Induction of labour

Short Text

Induction of labour

Introduction

This pathway covers the policy and methods of induction, and the care of women being offered and having induction.
In 2004 and 2005, one in five deliveries in the UK was induced. Induced labours have an impact on the birth experience of women, and on their health and that of their babies.

Source guidance

The NICE guidance that was used to create the pathway.
Induction of labour. NICE clinical guideline 70 (2008)

Quality standards

Quality statements

Effective interventions library

Successful effective interventions library details

Implementation

Audit support

Audit support provides ready-to-use criteria, including exceptions, definitions, suggested data sources and a data collection tool.
Induction of labour: audit support
Induction of labour: questionnaire for women

Costing tools

Costing tools estimate national and local costs and benefits of implementing NICE guidance, or explain why costs are not considered to be significant.
Induction of labour: costing statement

Slide sets

Slide sets provide a framework for discussion and assist in local dissemination of the guidance. The slides contain the key messages from NICE guidance and can be tailored for local presentations.
Induction of labour: slide set

Pathway information

Information for patients and the public

NICE produces booklets for patients and the public, called 'Understanding NICE guidance'. They summarise, in plain English, the recommendations that NICE makes to healthcare and other professionals.
NICE has written a booklet for patients and the public explaining its guidance on induction of labour.

Patient-centred care

Patients and healthcare professionals have rights and responsibilities as set out in the NHS Constitution – all NICE guidance is written to reflect these. Treatment and care should take into account individual needs and preferences. People should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals. If someone does not have the capacity to make decisions, healthcare professionals should follow the Department of Health's advice on consent and the code of practice that accompanies the Mental Capacity Act. In Wales, healthcare professionals should follow advice on consent from the Welsh Assembly Government. If the person is under 16, healthcare professionals should follow the guidelines in Seeking consent: working with children.

Supporting information

Glossary

Membrane sweeping involves the examining finger passing through the cervix to rotate against the wall of the uterus, to separate the chorionic membrane from the decidua. If the cervix will not admit a finger, massaging around the cervix in the vaginal fornices may achieve a similar effect. For the purpose of this pathway, membrane sweeping is regarded as an adjunct to induction of labour rather than an actual method of induction.
The Bishop score is a group of measurements made by doing a vaginal examination, and is based on the station, dilation, effacement (or length), position and consistency of the cervix. A score of eight or more generally indicates that the cervix is ripe, or 'favourable' – when there is a high chance of spontaneous labour, or response to interventions made to induce labour.

Pregnant woman who may need induction

Pregnant woman who may need induction

Information and decision-making

Information and decision-making

Information and decision-making

Provide information and support, invite questions, and allow women time for discussion with partners and for making decisions.
Women should be informed that most women will go into labour spontaneously by 42 weeks. At the 38 week antenatal visit, all women should be offered information about the risks associated with pregnancies that last longer than 42 weeks, and their options. The information should cover:
  • membrane sweeping:
    • that membrane sweeping makes spontaneous labour more likely, and so reduces the need for formal induction of labour to prevent prolonged pregnancy
    • what a membrane sweep is
    • that discomfort and vaginal bleeding are possible from the procedure
  • induction of labour between 41+0 and 42+0 weeks
  • expectant management.
See the antenatal care pathway for more information on routine care.
Healthcare professionals should explain the following points to women being offered induction of labour:
  • the reasons for induction being offered
  • when, where and how induction could be carried out
  • the arrangements for support and pain relief (recognising that women are likely to find induced labour more painful than spontaneous labour)
  • the alternative options if the woman chooses not to have induction of labour
  • the risks and benefits of induction of labour in specific circumstances and the proposed induction methods
  • that induction may not be successful and what the woman's options would be.
See also the pathways on intrapartum care and antenatal care.
NICE has produced a booklet for patients and carers explaining the guidance on induction of labour.

Implementation

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Induction of labour: audit support
Induction of labour: questionnaire for women
Induction of labour: costing statement
Induction of labour: slide set

Source guidance

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CG70

Before induction

View the 'Before induction' path

Performing induction

View the 'Performing induction' path

Contractions begin

View the 'Contractions begin following induction' path

Paths in this pathway

Pathway created: November 2011 Last updated: November 2011

Copyright © 2012 National Institute for Health and Clinical Excellence. All Rights Reserved.

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