Outpatient Induction of Labour for Low Risk Pregnancy: Induction of labour (IOL) is the process of helping your body to start labour. We offer induction of labour either in hospital or as an outpatient.
Leaflet Details
| Title | Outpatient Induction of Labour for Low Risk Pregnancy |
| Department | Maternity |
| Author(s) | Joyanto Choudhury |
| Review Date | June 2019 |
| Next Review | May 2022 |
| Download | A5 Booklet PDF |
| Accessibility Options | Click on the Recite Me button to show our accessibility resources |
Patient Information
Introduction
Induction of labour (IOL) is the process of helping your body to start labour. We offer induction of labour either in hospital or as an outpatient.
This leaflet gives you information about Outpatient Induction of Labour.
Outpatient Induction of Labour is the process of induction that starts in the hospital maternity unit for women with low risk pregnancies who are then discharged to home and return to hospital for the birth of their baby.
Why have an Outpatient Induction of Labour?
An Outpatient Induction of Labour:
- Reduces the amount of time you will need to stay in hospital before your labour begins
- Allows you to stay at home and wait for labour to start
- Allows your birth partner to remain with you through all of the induction process
- Makes the process of induction feel less medicalised
Who can have Outpatient Induction of Labour?
You will be offered an Outpatient Induction of Labour if:
- You have a ‘low-risk’ pregnancy and are overdue by more than 10 days
- You have no relevant medical or obstetric problems
- You have not had any uterine surgery
- You have had no bleeding after 24 weeks of pregnancy
- You have a telephone
- You have an adult who will be with you at all times
- You have transport to bring you to the hospital
- You live within a 30 minute drive from the Hospital
Your midwife will have a discussion with you about the Outpatient Induction of Labour process and if you meet all of the criteria you will be offered this method of induction.
What happens on the day?
Your midwife will book an appointment for you to attend the Maternity Day Assessment Unit (MDAU) on ground floor in Abbey Wing at St Peter’s Hospital at 08.30am for your induction of labour.
Please remember to bring an overnight bag in case you do need to stay in hospital.
Outpatient Induction of Labour
Step 1:
When you arrive at MDAU you will have your pulse, blood pressure, temperature and urine checked by a Midwife or Maternity Care Assistant.
The midwife will read your notes and confirm that you are suitable for outpatient induction of labour. She will also discuss the process of induction with you and answer any questions you may have.
The midwife will examine and measure your abdomen to check your baby’s size and the way the baby is laying. She will also check that your baby is well by monitoring the baby’s heart beat on a Cardiotocograph (CTG) machine for about 30 minutes.
Step 2:
When the midwife is happy with the observations and the CTG monitoring, she will perform an internal examination (vaginal examination) to check the neck of the womb (cervix). If the cervix is open you will be admitted for Artificial Rupture of Membrane (ARM) or Prostin vaginal gel. If the cervix is closed, the induction medicine called Propess will be inserted into the vagina. Propess is a flat small pessary which contains prostaglandin (a naturally occurring female hormone) which will remain in your vagina for about 24 hours whilst it slowly releases the hormone to soften and thin out the neck of the womb. It is attached to a small tape so that it can be easily removed.
After the Propess is inserted you will need to lie in bed for 30 minutes with a continuous CTG monitoring of your baby's heart. During this time the Propess will absorb moisture from your vagina like a tampon which makes it swell slightly and settle into place. This reduces the chance of it falling out.
The Propess string will lie just outside of your vagina and it is important that you do not pull or drag on it. You will need to take care when wiping yourself, after going to the toilet, after washing and getting on and off the bed.
Step 3:
When the CTG recording has completed the midwife will assess the monitoring. If it is a normal recording you will be taken to the Abbey Birth Centre (ABC) for refreshments, we ask you to stay with us for 30 mins. You will be given the opportunity to ask any questions and if there are no concerns you will be able to go home.
The time of insertion and planned removal of Propess will be clearly documented by the midwife in your hand held notes.
Step 4:
You can continue with your day-to-day activities and eat and drink as normal. We encourage you to be as mobile as possible.
Please also monitor your baby’s movements.
Step 5:
If there are no concerns you will stay at home overnight and will be advised to return to Joan Booker Ward between 08:30 to 09:00 am the following morning (24 hours after Propess insertion time as documented in your notes). A midwife will remove the Propess from the vagina and assess changes to the cervix.
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Contact the ABC immediately on 01932 723761 If you experience any of the following:
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What happens when I go home?
The Propess works by ‘ripening’ the cervix (neck of womb) - this means that the cervix softens, shortens and begins to open. You will commonly feel a period type pain while this happens but sometimes tightening of the womb can occur and even labour can start. It is advisable to stay at home during this time and we recommend that you take Paracetamol and have a warm bath, but if the contractions become distressing or come every 5 minutes or less you should phone Maternity Triage and come in to be assessed.
Are there any side effects?
Propess can occasionally produce some side effects which are usually mild and include nausea, vomiting, dizziness or rarely palpitations and fever. If any of these occur to a distressing level you should phone the Pregnancy advice line (SpHA line) 0300 123 5473
There is a very rare chance that you may be very sensitive to Propess and start contracting very frequently and strongly:
- More than 5 times in 10 minutes
- A run of contractions each lasting more than 2 minutes
- Severe abdominal pain
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If this happens you must phone The SpHA line and attend the Labour ward immediately. |
If you have any further questions regarding outpatient induction of labour please speak to your community midwife.
Useful Contact Numbers
| The Abbey Birth Centre (ABC) | 01932 723761 |
| Joan Booker Ward | 01932 722291 01932 722378 |
| SpHA line | 0300 123 5473 |
Useful links
- National Institute for Health and Care Excellence. Clinical Guideline ‘Inducing labour’.
https://www.nice.org.uk/guidance/ng207
- National Institute for Health and Care Excellence. Information for the public ‘Induction of labour’.
https://www.nice.org.uk/guidance/ng207
- National Institute for Health and Care Excellence. Clinical Guideline ‘Intrapartum care for healthy women and babies’.
https://www.nice.org.uk/guidance/ng235
