Balloon induction of labour

Induction is a way of starting labour

The doctor or midwife will recommend that you are induced if it is felt to be safer for either you or the baby. Induction is not unusual - about 20% of labours are induced.

Why am I being induced?

There are lots of reasons why women are induced. The most common reason is that the baby is overdue. After about 42 weeks of pregnancy the placenta stops working as effectively and it is usually better for the
baby to be born.

Other reasons that the doctor may suggest induction include:

• if you have high blood pressure
• if your waters have broken and there is no sign of you going into labour
• if you have diabetes and your baby is growing very big
• if your baby's growth has slowed down

The doctor or midwife will discuss the reason and the procedure with you before a decision is made

Will it harm my baby?

The induction process mimics what happens naturally during labour and your baby will be monitored
appropriately throughout.

How is it different from a natural birth?

The aim is that your baby will still be delivered vaginally, as with a natural birth, but medicine or other methods are used to help start labour.

While your baby is developing in the womb, it is protected inside a membrane filled with fluid called amniotic fluid. During pregnancy, your cervix (the entrance to your womb) is closed.

When your baby is ready to be born, the following changes show that labour is beginning:

your cervix starts to get thinner and softer. This is called the ‘ripening of the cervix' once your cervix is ripe, it will start to open or ‘dilate'. By the end of labour, the cervix will open to about 10cm.

The process is properly underway once the cervix has opened to about 3cm, although you may already have experienced other signs of labour (e.g. contractions have started).

Waters Break

The membranes around your baby break and the fluid is released through your vagina. This is also known as ‘the waters breaking'. You might feel the waters being released suddenly as a gush or as a gentle trickle.

Contractions start

The muscles of your womb start to make regular movements, called contractions. The contractions push your baby's head down and cause your cervix to start opening, When your cervix is open or dilated enough, the contractions help to push your baby out.

Contractions start off weak and irregular and gradually become stronger and more regular. Labour can last anything from a few hours to a few days and is different for every woman.

There are various ways of inducing labour. Sometimes a couple of methods are combined.

Membrane sweeping

This may be done by the midwife or doctor placing her finger inside your cervix and making a circular movement to separate the membranes from the cervix. This encourages your waters to break and labour to start naturally. It may cause some discomfort and light bleeding.

The midwife can visit you at home to sweep the membranes or it can be done by the midwife or doctor in the clinic or on the antenatal ward.

Balloon

Cook balloon is a slim silicone tube with two inflatable balloons which act to ripen and dilate the cervix. It can be inserted by a doctor or midwife. Once the inserted they are inflated with salt water (normal saline). One balloon will be in your uterus and the other in your vagina. The balloons do not contain any medication, but their presence there encourages natural labour to begin. Once inserted, the balloons will stay inside usually for 12 hours.

You may be able to go home during this period. While the balloons are inside, you are safe to mobilize and eat as normal.

You should contact your midwife if:

you have regular contractions
your waters break
you have bleeding
you have any concerns

The balloon will be deflated and removed if it has not fallen out by the time you are seen again. An internal exam will be conducted to assess suitability for your waters to be broken. If your cervix has not changed, you may need prostaglandins or other interventions.

Prostaglandin

Prostaglandin is a hormone which is released naturally by the cervix during labour to stimulate contractions. Giving prostaglandin helps make the process close to natural labour.

Prostaglandin gel is placed into your vagina by the midwife on the antenatal ward. The prostaglandin encourages your cervix to open, your waters to break and your contractions to start.

The midwife will insert the prostaglandin gel when you are on the antenatal ward. You will have to lie down for 1 hour after being given the prostaglandin while we monitor your baby’s heart beat, but then you will be able to get up and move around. Further doses can be given if needed.

Amniotomy

This is another method used to help start labour, also called artificial rupturing of the membranes or ‘breaking the waters’. This encourages the womb to contract to start labour. A small hook is inserted into your vagina to do this and it won't touch your baby.

This procedure is usually done in the labour ward.

Oxytocin 

This method is usually used following one, or both of the above methods, generally if your waters have broken but your contractions have not started. Oxytocin is a natural hormone which builds up during labour and causes contractions.

During induction, Oxytocin is given into your vein via a drip. A doctor or midwife in the delivery suite will attach the drip to your arm. Once the drip is put into your arm, you might not be able to walk around.

Will it be painful?

Induction is generally no more painful than a natural birth.

How long will it take?

Your baby won't necessarily be born on the day that you come in to be induced. The process of induction varies a great deal from woman to woman. It is hard to say when it will start or how long it will take but, as with natural labour, induction takes two or three days on average. Pain relief will be available.

Occasionally a round of Induction may not work - if this happens the Doctor will discuss with you a second round of induction. There will be a period of 'rest' between the first and second induction process and it is likely you would be able to go home during this time.

Date: __________________________________

Time: _________________________________

Ward: _________________________________

Telephone: 01896 826017

Please telephone at 7:30am / 6pm to confirm your appointment before you come in