Outpatient induction of labour

The Trust offers outpatient induction of labour. Ask your midwife about this service to see if you could have your labour induced at home.

What is Induction of Labour?

Induction of Labour (IOL) is the process of starting labour artificially. Births are induced for a variety of reasons one of those being when pregnancy has gone past the due date. At East Lancashire Hospitals we offer either IOL in hospital or as an outpatient. This leaflet gives you information about Outpatient IOL.
Outpatient IOL will only be offered to you if you have had a normal ‘low- risk’ pregnancy. This will normally be 7 days past your due date.

An outpatient IOL:

• Allows you to return home once the induction process has been started in the hospital and wait for labour to start
• Reduces the amount of time you will need to stay in hospital before your labour begins.
• Makes the process of induction more normal.

Who can have Outpatient Induction of labour?

You may be offered an Outpatient induction of labour if:

• Your pregnancy is ‘low risk’ and your intended place of birth is the Birth Centre.
• You have no medical, obstetric or gynaecological problems.
• Your pregnancy is overdue by at least 7 days.
• Your BMI is less than 35.
• You are aged less than 40 years.
• You have the ability to communicate with staff to discuss the process both at the hospital and at home.
• You have a birth supporter who is able to stay with you whilst you are at home.
• You have a functional telephone.
• You have transport available to bring you to the hospital and live within 30 minutes of the hospital.

Your midwife or doctor will have a discussion with you about the outpatient IOL process and if you meet all the criteria, you will be offered this method of induction

What happens on the day of my Induction?

Your midwife will book an appointment and scan for you to attend Lancashire Women and Newborn Centre (LWNC) for your IOL.
Please attend the scan department within Antenatal clinic at 08:45 hours, prior to your appointment on the Antenatal Ward (ANW) at 09:00 hours where the scan will be reviewed and if normal, the induction process will commence. This will involve a full antenatal check and monitoring of your pulse, blood pressure and temperature. The midwife will discuss the process with you and answer any questions you may have. The midwife will also perform a monitoring of your baby’s heartbeat for around 30 minutes.

Once the midwife is happy with your observations and the fetal monitoring she will gain permission from yourself to perform an internal examination to assess the neck of your womb (the cervix) and to insert the inducing pessary. Propess pessaries are small flat tampons which will remain inside you for up to a maximum of 24hours. The string of the pessary will lie just inside the vagina for ease of removal. Following insertion of the Propess pessary the midwife will perform another monitoring to assess your baby’s heartbeat for 30 minutes. When the midwife is happy that both you and your baby are well, you will then be able to go home.
You will receive a phone call from a midwife 8-10 hours after you have left the hospital. This is to ensure you are well and that it is still appropriate for you to be at home.

What should I expect when I’m at home?

Women are all different and will respond to induction of labour differently. You may start to feel some period type pains, mild backache or a dull ache at the top of your legs. You may also experience some mild, irregular tightening/contraction of the muscles in your womb. These are all positive effects of the Propess working, as it is ripening your cervix.

Over time you may notice that the period type pains and contractions are becoming more regular. At this point you should start to time them. You are looking for a regular pattern of contractions, that all last the same amount of time (around 60 seconds) and that they all feel as intense as each other. 
Once you are having 3-4 regular contractions in a 10 minute period then you should contact the Antenatal Triage department.
Whilst you are at home you can continue with your normal day to day activities and you should eat and drink as normal. During the time you are at home it is ok for you to use the bath/shower/TENS machine as and how you choose to. Mobilising, being as upright and as active as possible will encourage your labour to begin and progress.

Are there any side effects?

Propess can occasionally produce mild side effects such as nausea, vomiting, diarrhoea, fever, dizziness and vaginal irritation. If any of these occur to a distressing level then contact the Triage department for appropriate advice. Telephone numbers can be found on the back of this leaflet.
Rarely, some women experience contractions that become very frequent and strong and/or severe abdominal pain. Again if you experience this then contact Antenatal Triage immediately.

You may find that the Propess falls out, whilst this is uncommon it does happen and you should arrange to come back into hospital to have it re- inserted by contacting Antenatal Triage.

You should contact triage immediately if you have any of the following:

• Regular uterine contractions.
• Contractions more than 5 times in 10 minutes
• A run of contractions each lasting more than 2 minutes.
• Severe abdominal pain.
• In the event that the pessary falls out.
• Any fresh red vaginal bleeding that isn’t a ‘show’.
• If you think your waters have broken.
• If you are concerned about your baby not moving as much as usual.
• If you have any other concerns or worries.
• If you decide that you would prefer to be in hospital for the induction.

What if nothing happens?

You may feel that whilst you’ve been at home that nothing much has happened. This can be normal and it doesn’t necessarily mean that the Propess pessary has not been working. The pessary can often ripen your cervix without you realising.
You will be given an appointment time to return to the Antenatal ward 24 hours following the insertion of the pessary.

At this appointment the midwife will remove the pessary and examine your cervix. She will discuss her findings with you and make a further plan of care accordingly. This could be that you continue with your induction of labour on the Antenatal ward or that you and your birth supporter are transferred to the Central Birth Suite for the next step of the induction process.