What to expect during induction

Monitoring you and your baby

Before your induction begins

Before your induction your midwife will assess where your baby is lying in your womb and how far down the baby’s head is in your pelvis. They will do this by examining your abdomen. The midwife or doctor may then perform an ultrasound scan if they want to confirm your baby’s position. You will have a heart rate monitor (CTG/cardiotocography) to check your baby’s heart rate is normal.

You will then need a vaginal examination to assess the cervix. The examination will help to calculate a ‘Bishop score’, which helps to understand your progress in labour and assess what is the right induction agent for you.

During your induction

An illustration of a machine next to a pregnant person's belly. There are pads placed on the belly, held down by straps. These pads give readings to the machine wirelessly..An illustration of a pregnant belly with a hand holding up a monitor device to the belly. The device is attached by wire to a larger monitor display.

Your baby’s heart rate will be monitored before and after inserting the medication or mechanical device for your induction.

Your midwife will monitor contractions and your baby’s heart rate regularly if you are having an inpatient induction.  When you start to have contractions, the midwife will put you on the heart rate monitor. If your baby’s heart trace is normal, then they may keep listening in to the baby’s heart using a handheld doppler device.


If there are concerns about the baby’s heart rate or how often your contractions are coming, we will suggest continuing the heart rate monitoring. We may also advise removing any medication we have used for induction and give you a medication to slow down contractions.

During your labour

When your cervix is examined and we can break your waters (artificial rupture of membranes/amniotomy), you will usually be transferred to the delivery suite/labour ward. You will be offered a hormone drip (oxytocin) which increases the frequency and strength of contractions. Your baby’s heart rate will be monitored continuously whilst you are having oxytocin. Once you are having 3-4 strong contractions in 10 minutes and your cervix has reached 4cm dilated you are in established labour.  You will be offered a vaginal examination every 4 hours to assess the progress of your labour.

Your midwife will monitor your baby’s heart rate and your contractions. If at any point they find it difficult to monitor the baby or your contractions, they may reposition the CTG sensors, ask you to change your position or offer to place a device on the baby’s head called a fetal scalp electrode (FSE). They will formally assess your CTG every hour and document their findings.

An illustration of a cross-section of a baby in a womb with a small clip (fetal scalp electrode) attached to their head with a wire extending out of the vagina and it strapped to a leg to measure baby's heart rate. A flat probe is placed on the pregnant belly with a wire attached to it to measure contractions.

Every four hours, during the first stage of labour (from when your cervix is 4cm to 10cm dilated), your midwife will take your temperature, blood pressure and measure how fast you are breathing. They will check your pulse rate every hour.

If you choose an epidural during labour, your observations will initially be undertaken every 5 minutes for 15 minutes. Your midwife will also check how well the epidural is working every hour.


References

  1. National Institute for Health and Care Excellence (2021). Overview/ Inducing Labour/ Guidance/ NICE. (online) www.nice.org.uk

  2. National Institute for Health and Care Excellence (2022). Overview/ Fetal monitoring in labour/ Guidance/ NICE. (online) www.nice.oeg.uk

  3. Trust, N. National C. (2022) Induced labour: reasons, pros and cons/ Pregnancy, Your pregnancy week by week articles and support/ NCT (National Childbirth Trust)

  4. National Institute for Health and Care Excellence (2023). Overview/ Intrapartum Care/ Guidance/ NICE. (online) www.nice.org.uk

  5. www.nice.org.uk. (N.D) Information for the public/ Inducing labour/ Guidance/ NICE. (online) 

  6. NHS National Institute for Health Research (2016) Choices when pregnancy reached 41 weeks. 

  7. Gülmezoglu AM (2012) Induction of labour for improving birth outcomes for women at or beyond term. Cochrane Database Systematic Review. 2012 Jun 13 ;(6): CD004945.

  8. Stock S (2012) Outcomes of elective induction of labour compared with expectant management: population based study. British Medical Journal. BMJ 2012;344:e2838 doi: 10.1136/bmj.e2838 (Published 10 May 2012)

  9. Middleton P. et al. (2020) Induction of labour in women with normal pregnancies at or beyond 37 weeks. (online) www.cochrane.org.