What to expect during induction
Monitoring you and your baby
Before your induction begins
Before the induction process is started the midwife looking after you will assess the position and level of your baby’s head by examining your abdomen. The midwife may then perform an ultrasound scan of your abdomen if they want to confirm your baby’s position.
You will be offered a vaginal examination to assess the neck of your womb (cervix). The midwife will be checking for a range of different things when examining including the length, position and dilation of your cervix. The examination will help to calculate a ‘Bishop score’, a value which will help with monitoring the progress of your induction and labour.
A midwife will then put you on the CTG (cardiotocography) monitor to check your baby’s heart rate is normal and to check if you are contracting.
Wired cardiotocography
Monitoring during induction
When you start to have contractions, the midwife will put you back on the CTG 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.
A CTG will be done before and after inserting the medication or mechanical device to undertake your induction.
Wireless (telemetry) cardiotocography
Doppler fetal heart rate monitoring
If there are concerns about the baby’s heart trace or if you are contracting too often then we will keep monitoring, you and your baby on the CTG. We may also remove any vaginal medication we have used for induction and withhold inserting any further medication.
When your cervix is examined and it is deemed appropriate to break your waters (artificial rupture of membranes/amniotomy), this will be undertaken on the delivery suite. You will be offered a hormone drip (oxytocin). Oxytocin increases the frequency and strength of contractions and if started you will be advised to have your baby’s heart rate continuously monitored using the CTG. Once the oxytocin has caused you to have regular contractions in ‘established labour’ (your cervix has reached 4cm and you are having 4 contractions every 10 minutes), you will be examined every 4 hours to assess the progress of your labour.
Your midwife will assess the CTG trace throughout your labour. They will also monitor your contractions. If at any point they find it difficult to monitor the baby or your contractions, they may reposition the CTG transducers, ask you to change your position or they may place a clip on the baby’s head called a fetal scalp electrode (FSE). They will formally assess your CTG every hour and document their findings.
Every four hours, during the first stage of labour (from when your cervix is 4cm to 10cm dilated), your midwife will take and record your temperature, blood pressure and your respiratory rate. They will check your pulse rate and document it every hour.
If you opt to have 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 by checking how well you can feel sensation/ cold.
References:
National Institute for Health and Care Excellence (2021). Overview/ Inducing Labour/ Guidance/ NICE. (online) www.nice.org.uk
National Institute for Health and Care Excellence (2022). Overview/ Fetal monitoring in labour/ Guidance/ NICE. (online) www.nice.oeg.uk
Induced labour: reasons, pros and cons/ Pregnancy, Your pregnancy week by week articles and support/ NCT (National Childbirth Trust)
National Institute for Health and Care Excellence (2023). Overview/ Intrapartum Care/ Guidance/ NICE. (online) www.nice.org.uk
www.nice.org.uk. Information for the public/ Inducing labour/ Guidance/ NICE. (online)
NHS National Institute for Health Research (2016) Choices when pregnancy reached 41 weeks.
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.
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)
Middleton P. et al. (2020) Induction of labour in women with normal pregnancies at or beyond 37 weeks. (online) www.cochrane.org.
