Once you arrive in hospital, you will have your first assessment where your vital signs and your baby's heart rate will be checked and the neck of your womb will be examined. We will then recommended either a cervical ripening method (for up to 24 hours) or you may be ready to skip this step and have your waters broken (amniotomy) on labour ward. Once your waters are broken, you may need a hormone drip to encourage contractions, aiming for 3-4 contractions in 10 minutes. Throughout the process you and your baby will be monitored. The aim is to get to 10cm (fully) dilated so you can begin to push. Partner involvement: Partners or supporters are welcome during labour and can help provide emotional and practical support. Ask your local unit for their policy. Factors affecting induction: Success depends on things like: · The readiness of the cervix. · If you’ve laboured before. · Baby’s growth. · Your health and age. Overall, the induction process involves careful monitoring, various options for encouraging labour to start, and ensuring the safety of both mother and baby.

The practicalities of what will happen on the day of your induction will vary between hospitals. Discuss these with your team. During your induction, you can eat and drink as you please unless advised otherwise. Moving around during induction e.g. birthing balls, showers & baths: • During the first part of your induction, you can move around, take showers and baths and use a birthing ball. • Once in active labour, your movement may be more restricted by monitoring equipment, treatments required and pain relief choices. Key questions that you may wish to ask: • Where do I go? • Where will I stay? • (In most units you will start in one part of the labour ward and move to a different part when you are having your waters broken). • How long can my birth partner stay with me? • Can my birth partner stay overnight?

Before your induction begins: • Your midwife will assess the baby's position and may perform an ultrasound to check. • You will be offered a vaginal exam to check the readiness of the cervix, which helps track the progress of induction. • Your baby's heart rate will be monitored using a CTG (cardiotocography). During your induction: • Your baby’s heartrate will be monitored before and after your cervical ripening medication or balloon dilator . • During your induction, your midwife will monitor contractions and the baby's heart rate as needed. • If an oxytocin drip is used continuous heart rate monitoring is recommended to monitor your baby’s heart pattern in response to your contractions. During your labour: • Once labour is established (cervix at 4 cm, 3-4 contractions per 10 minutes), vaginal exams are advised every 4 hours to track the progress of your labour. • Your midwife will assess your baby’s heart rate, sometimes a fetal scalp electrode is needed. • Your temperature, heart rate, and blood pressure (vital signs) are checked regularly throughout your labour.

Pharmalogical methods: • Tablets (paracetamol dihydrocodeine) - Onset at around 1 hour and duration of 4-6 hours with mild to moderate pain relief. • Gas & Air - Onset immediately and wears off within a few minutes to provide mild pain relief, does not fully eliminate pain. Safe for both mother and baby and can be used at any stage of labour. • Injections (opioids, pethidine, diamorphie) - Onset at around 30 minutes with a duration of a few hours. Strong painkillers that may cause drowsiness or slow breathing in mother and baby; anti-sickness medication may be needed due to feeling sick which is a common side effect. • Epidural - Onset at around 40 minutes with continuous relief throughout labour. Very effective, doesn't cause drowsiness or sickness, minimal effect on baby but may increase likelihood of instrumental birth (e.g., forceps or ventouse). • Patient-controlled Intravenous Analgesia (PCA) - Quick onset after adminstration. Duration is short-term, effective for contractions. Allows self-administered opioid reflied and can be combined with gas & air. Requires close monitoring for potential side effects like reduced breathing or oxygen. Non-pharmalogical methods: • Sterile Water Injections - Onset starts around 10 minutes for up to 3 hours. Useful for relieving back pain, may cause a brief stining sensation at injection site initially. • Other techniques - Include natural methods for early labour pain relief; breathing exercises, TENS showers, baths/birthing pool, and massages. Unlikely sufficient in later stages of labour.