11/13/24, 8\:18 PM Guide | Induction of labour counselling

Induction of labour counselling

Table of contents

Opening the consultation

Wash your hands and don PPE if appropriate.
Introduce yourself to the patient including your name and role.
Con
Explain the reason for the consultation\:
“I u n d e r s t a n d t h a t y o u’ r e h e r e t o d i s c u s s i n d u c t i o n o f l a b o u r , i s t h i s c o r r e c t ? ”
It is important to establish a good rapport and an open line of communication with the patient early in the consultation\:
h a v e a n y q u e s t i o n s a t a n y p o i n t , o r i f s o m e t h i n g i s n o t c l e a r , p l e a s e f e e l f r e e t o i n t e r r u p t a n d a s k m e .
”
“ I f y o u
Make sure to check the patient’s understanding at regular intervals throughout the consultation and provide opportunities to
ask questions (this is often referred to as ‘chunking and checking’).
Throughout the consultation, be receptive to the patient’s language and try only to use words and terminology they
are comfortable with.

Ideas, concerns and expectations

A key component of history taking involves exploring a patient’s ideas, concerns, and expectations (often referred to as ICE) to
gain insight into the patient’s thoughts about having an induction of labour, what they are worried about and what they expect
from the consultation. When discussing concerns, do so in a sensitive and honest manner.
It can be challenging to use the ICE structure in a way that sounds natural in your consultation, but we have provided
several examples for each of the three areas below.
Ideas
“ W h a t d o y o u a l r e a d y k n o w a b o u t i n d u c t i o n o f l a b o u r ?”
“ D o y o u k n o w w h y w e o
“ H a v e y o u h e a r d a b o u t a n y m e t h o d s u s e d f o r i n d u c i n g l a b o u r ?”
Concerns
“ I s t h e r e a n y t h i n g t h a t w o r r i e s y o u a b o u t i n d u c t i o n o f l a b o u r ?”
Expectations
“ W h a t w e r e y o u h o p i n g w e w o u l d c o v e r t o d a y r e ga r d i n g i n d u c t i o n o f l a b o u r ?”
“ I s t h e r e a n y t h i n g y o u s p e c i

Patient history

Although the purpose of this station is to explain the procedure, it is a good idea to gather a quick, focused history early in the
consultation.
This should include understanding the patient’s reason for needing an induction of labour and how their pregnancy has gone
so far.
Understanding the indication for inducing labour will allow you to tailor your explanation.
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What is induction of labour?

Using patient-friendly language, explain that induction of labour is when healthcare professionals use techniques to help start
the process of labour before it occurs spontaneously.
Induction of labour is often recommended when continuing the pregnancy might pose a greater risk to the health of the baby
or the mother, compared to the risk of inducing labour.
1
It is important to thoroughly discuss the risks and bene
outcome, the labour experience, and future pregnancies.
2
“ U s u a l l y , l a b o u r w i l l o c c u r n a t u r a l l y a n d s t a r t b e t w e e n 3 7 a n d 4 2 w e e k s . I f w e b e l i e v e t h a t c o n t i n u i n g t h e p r e gn a n c y a t a n y p o i n t
m i g h t i n v o l v e s i g n i
u s e d t o h e l p s t a r t t h e l a b o u r p r o c e s s b e f o r e i t h a s s t a r t e d o n i t s o w n .
”
“ I w i l l n o w e x p l a i n s o m e o f t h e r e a s o n s w h y i n d u c t i o n o f l a b o u r i s o

Indications

It is important for the woman to understand why induction is necessary and the potential risks of delaying childbirth. Tailor the
explanation to the patient's individual situation, outlining the speci
inducing labour include\:

Prolonged gestation

Prolonged gestation is when a pregnancy lasts longer than 41 weeks. 2 3
It is the most common reason for inducing labour.
“ I f y o u r p r e g n a n c y g o e s b e y o n d 4 1 w e e k s , a d m i s s i o n a n d s t i l l b i r t h .
”
t h e r e i s a h i g h e r r i s k o f c o m p l i c a t i o n s , i n c l u d i n g c a e s a r e a n s e c t i o n , n e o n a t a l u n i t

Prelabour rupture of membranes

“ D u r i n g p r e g n a n c y , y o u r b a b y i s s u r r o u n d e d b y a b a g o f
b e f o r e l a b o u r s t a r t s , t h e r e i s a h i g h e r r i s k o f i n f e c t i o n f o r b o t h y o u a n d y o u r b a b y . W e m a y r e c o m m e n d a n i n d u c t i o n o f l a b o u r t o
r e d u c e t h i s r i s k , b u t t h i s w i l l b e d e p e n d e n t o n h o w f a r i n t o t h e p r e gn a n c y y o u a r e .
”
1 ,4

Maternal health conditions

“ A n i n d u c t i o n m a y b e a d v i s e d i f y o u h a v e a m e d i c a l c o n d i t i o n t h a t m a k e s i t s a f e r f o r y o u a n d y o u r b a b y t o d e l i v e r e a r l i e r . e x a m p l e , d i a b e t e s , h i g h b l o o d p r e s s u r e o r h e a r t d i s e a s e .
”
1
F o r
“ I f y o u h a v e d i a b e t e s , i n d u c t i o n o f l a b o u r i s s u g g e s t e d t o r e d u c e t h e r i s k o f s t i l l b i r t h . I t c a n a l s o h e l p t o p r e v e n t t h e b a b y f r o m
g r o w i n g t o o b i g , w h i c h c a n i n c r e a s e t h e r i s k o f t h e b a b y b e c o m i n g s t u c k d u r i n g b i r t h .
”
2

Concern for baby’s wellbeing

“ I f t h e r e i s a n y c o n c e r n a b o u t t h e b a b y’ s h e a l t h o r g r o w t h , w e m a y s u g ge s t i n d u c t i o n t o s h o r t e n t h e p r e gn a n c y a n d r e d u c e r i s k
t o t h e b a b y .
”
Patient request for induction
Patient requests for induction of labour should only be considered after discussing the bene
taking into account their circumstances and preferences.
2
Advantages of induction of labour
The advantages depend on the indication, with the intention to reduce the risk of complications for the woman or baby (or
both) by delivering earlier.
Induction of labour at 41 weeks gestation is associated with a lower risk of perinatal death compared to continuing the
pregnancy beyond 41 weeks.
Disadvantages of induction of labour
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Induction of labour is a medical process that may a
induction usually means giving birth in a labour ward rather than a midwifery-led unit, and options such as a birthing pool may
not be available.
Induced labour may be more painful than spontaneous labour and may mean a longer stay in hospital.
2

Contraindications

Inducing labour is unsuitable when vaginal delivery poses signiplacenta praevia, transverse
fetal lie or if the mother or baby may be unable to tolerate labour (e.g. signi
fetal growth restriction).
Induction is generally not recommended for breech presentations due to increased complexities.
Women who have undergone caesarean sections or uterine surgeries require careful consideration. Inducing labour in these
circumstances increases the risk of uterine scar rupture, especially when prostaglandins are used. Mechanical methods are
often preferred in such situations. Induction can still be o
informed of the risks.
5

Methods for inducing labour

Membrane sweep

Before inducing labour, women may be o
separating the fetal membranes from the cervix. This can stimulate the release of prostaglandins, which can trigger labour.
1,6
“ A m e m b r a n e s w e e p i n v o l v e s y o u r m i d w i f e o r d o c t o r g e n t l y i n s e r t i n g a
w o m b . T h i s h e l p s s e p a r a t e t h e m e m b r a n e s s u r r o u n d i n g t h e b a b y f r o m t h e c e r v i x a n d r e l e a s e s h o r m o n e s t o h e l p s t a r t l a b o u r .
”
Advantages
A membrane sweep may increase the chances of labour starting naturally and reduce the likelihood of requiring further
interventions to induce labour.
1,7
“ I t c a n r e d u c e t h e l i k e l i h o o d o f r e q u i r i n g a n i n d u c t i o n o f l a b o u r .
”
“ T h i s p r o c e d u r e c a n t a k e p l a c e e i t h e r a t h o m e , d u r i n g a n o u t p a t i e n t a p p o i n t m e n t , o r i n t h e h o s p i t a l .
”
Disadvantages
“ F o r s o m e w o m e n , ”
1
s w e e p .
t h i s p r o c e d u r e c a n c a u s e d i s c o m f o r t o r p a i n . Y o u m a y e x p e r i e n c e c r a m p i n g a n d v a g i n a l b l e e d i n g a f t e r t h e
“ T h e s w e e p m a y n o t s t a r t l a b o u r o n t h e
”

Bishop scoring system

There are various steps in the induction process. The
performing a vaginal examination and using the Bishop scoring system.
Table 1. Bishop scoring system
8
Score 0 1 2 3
Cervical dilation (cm) Closed 1-2 3-4 5-6
E
Position of cervix Posterior Mid position Anterior -
Consistency of cervix Firm Medium Soft -
Fetal head station (relative to ischial
spines)-3 -2 -1, 0 +1,
+2
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If the Bishop score is ≤6 (i.e. the cervix is unfavourable), either prostaglandins or a mechanical method (e.g. a balloon catheter)
should be o
although they may themselves cause the initiation of labour.
If the Bishop score is >6 (i.e. the cervix is favourable), an amniotomy with or without an oxytocin infusion is recommended.
2
“ T o i n d u c e l a b o u r , y o u w i l l n e e d t o g o t o t h e h o s p i t a l m a t e r n i t y u n i t s o w e c a n m o n i t o r y o u w h i l e i t h a p p e n s . Y o u r m i d w i f e o r
d o c t o r w i l l p e r f o r m a n i n t e r n a l e x a m i n a t i o n t o d e t e r m i n e h o w r e a d y y o u r c e r v i x i s f o r l a b o u r . T h i s h e l p s u s d e c i d e t h e b e s t w a y
t o i n d u c e l a b o u r .
”
“ T h e r e a r e v a r i o u s w a y s t o i n d u c e l a b o u r \: m e d i c a t i o n s a n d m e c h a n i c a l m e t h o d s . I w i l l d e s c r i b e w h a t e a c h o f t h e s e m e t h o d s
i n v o l v e s , a n d w e w i l l e x p l o r e w h i c h t y p e m i g h t b e s t s u i t y o u , a s e a c h h a s a d v a n t a g e s a n d d i s a d v a n t a ge s .
”

Prostaglandins

Arti
They are recommended as an initial approach for inducing labour.
2
“ W e c a n i n s e r t a g e l , p e s s a r y o r t a b l e t i n t o t h e v a g i n a c o n t a i n i n g a h o r m o n e c a l l e d p r o s t a gl a n d i n . T h e s e h o r m o n e s m i m i c t h e
o n e s y o u r b o d y p r o d u c e s t o s t a r t c o n t r a c t i o n s a n d p r e p a r e t h e c e r v i x f o r l a b o u r . T h r o u gh o u t t h e p r o c e s s , w e w i l l m o n i t o r y o u
a n d y o u r b a b y c l o s e l y t o e n s u r e e v e r y t h i n g i s p r o gr e s s i n g s a f e l y .
”
Advantages
invasive procedure.
Prostaglandins may be preferred as they reduce the likelihood of needing mechanical methods and the requirement for an
“ T h e s e c a n b e q u i c k e r a n d m a y i n v o l v e l e s s d i s c o m f o r t d u r i n g i n s e r t i o n t h a n m e c h a n i c a l m e t h o d s .
”
Disadvantages
“ S o m e t i m e s t h e s e h o r m o n e s c a n c a u s e c o n t r a c t i o n s t h a t a r e t o o f r e q u e n t o r t h a t l a s t t o o l o n g . T h i s i s k n o w n a s
h y p e r s t i m u l a t i o n . T h i s c a n b e p a i n f u l a n d c a n m e a n t h a t t h e b a b y b e c o m e s d i s t r e s s e d i f t h e r e i s n o t e n o u gh r e s t b e t w e e n
c o n t r a c t i o n s . I t i s a l s o p o s s i b l e f o r t h e w o m b t o b e i n j u r e d , a l t h o u gh t h i s i s n o t c o m m o n . 2
W e w i l l m o n i t o r y o u t h r o u g h o u t , a n d i f
h y p e r s t i m u l a t i o n d o e s o c c u r , t h e i n d u c t i o n p r o c e s s w i l l b e s t o p p e d , a n d m e d i c a t i o n c a n b e gi v e n t o s l o w t h e c o n t r a c t i o n s .
”
“ H o r m o n a l i n d u c t i o n i s n o t s u i t a b l e f o r s o m e w o m e n , s u c h a s t h o s e w h o h a v e h a d a p r e v i o u s c a e s a r e a n s e c t i o n , a r e a t a h i gh e r
r i s k o f h y p e r s t i m u l a t i o n o r c h o o s e t o u s e a m e c h a n i c a l m e t h o d .
”
“ S o m e w o m e n m a y e x p e r i e n c e s i d e e
”
9
e s p e c i a l l y i f t a k e n b y m o u t h . T h e s e i n c l u d e n a u s e a , v o m i t i n g

Mechanical

If prostaglandins are not suitable or have not been successful in inducing labour, women may be o
like a balloon catheter or osmotic cervical dilator.
2
“ M e c h a n i c a l m e t h o d s f o r i n d u c i n g l a b o u r i n v o l v e u s i n g p h y s i c a l d e v i c e s t o h e l p y o u r b o d y s t a r t t h e l a b o u r p r o c e s s . O n e
c o m m o n a p p r o a c h i s u s i n g a s m a l l b a l l o o n a t t a c h e d t o a t u b e . T h e b a l l o o n i s g e n t l y i n s e r t e d i n t o t h e c e r v i x b y y o u r m i d w i f e o r
d o c t o r a n d i n
”
Advantages
“ M e c h a n i c a l t e c h n i q u e s a r e l e s s l i k e l y t o c a u s e h y p e r s t i m u l a t i o n t h a n h o r m o n a l i n d u c t i o n .
”
“ T h e y a r e a m i n i m a l l y i n v a s i v e o p t i o n a n d d o n o t r e q u i r e m e d i c a t i o n s . h o m e .
”
9
S o m e w o m e n c a n s a f e l y u s e t h i s m e t h o d w h i l s t a t
Disadvantages
“ T h e i n s e r t i o n o f t h e b a l l o o n m a y b e u n c o m f o r t a b l e a n d c a u s e c r a m p i n g.”
“ T h e i n d u c t i o n p r o c e s s m a y t a k e l o n ge r c o m p a r e d t o o t h e r m e t h o d s .
”
“ T h e r e i s a s m a l l r i s k t h a t t h e u m b i l i c a l c o r d c a n p a s s t h r o u g h t h e c e r v i x . T h i s i s c a l l e d a c o r d p r o l a p s e , w h i c h c a n r e d u c e b l o o d

”
9

Amniotomy

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Once the cervix is favourable, an amniotomy may be o
the membranes. Like a membrane sweep, this releases prostaglandins to help speed up labour. Often, an amniotomy is paired
with an oxytocin infusion to enhance contractions.
2
“ A n a m n i o t o m y i s w h e n y o u r d o c t o r o r m i d w i f e w i l l u s e a s m a l l , i s d o n e t h r o u g h t h e v a g i n a a n d c a n h e l p t o s p e e d u p l a b o u r . t h i n t o o l t o b r e a k t h e s a c o f
O f t e n a h o r m o n e d r i p i s gi v e n a l o n gs i d e .
”
Advantages
“ B r e a k i n g t h e w a t e r s c a n r e l e a s e h o r m o n e s t h a t h e l p t o m a k e y o u r c o n t r a c t i o n s s t a r t , s t r o n g e r .
”
o r m a k e t h e m m o r e f r e q u e n t a n d
“ T h i s p r o c e d u r e i s n e c e s s a r y b e f o r e c o n s i d e r i n g t h e h o r m o n e d r i p t o h e l p t h e c o n t r a c t i o n s ( o x y t o c i n ) .
”
Disadvantages
“ A m n i o t o m y i s d o n e d u r i n g a v a g i n a l e x a m i n a t i o n , a n d t h e e x a m i n a t i o n c a n b e u n c o m f o r t a b l e . T h e m i d w i f e o r d o c t o r
p e r f o r m i n g t h e e x a m i n a t i o n w i l l d i s c u s s p a i n r e l i e f o p t i o n s ( s u c h a s ga s a n d a i r ) w i t h y o u .
”

Oxytocin

Oxytocin is used to increase both the frequency and strength of contractions. It is given as an intravenous infusion, usually
only once the membranes have been ruptured.
“ O x y t o c i n i s a h o r m o n e t h a t i n c r e a s e s t h e n u m b e r a n d s t r e n g t h o f c o n t r a c t i o n s . I t i s gi v e n t h r o u gh a d r i p i n t o a v e i n i n y o u r a r m
o r h a n d . I t c a n b e s t a r t e d i m m e d i a t e l y a f t e r b r e a k i n g t h e w a t e r s , o r a f t e r a p e r i o d t i m e i f c o n t r a c t i o n s d o n o t s t a r t o n t h e i r o w n .
”
Advantages
“ O x y t o c i n i n c r e a s e s t h e n u m b e r a n d s t r e n g t h o f t h e c o n t r a c t i o n s t h a t a r e n e e d e d f o r l a b o u r t o p r o g r e s s .
”
Disadvantages
“ O x y t o c i n c a n m a k e c o n t r a c t i o n s m o r e p a i n f u l . Y o u r m i d w i f e o r d o c t o r w i l l d i s c u s s p a i n r e l i e f o p t i o n s w i t h y o u .
”
“ I f y o u a r e r e c e i v i n g a n o x y t o c i n d r i p , y o u r b a b y’ s h e a r t b e a t s h o u l d b e c o n t i n u o u s l y m o n i t o r e d . T h i s i s l i k e l y t o m e a n t h a t c e r t a i n
b i r t h c h o i c e s a r e n o t a v a i l a b l e t o y o u , s u c h a s g i v i n g b i r t h i n a m i d w i f e r y-l e d u n i t o r i n a b i r t h i n g p o o l .
”

Unsuccessful induction of labour

" S o m e t i m e s , i n d u c t i o n d o e s n' t s t a r t l a b o u r a s e x p e c t e d . Y o u r o b s t e t r i c i a n a n d m i d w i f e w i l l m o n i t o r y o u a n d y o u r b a b y c l o s e l y .
T h e y w i l l d i s c u s s a l t e r n a t i v e i n d u c t i o n m e t h o d s o r p o s s i b l y a c a e s a r e a n s e c t i o n , o r t h e y m a y w a i t a n d r e a s s e s s y o u r p r o gr e s s i n
a f e w h o u r s . T h e y a r e h e r e t o s u p p o r t y o u a n d w i l l e x p l a i n a l l o p t i o n s s o y o u c a n m a k e t h e b e s t d e c i s i o n s f o r y o u a n d y o u r
b a b y .
"

Closing the consultation

Ask if the patient has any questions before the end of the consultation. Close the consultation by summarising what you have
discussed. This allows you to emphasise the key points of the consultation.
Finally, thank the patient for their time and o
Dispose of PPE appropriately and wash your hands.

References

1. NHS.UK. I n d u c i n g l a b o u r . 2023. Available from\: [LINK].
2. NICE guideline [NG207]. I n d u c i n g L a b o u r . 2021. Available from\: [LINK].
3. Layden EA, Thompson A, Owen P, et al. C l i n i c a l O b s t e t r i c s a n d G y n a e c o l o g y . 5th ed. Elsevier. 2022. p. 395.
4. NHS.UK. S i g n s t h a t l a b o u r h a s b e g u n . 2023. Available from\: [LINK].
5. Layden EA, Thompson A, Owen P, et al. C l i n i c a l O b s t e t r i c s a n d G y n a e c o l o g y . 5th ed. Elsevier. 2022. p. 396.
6. Collins S, Hayes K, Arulkumaran S, et al. O x f o r d H a n d b o o k o f O b s t e t r i c s a n d G y n a e c o l o g y . 4th ed. Oxford University Press. 2023.
p. 645.
7. NHS University Hospitals Coventry and Warwickshire. P a t i e n t I n f o r m a t i o n \: I n d u c t i o n o f L a b o u r . 2024. Available from\: [LINK].
https\://app.geekymedics.com/osce-guides/counselling/induction-of-labour-counselling/ 5/611/13/24, 8\:18 PM Guide | Induction of labour counselling
8. Bishop EH. P e l v i c s c o r i n g f o r e l e c t i v e i n d u c t i o n . Obstetrics & Gynecology. 1964. Available from\: [LINK].
9. NHS Imperial College Healthcare. I n d u c t i o n o f l a b o u r \: I n f o r m a t i o n f o r p a t i e n t s , r e l a t i v e s a n d c a r e r s . 2023. Available from\: [LINK].

Reviewer

Dr Simon Williams
Consultant Obstetrician
Source\: geekymedics.com
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