In some cases, labour needs to be initiated, at which point the body is helped in various ways so that the cervix becomes soft and is able open with the help of the contractions. In this article, we walk you through how!

Perhaps you’re thinking about how to induce labour if it isn’t starting naturally? Inducing labour may be done for several reasons. These can include hepatitis and gestational diabetes, but also prolonged pregnancy and if it has been a long time since your waters broke. In healthcare, we call initiating childbirth induction.

The choice of induction method depends on how mature your cervix is, but also if there are any individual risk factors such as having had a C-section. The midwife or doctor will perform a vaginal examination to assess the direction of your cervix, consistency, how far the head has penetrated into the pelvic canal, how much remains of your cervix but also whether the cervix has opened slightly. It could be that the foetus’s head is not engaged or that your amniotic fluid has already been lost. Depending on the results of the examination, there are different methods of inducing labour:

• Medication using prostaglandins (can be administered orally or vaginally)
• Dilation of the cervix using a cervical balloon
• Pierce the amniotic membranes (amniotomy) and then use a labour-inducing drip if necessary

If your cervix is very immature, induction usually starts with administering prostaglandins, which cause the cervix to mature. The medication can be given repeatedly and the midwife will assess whether you are having contractions between doses and runs a CTG to make sure the foetus is doing well in your womb.

In order to insert a cervical balloon, you need to be open enough to insert the catheter (about 1-2 cm), but even here you may have to start medication as it may not feel mature enough. The midwife will then pull on the balloon at regular intervals to ensure that it is taut and is exerting optimal pressure on the cervix. The idea is that it should generate a similar effect on the cervix as the pressure from the foetus’s head would have done (but which may not currently be far enough down). When the balloon comes out, you will be about 3-4 cm dilated, and the midwife will usually follow up by puncturing the amniotic membranes. After a while, the midwife will examine you to evaluate the effect of your waters breaking.

If you haven’t gone into labour or your cervix has not opened up spontaneously, you may get a labour-inducing drip. You may not go through all the steps described above, but it depends on how your cervix reacts to each procedure and whether your amniotic membranes are intact or not. In some cases, you will dilate so quickly from the medication that the step using the cervical balloon becomes redundant. Do not forget that these are always individual assessments and that regional guidelines may differ.

One tip is to prepare for the fact that inducing labour can take time, sometimes several days. So, try to bring things with you that can help you pass the time. Don’t forget that the time you spend in hospital before you are in the active phase would otherwise likely have been spent at home.