What to expect during induction

What to expect during induction

The Induction of Labour Journey


Start: you arrive at hospital An initial assessment with your clinician can include Discussion, Observations, Vaginal examination, Monitor baby’s heart (CTG), +/- membrane sweep. If you have a Bishop Score of 6 or below, You will be given vaginal medication (prostaglandin) or a mechanical device in your cervix. You will then have a risk assessment for where you can be while you wait. This will be for up to 24 hours. Location options are Inpatient induction (hospital) or Outpatient induction (home) Then re-assessment & re-examination to determine if your cervix is open. If Cervix is not open, options include Re-attempt Step 1, Rest, Wait and see, Caesarean birth If Cervix is open, progress to next stage. If you have a Bishop Score of 7 or above at initial assessment, you will skip the previous steps and immediately progress to next stage. Aim of this stage: Progress to at least first stage of labour: 0-4cm dilation, latent phase. You will be transferred to labour ward and CTG monitoring is started. Your waters will be broken (amniotomy/artificial rupture of membranes). You may be started on an oxytocin drip to encourage contractions (aim: 3-4 contractions in 10 minutes). Aim of next stage: Progress through first stage of labour (4-10cm dilation, active phase), and into second stage (10cm dilated). Then Birth of baby

Below, we've written about the induction process in further detail:

The care you will receive before and during an induction

Arriving for your induction:

Induction of labour can be carried out in hospital (inpatient) or at home (outpatient). Outpatient induction may be offered with medication (prostaglandin) or a mechanical device in the cervix.

The initial assessment:

In hospital, a clinical assessment will be carried out of you and your baby before induction begins including; vaginal examination to assess the readiness of your cervix (Scroll down to view the Bishop Score), measuring your vital signs and monitoring your baby’s heart rate.

Outpatient induction:

This can be offered to women who wish to return home, and who have no medical problems or additional risks.

The risks and benefits will be discussed with you and when to contact the hospital team will be explained. This includes if:

  • Contractions begin. 

  • Your waters break. 

  • You have vaginal bleeding. 

  • You have any other concerns, such as reduced fetal movements, severe pain or contractions that are very close together. 

  • If your vaginal medication or mechanical device falls out.

We may recommend that your place of induction (and or birth) change for:

  • Certain medications (e.g. a hormone drip) or pain relief (e.g. an epidural). AND/OR 

  • Your baby’s heart rate needs monitoring continuously. 

Inpatient induction: 

You may decide or your team may recommend that you stay in hospital to have your induction – this is called “inpatient induction”.


Factors that impact induction of labour

We cannot guarantee induction of labour will work for you but there are some factors influencing whether it works or not.

One of the main factors is the assessment of the cervix using the Bishop score.


What is a Bishop Score?

The Bishop score is a number/score obtained by doing a vaginal examination. It helps us to see how ready your cervix is for labour and gives us an idea of which methods for inducing labour may be more suitable. It is based on:  

  • How many centimetres dilated you are – dilatation is from 0 – 10cm. 

  • Length (effacement) of the cervix – this ranges from long– paper thin

  • Position of the cervix in your vagina – it can be at the back (less ready) or towards the front (more ready). 

  • How firm the cervix feels - it changes from firm to soft during labour. 

  • How far down into the pelvis your baby’s head is (station).


Other factors:

  • If you’ve had a vaginal birth before.

  • Your baby’s weight being estimated to be within a normal weight range.

  • How many weeks pregnant you are.

  • If your BMI is more than 30 you are more likely to have a caesarean birth during induction than those will a BMI less than 30. 

  • Your age and if you have any medical conditions can influence your chances of the induction leading to vaginal or caesarean birth. 

During the induction

Step 1 - When your cervix is less ready (Bishop score is 6 or less) you will usually be offered medication or a mechanical method to ripen the cervix for labour.

With vaginal medication; your baby’s heart rate and your contractions will be checked regularly. 

Induction with a mechanical device in the cervix is less likely to cause excessive contractions than vaginal medication but your baby’s heart rate and your contractions will still be checked regularly.

Step 2 - When your cervix is more ready (Bishop score is more than 6), it will be possible to break your waters (amniotomy) and you may be given a hormone drip (oxytocin link) through a vein in your arm to stimulate contractions. Step 2 takes place on delivery suite/labour ward.  

Depending on the Bishop score calculated during your initial vaginal exam - you may be able to skip step 1 described above that prepares your cervix for step 2.

If you have undergone step 1, once your cervix is ready, you will move on to step 2.

There are pain relief options available throughout.

You can develop excessive contractions (hyperstimulation) and if this happens, your vaginal medication will be removed (if possible), or your hormone drip will be stopped. There is also medication that can slow your contractions down. 

For more information about the labour process please refer to our vaginal birth core information set