight is below the 3^rd centile, it is much more likely that the smallness of the baby is due to growth restriction.

Some babies are small because this is normal for them. It is not always possible to tell which babies are small because this is normal for them and which babies have growth restriction.

Small babies and stillbirth (baby dying before birth)

If your baby is growth restricted they have a higher chance of being stillborn, being unwell at birth or dying shortly after birth. These risks can be reduced by planning the time when the baby is born.

If your baby’s estimated weight is between the 3^rd and 10^th centile and has normal blood flow through the placenta, you will be recommended to have induction of labour between 39+0 and 39+6 weeks. This is in line with national guidance.

If your baby’s estimated weight is below the 3^rd centile, or is above the 3^rd centile but has abnormal blood flow through the placenta, you will be recommended to have induction of labour between 37+0 and 37+6 weeks. This is in line with national guidance.

If your baby is growth restricted earlier in pregnancy you will have additional scans and monitoring. Sometimes it may be necessary to deliver the baby prematurely (before 37 weeks), especially if there are changes in the blood flow to the baby. Sometimes it will be recommended that your baby is born by caesarean. Your fetal medicine consultant will give you specific advice and guidance based on your individual pregnancy.

• Induction of labour will reduce the risk of stillbirth and early neonatal death for small babies.

Risks of declining induction of labour if your baby is expected to be small

• If the placenta is not working effectively the chance of stillbirth is increased. The chance of stillbirth may increase when you wait longer for labour to start on its own.

Risks of having induction of labour if your baby is expected to be small

• Babies born at 37 and 38 weeks of pregnancy have a higher chance of needing admission to the neonatal unit. At 37 weeks 10 inductions will lead to 1 baby being admitted to the neonatal unit. This is should be weighed up against the rare but more serious risk of stillbirth when continuing the pregnancy beyond the recommended time of induction of labour.

• Small babies can have less reserves to cope with the stress of labour. There may therefore be a higher chance of you needing a caesarean section during labour to deliver your baby safely. Evidence is not available to show whether this chance is higher with induced labour compared to labour that starts on its own.

• Induction of labour is a medical intervention that may affect your birth options and experience. Where you can have your baby will be limited and your hospital stay may be longer than if labour that starts on its own. You will need additional interventions and monitoring during induced labour and may require more pain relief. (see ‘Frequently Asked Questions’ section).

• Induction of labour can sometimes make the contractions become too frequent (less than 60 seconds apart) or too long (lasting over 90 seconds). If this happens we may need to give you medication to reduce your contractions or turn off your oxytocin drip to give you and your baby a rest. The induction may be restarted after some time if it is considered safe for you and your baby. In some cases, a caesarean birth may be advised.

• If your labour is induced there may be an increased need for an assisted vaginal birth (with forceps or ventouse) which can also be linked to more severe perineal tears.

Alternatives to induction of labour if your baby is expected to be small

• You may choose to wait for labour to start on its own and not to have labour induced at the recommended time.

• You may choose to plan induction of labour for a later date (e.g. 40 weeks). This would give more time for labour to start on its own.

• If you are not happy with these options you can discuss this further with your doctor or midwife.

Intuition – Is induction of labour the right option for you?

• After considering the information provided and what is right for you, you can make a plan with your midwife or doctor. This plan should include your wishes if your labour starts before the date of a planned induction of labour, including your planned place of birth.

• If labour starts on its own before the recommended timing of induction of labour you may still choose to have your baby on The Birth Place (midwifery-led unit). Our guidance supports this if your baby’s estimated weight is between the 3^rd and 10^th centiles and there is normal blood flow through the placenta. We recommend you consider this rather than homebirth so that we can transfer you quickly to Delivery Suite if there are any concerns about your baby’s condition during labour. If your baby’s estimated weight is below the 3^rd centile and/or there is abnormal blood flow through the placenta we recommend that you give birth on Delivery Suite with continuous monitoring of your baby’s heartrate during labour.

• Whatever you decide, we will support you in your choices. You can change your mind at any time. Speak with your midwife or doctor if you want to reconsider your options and plan.

What if you do nothing?

• If you choose not to be induced at the recommended time you may be offered additional monitoring. This may include further scans and monitoring of your baby’s heat rate. The monitoring can provide reassurance about how the baby is at that moment. Scans and heartbeat checks cannot predict any changes that might happen after the monitoring ends. Stillbirth cannot be reliably predicted or prevented, even with a plan of additional monitoring.

Your baby’s size may be 10-15% bigger or smaller than the scan measurements suggest.

If your baby is expected to be big we will advise you to have a blood test to check whether you have gestational diabetes. Babies of mothers with gestational diabetes are more likely to be big and may be at risk of other complications (please see the ‘Diabetes’ section for more information).

If you baby is expected to be big (without diabetes) you will be offered induction of labour at around 40 weeks. There is uncertainty about the benefits and risks of induction of labour compared to waiting for labour to start on its own.

Big babies and shoulder dystocia

Induction of labour is offered to try to reduce the chance of complications that can occur when giving birth to a big baby. One possible complication of giving birth to a big baby is shoulder dystocia. This happens when one of the baby’s shoulders gets stuck behind the mother’s pubic bone, delaying the birth of the baby. Extra help may be needed to deliver the baby’s shoulder and the baby may be more likely to require resuscitation at birth.

Shoulder dystocia happens in around 1 in150 births (0.79%). It is more likely with big babies, however there is no difficulty delivering the shoulders for most babies born weighing over 4.5kg (10lb). Over half of all shoulder dystocias happen for babies weighing less than 4kg (about 9lb). More information about shoulder dystocia can be found in the patient information leaflet below.

• Big babies have a higher chance of being injured during birth. Induction of labour reduces the chance of shoulder dystocia and the chance of the baby having a fracture. (Induction of labour does not make a difference to the chance of nerve injury to the baby or to the chance of the baby having a low Apgar score or low oxygen levels in the blood).

• Induction of labour reduces the birthweight by an average of 178g compared to waiting for labour to start naturally.

• Induction of labour does not increase the chance of caesarean or instrumental birth.

• At 40 weeks your baby is fully developed and ready to be born.

  (please see infographic below for more information about the chance of these outcomes and the studies that the research comes from)

Risks of declining induction of labour if your baby is expected to be big

• The longer your pregnancy continues the bigger the baby will grow, which may increase the chance of complications for the birth.

• If you have diabetes (type 1, type 2 or gestational diabetes), having a big baby may be linked to high sugar levels in your blood. This can put your baby at risk of other complications and should be discussed with you by your care team (please see the ‘Diabetes’ section for more information)

Risks of having induction of labour if your baby is expected to be big

• Estimating a baby’s weight before birth is not very accurate, so induction will sometimes be unnecessary.

• Induction of labour is a medical intervention that may affect your birth options and experience. Where you can have your baby will be limited and your hospital stay may be longer than if labour that starts on its own. You will need additional interventions and monitoring during induced labour and may require more pain relief. (see ‘Frequently Asked Questions’ section).

• Induction of labour can sometimes make the contractions become too frequent (less than 60 seconds apart) or too long (lasting over 90 seconds). If this happens we may need to give you medication to reduce your contractions or turn off your oxytocin drip to give you and your baby a rest. The induction may be restarted after some time if it is considered safe for you and your baby. In some cases, a caesarean birth may be advised.

• If your labour is induced there may be an increased need for an assisted vaginal birth (with forceps or ventouse) which can also be linked to more severe perineal tears.

Alternatives to induction of labour if your baby is expected to be big

• You may choose to wait for labour to start on its own.

• You may choose to plan induction of labour for a later date (eg 41 weeks). This would give more time for labour to start on its own.

• If you are not happy with these options you can discuss this further with your doctor or midwife.

Intuition – Is induction of labour the right option for you?

• After considering the information provided and what is right for you, you can make a plan with your midwife or doctor. This plan should include your wishes if your labour starts before the date of a planned induction of labour.

• You may want to think about where you want to have your baby. If you go into labour naturally before 40 weeks (or when you baby is estimated to be under 4kg, about 9lb) you may choose to give birth in The Birth Place (midwifery-led unit) or at home.

• Whatever you decide, we will support you in your choices. You can change your mind at any time. Speak with your midwife or doctor if you want to reconsider your options and plan. 

What if you do nothing?

• If you choose not to be induced you should continue to see your community midwife as planned. You will not require additional monitoring in your pregnancy and do not need to have any further scans.

• If labour starts on its own after 40 weeks (or when you baby is estimated to be around 4kg, about 9lb) you will be recommended to give birth on Delivery Suite. This is so that the team of obstetric and neonatal doctors will be close at hand if you need any assistance to deliver your baby.

The waters break before labour starts in about 8% of pregnancies. For most women labour will then start on its own.

·         60% will be in labour within 24 hours (1 day and night)

·         90% will be in labour within 48 hours (2 days and nights)

If your waters have broken you will be offered a choice between having induction of labour as soon as possible, or waiting for labour to start on its own. If labour has not started on its own by 24 hours, induction of labour is recommended to reduce the chance of you or your baby developing infection. Infections in newborn babies can be serious, especially if they are not treated quickly.

• Induction of labour at or before 24 hours from when your waters broke can help to reduce the chance or you or your baby developing serious infection.

• The risk of serious neonatal infection is 1 in 100 (1%) for women whose waters have broken before labour starts and the risk may increase over time. This is compared to 1 in 200 (0.5%) for women whose waters have not broken before labour starts.

• Opting for induction of labour as soon as possible may reduce the chance of your baby needing to have antibiotics.

• Induction of labour for pre-labour rupture of membranes does not increase the chance of caesarean or instrumental birth.

Risks of declining induction of labour when you have pre-labour rupture of membranes

• The longer it is between your waters breaking and your birth, the higher the chance that you or your baby will develop infection.

• There are some reasons that make it riskier to wait before having induction of labour. For example, if there is meconium in the waters (baby has had a poo) or you have been told that you are GBS positive. In these situations, induction of labour would be recommended as soon possible. You can discuss this further with your midwife or doctor.

Risks of having induction of labour when you have pre-labour rupture of membranes

• The absolute chance of developing an infection is not very high. Induction of labour may therefore be unnecessary.

• Induction of labour is a medical intervention that may affect your birth options and experience. Where you can have your baby will be limited and your hospital stay may be longer than if labour that starts on its own. You will need additional interventions and monitoring during induced labour and may require more pain relief. (see ‘Frequently Asked Questions’ section).

• Induction of labour can sometimes make the contractions become too frequent (less than 60 seconds apart) or too long (lasting over 90 seconds). If this happens we may need to give you medication to reduce your contractions or turn off your oxytocin drip to give you and your baby a rest. The induction may be restarted after some time if it is considered safe for you and your baby. In some cases, a caesarean birth may be advised.

• If your labour is induced there may be an increased need for an assisted vaginal birth (with forceps or ventouse) which can also be linked to more severe perineal tears.

Alternatives to induction of labour when you have pre-labour rupture of membranes

• You may choose to wait for labour to start on its own.

• You may choose to plan induction of labour at a later point (e.g. if labour has not started on its own by 48 hours). This would give more time for labour to start on its own.

• If you are not happy with these options you can discuss this further with your doctor or midwife.

Intuition – Is induction of labour the right option for you?

• After considering the information provided and what is right for you, you can make a plan with your midwife or doctor. This plan should include your wishes if your labour starts before the time of a planned induction of labour.

• You may want to think about where you plan to have your baby. If active labour starts within 24 hours of your waters breaking, you may choose to give birth in The Birth Place (midwifery-led unit) or at home.

• Whatever you decide, we will support you in your choices. You can change your mind at any time. Speak with your midwife or doctor if you want to reconsider your options and plan.

What if you do nothing?

If you choose to wait beyond 24 hours after your waters break for labour to start on its own:

• You will be advised to give birth on Delivery Suite. This is so that you can have continuous monitoring of your baby’s heartrate during labour due to the increased risk of infection.

• You should look out for any symptoms that could mean you are developing an infection. This might include a change in the colour of the amniotic fluid, an offensive smell from the amniotic fluid, you feeling unwell or having flu-like symptoms, you having a high temperature, your baby moving less. If you have any of these symptoms please contact our ‘Call the Midwife’ phone line so that we can arrange to see you as soon as possible.

• Your midwife or doctor will arrange follow up appointments with you every 24 hours until you go into labour.

• If your waters have broken for more than 24 hours before your baby is born, it is recommended that you stay in hospital for at least 12 hours after birth. This is so that your baby can have additional monitoring for any signs of infection. Sometimes the doctors for the baby will advise that the baby has antibiotics after birth if there are extra risk factors.

If you have diabetes there is a higher chance of health problems for you and your baby during pregnancy, during the birth and after the birth. You will be offered extra care and support from the diabetes team to manage your diabetes and reduce the risks to you and your baby.

Diabetes and timing of birth

If your pregnancy carries on for too long, the chance of problems for you and/or your baby may increase. The risks linked to diabetes can be reduced by planning the time when the baby is born.

If you have type 1 or type 2 diabetes: You will be recommended to have your labour induced (or a caesarean section if this is the best option for you) during week 37 or 38 of pregnancy. You may be advised to have your baby earlier than this if there are complications (such as high blood pressure or a slowing down of your baby’s growth).

If you have gestational diabetes: You will be recommended to have your labour induced (or a caesarean section if this is the best option for you) around 39-40 weeks of pregnancy. You may be advised to have your baby earlier than this if there are complications (such as high blood pressure or a big baby).

• Planning the time when your baby is born can help to reduce the risks linked to diabetes. These include:

  • Your blood sugar levels becoming more difficult to control

  • Your baby growing larger than usual (which can also cause difficulties for birth)

  • Developing pre-eclampsia

  • Your baby needing admission to the special care baby unit

  • Stillbirth (although this is rare)

Risks of declining induction of labour if you have diabetes

• The chance of developing the complications of diabetes may increase if you wait longer for labour to start on its own.

• The chance of stillbirth is greater if your pregnancy continues past the recommended timing of birth.

Risks of having induction of labour if you have diabetes

• Babies born at 37 and 38 weeks of pregnancy have a higher chance of needing admission to the neonatal unit. At 37 weeks 10 inductions will lead to 1 baby being admitted to the neonatal unit. This is should be weighed up against the rare but more serious risk of stillbirth when continuing the pregnancy beyond the recommended time of induction of labour.

• Induction of labour is a medical intervention that may affect your birth options and experience. Where you can have your baby will be limited and your hospital stay may be longer than if labour that starts on its own. You will need additional interventions and monitoring during induced labour and may require more pain relief. (see ‘Frequently Asked Questions’ section).

• Induction of labour can sometimes make the contractions become too frequent (less than 60 seconds apart) or too long (lasting over 90 seconds). If this happens we may need to give you medication to reduce your contractions or turn off your oxytocin drip to give you and your baby a rest. The induction may be restarted after some time if it is considered safe for you and your baby. In some cases, a caesarean birth may be advised.

• If your labour is induced there may be an increased need for an assisted vaginal birth (with forceps or ventouse) which can also be linked to more severe perineal tears.

Alternatives to induction of labour if you have diabetes

• You may choose to wait for labour to start on its own and not to have labour induced at the recommended time.

• You may choose to plan induction of labour for a later date (e.g. 40 weeks). This would give more time for labour to start on its own.

• If you are not happy with these options you can discuss this further with your doctor or midwife.

Intuition – Is induction of labour the right option for you?

• After considering the information provided and what is right for you, you can make a plan with your midwife or doctor. This plan should include your wishes if your labour starts before the date of a planned induction of labour, including your planned place of birth.

• If you have type 1 or type diabetes: We recommend that you give birth on the Delivery Suite where there is support from the obstetric team and we can provide continuous monitoring of your baby’s heartrate during labour. This is the same however labour starts.

• If you have gestational diabetes that is well controlled without medication: You may choose to have your baby on The Birth Place (midwifery-led unit) if labour starts on its own before the recommended timing of induction of labour. We recommend you consider this rather than homebirth so that we can provide additional monitoring for your baby during the 24 hours after birth. You can discuss this further with your midwife.

• Whatever you decide, we will support you in your choices. You can change your mind at any time. Speak with your midwife or doctor if you want to reconsider your options and plan.

What if you do nothing?

• If you choose not to be induced at the recommended time you may be offered additional monitoring. This may include further scans and monitoring of your baby’s heat rate. The monitoring can provide reassurance about how the baby is at that moment. Scans and heartbeat checks cannot predict any changes that might happen after the monitoring ends. Stillbirth cannot be reliably predicted or prevented, even with a plan of additional monitoring.

A midwife from Team Maia will keep in contact with you by phone from the first day that your induction of labour is planned for. If there is any delay she will help to plan whether it is safe for you to wait and whether any extra monitoring is needed.

Michelle Keeler (Consultant Midwife)

Medway NHS Foundation Trust

Last updated:

July 2024

Due to be reviewed:

July 2026