Induction of Labour

Sometimes, it is necessary to bring on labour before its natural onset. The two most common reasons are postdates pregnancies that are 10 days overdue, and when the water breaks but labour does not start spontaneously. Induction is also recommended in higher risk situations (eg. mothers over 40, insulin-treated diabetes, high blood pressure, fetal growth restriction).

The method of induction will depend on the reason for induction and the status of the cervix. When the cervix is ‘unfavourable’ (not yet dilated or thinned out), a prostaglandin medication called Cervidil is typically used. It is delivered on a shoestring-like device, which is inserted by a specialized RN at a scheduled hospital appointment. Multiple doses are sometimes needed, and re-assessments are done at 24-hour intervals, with the woman going home in between. In higher risk cases, women will stay in hospital on the antepartum unit during their induction. Induction can take a few days, and women are advised to rest as much as possible during the process.

In cases where Cervidil is not possible, induction may be started by placing a balloon (Foley catheter) into the cervix, and administering IV oxytocin.

When the cervix is already dilated, or if the water has broken, induction is usually done with IV oxytocin, which is administered in a labour room with one-on-one nursing and continuous fetal monitoring. The oxytocin dose is slowly increased until the desired contractions are achieved. Women do not leave the hospital until they have delivered.