Induction of Labourflipbooks.leedsth.nhs.uk/LN000726.pdf4 Induction of labour, when compared to waiting for spontaneous labour in lower risk pregnancies, does not significantly alter

Leeds Maternity Care

nThe Leeds

Teaching HospitalsNHS Trust

Induction of Labour My information & personal planner

Information for patients

2

This leaflet contains information to help you understand the care and treatment that you will receive during your induction of labour.

What is induction of labour?Labour is a natural process that normally starts on its own but sometimes needs to be started artificially. This is called induction of labour.

Why does my labour need to be induced?The reason I have been recommended to have my labour induced is:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

How is natural labour encouraged?Before you are offered induction, you may be offered a membrane sweep. A “sweep” has been shown to increase the number of women who go into labour naturally in the following 48 hours after it is performed. It takes only a few minutes and can be carried out at home, in clinic or on the ward.

3

A membrane sweep involves a vaginal examination performed by your Midwife or Doctor, during which a finger is gently put just inside the cervix (neck of the womb) and circular, sweeping movements are made to separate the membranes that surround the baby.

This stimulates the cervix to release labour inducing hormones which are naturally produced by the body called prostaglandins. Despite being gentle, some women may still find this moderately uncomfortable and afterwards there may be some period type pains.

It is very common to notice some blood staining or a “show” especially on wiping or after passing urine. This is not harmful and should settle after a few hours. After the examination you will be able to continue your usual daily activities. Some women have more than one “sweep.”

What are the benefits and risks of induction of labour?There are many reasons why you may have been offered an induction of labour. Broadly speaking the reason this has been offered is because it may be better or safer for you and/or your baby for the baby to be born sooner.

Induction of labour is a different process to spontaneous labour, and the process is explained later in this leaflet. However, studies comparing the experience women have with induction compared to spontaneous labour don’t suggest that induction is a worse experience.

4

Induction of labour, when compared to waiting for spontaneous labour in lower risk pregnancies, does not significantly alter how the baby is born. Most studies suggest no difference in the rate of emergency caesarean section, with some suggesting slightly lower caesarean rates, with a possible small increased chance of instrumental delivery (ventouse or forceps). There also appears to be no difference in other outcomes for the mother, except that there is a lower risk of developing blood pressure problems by being induced rather than waiting. If there have been other complications in your pregnancy then having the baby sooner may be safer for you.

For the baby, overall induction of labour is safe. Usually part of the reason it is being offered is so the baby is born sooner and so reducing the risk of stillbirth. If a baby is born before 39 weeks there is small increased risk (an extra one in 1000) that it may need admission to the neonatal unit, so inductions before 39 weeks are performed when there is more concern with waiting. However, the actual process of induction does not seem to increase the risk of complications for the baby or mother.

In lower risk pregnancies we offer induction to all patients from 41 weeks. This is because the risk of stillbirth increases most quickly after 42 weeks. The risk of stillbirth at 42 weeks is 1 in 1000 births and increases up to 3 in 1000 if the pregnancy continues up to 44 weeks gestation.

What happens on the day the induction starts? Induction of labour is usually started on our antenatal ward or Delivery Suite. It can be started at any time during the day depending on bed availability, for this reason we may occasionally delay your admission to hospital.

5

Some women may be suitable for induction as an outpatient.

Once orientated to the ward, some routine checks will be performed on you and your baby including:

• Reviewing your pregnancy history and any test results

• Checking your temperature, pulse, urine and blood pressure

• Examining your abdomen to check the size and position of the baby

• Monitoring the baby’s heart rate for a short period of time, with a CTG machine, usually around 20 minutes (may however be longer in some instances)

After the initial assessment your midwife will:

• Discuss with you why induction has been suggested

• Make sure you understand the plan of care

• Answer any questions or concerns you may have

How is labour started?When trying to start labour the cervix needs to be open enough to break the waters around the baby (artificial rupture of the membranes). If this is not possible when your induction is to be started, then we have two main methods to induce the labour:

• Non-hormonal/mechanical dilator (Dilapan-S®)

• Hormonal pessary (Propess®)

6

What does induction with Dilapan-S® involve?

Dilapan-S® is a synthetic rod that absorbs fluid and expands. Usually 3-4 rods are placed inside the cervix during a speculum or vaginal examination, and over 12-24 hours they expand and dilate/soften the cervix gradually. After this time they are removed and a repeat vaginal examination is performed and most of the time (in over 90%) we find we are now able to break the waters. The waters can be broken once there is a midwife on delivery suite available to continue your care.

The insertion takes around 5-10 minutes, and can be uncomfortable, but most patients tolerate it well. Minor bleeding can occur afterwards but this is not a concern. You will be asked to lie down flat after their insertion for 20-30 minutes, but after this can move around and go about daily activities normally (with the exception that having a bath is not recommended). You may leave the ward, but not the hospital (unless outpatient induction has been agreed, see below), for short periods but check with your midwife that it is safe to do so and let them know you will return. Whilst the Dilapan-S® rods are in place most patients are not aware of them, and they do not usually cause contractions so there is not usually any pain. You should let the midwife know if you think the rods are falling out.

What does an induction with Propess® involve?

Prostaglandins are naturally occurring hormones released by the body in normal labour and also after a membrane sweep. The aim of the pessary (synthetic prostaglandin) is to soften and open the cervix, so the waters are able to be broken.

A Propess® pessary is inserted into the vagina during examination. Once in place, it sits behind the cervix and

7

slowly releases prostaglandins that cause the cervix to soften and the womb to contract. It is a bit like a tampon and has a tape so that it can be easily removed; either once labour starts, at the end of the treatment time (24 hours) or earlier if complications arise.

After the pessary is inserted you will need to stay on the bed for half an hour, then you will be encouraged to mobilise as this helps stimulate active labour. Take care after washing and going to the toilet so as to not dislodge the pessary. You can remain dressed and eat and drink as normal. You may leave the ward, but not the hospital (unless an outpatient induction has been agreed, see page 6), for short periods but check with your midwife that it is safe to do so and let them know when you will return.

Sometimes you will be aware of period type pains which are less intense than contractions. These may build up to proper labour pains or fade away as the effect of the medication wears off. If you are feeling uncomfortable, discuss with your Midwife what pain relief you would like. There is a range of options even in the very early stages of labour including gentle mobilisation, lying in a warm bath, pain relieving tablets or a TENS machine (if you have one).

During this time the Midwife will review you regularly by:

• Checking your temperature, pulse and blood pressure

• Asking about any pain or vaginal loss

• Asking about your need for pain relief

• Listening to your baby’s heartbeat, this may involve being continuously monitored for a time

8

Please inform your Midwife if you have any vaginal bleeding, think your waters have broken or feel unwell in any way. Please be aware that if you begin the induction of labour process and require a synthetic hormone (oxytocin) through a drip, we would not advise a water birth due to the need for continuous fetal monitoring once in labour. It is important to remember that it is normal for it to take several days from the beginning of the induction process until your baby arrives.

What is the difference between Dilapan-S® and Propess®

Usually both of these methods are available for you to choose. However, in some cases one method might be recommended as safer for you and your baby. The main differences are:

• Dilapan-S® does not usually cause contractions, it mechanically dilates the cervix. This means it might be safer if you have had a caesarean before, if you have had more than two children before or if your baby is small and we are more concerned about the impact of contractions on the heartbeat.

• Dilapan-S® tends to cause less pain during the induction as it causes less contractions.

• Dilapan-S® seems to have a more reliable effect. On one hand this means we are more likely to be able to break your waters after 12-24 hours of its use when compared to Propess®. However, because it does not usually cause contractions it won’t start off labour, which can sometimes occur with Propess®. This means you are more likely to need synthetic oxytocin through a drip to help with the contractions (this is needed in around 95% of inductions with Dilapan-S®, and 70% with Propess®).

9

• Overall from when the induction of labour is started to when you have the baby the time is similar whichever is used first.

• How the baby is born is similar whichever is used first (e.g. there are similar rates of emergency caesarean section).

What happens if the Dilapan-S® or Propess® doesn’t work?

After one course of treatment with Dilapan-S® we are unable to break the waters in around one out of 10 women. With Propess® we are unable to break the waters in three out of 10. If this is the case then you would be offered a repeat treatment with the same agent, or a different agent. If this is unsuccessful then sometimes a hormone gel can be used rather than a pessary (called Prostin). Other options will include resting for a period of time before trying again or having a caesarean section.

Outpatient induction of labour Some women can be offered an outpatient induction. This gives you the opportunity to reduce the amount of time you spend in the hospital during the induction process.

You might be offered an outpatient induction if you meet the following criteria:

• You and baby are both well and observations are normal

• You have previously had three babies or fewer

• You have never had a caesarean or other uterine surgery

• You live within 30 minutes driving distance and have access to a phone and transport

10

Some of the conditions that might be suitable for outpatient induction include:

• Overdue baby (between 41 and 41+6 weeks)

• IVF pregnancy

• Age 40 or more

• Well controlled gestational diabetes (GDM) managed with diet or Metformin

• Well controlled obstetric cholestasis

• A small baby where there are no other concerns

Please note there are some circumstances that would mean we cannot offer an outpatient induction, such as recent reduced fetal movements. You can discuss your suitability with a midwife or doctor.

If you are having an outpatient induction, you would come into the hospital on the day of your induction to have an assessment with a midwife. They will check that you and your baby are both well before starting the induction with either Propess or Dilapan. After this is inserted, if you and baby are both well and you meet the criteria to go home, you may be allowed home for an agreed period of time. This is normally between 12 and 24 hours. After this, you would return to hospital to stay in for the remainder of the induction until your baby is born. You can be asked to come back to hospital sooner if:

• You go into labour (having regular contractions)

• Your waters break

• You have any vaginal bleeding

11

• You have concerns about the baby’s movements

• You have any side effects (such as dizziness, vomiting, palpitations or fever)

• The Propess® pessary falls out

If you have any concerns or questions whilst at home or need advice you can ring the Antenatal Ward or MAC at any time. When you return to hospital you will be reassessed to see if your waters could be broken or if a further pessary or treatment is required. Please note that there may be changes to the cervix even with minimal discomfort.

What does breaking the waters involve?If a vaginal examination is performed and your cervix has started to open and the membranes surrounding baby can be felt then we should be able to break your waters. This is also referred to as artificial rupture of membranes (ARM).

Prior to breaking your waters we would monitor baby’s heart rate for around 20 minutes or longer if required. The procedure begins as a vaginal examination to assess the cervix, however, during the procedure a long plastic device is gently inserted alongside the examining finger. This device has a specially designed tip which makes a hole in the membranes surrounding the baby and releases the fluid inside the womb. The midwife will check the fluid is clear and listen to baby’s heartbeat.

Once the waters are broken and baby’s head descends onto the cervix, some women may start to feel period type pains which may increase in intensity and continue to become contractions.

12

What is a Syntocinon® drip?If after breaking the waters your labour doesn’t begin, you will require a drip called Syntocinon® (which contains oxytocin) to start contractions. This is an artificial version of the hormone produced by the body that normally generates contractions. The drip is gradually increased until you are having regular contractions, 4-5 in every 10 minutes, and progressing in labour. The baby’s heart rate will need to be continuously monitored whilst on the drip. Very occasionally Syntocinon® can make your womb contract too frequently which may affect your baby’s heart rate. If this happens the drip will be adjusted or stopped for a while to allow contractions to slow down. Very rarely, if the baby’s heart rate is affected and doesn’t return to normal, a caesarean section may be required. For this reason, once the drip is in place, you will be on Delivery Suite where you can be monitored closely.

If this is your first pregnancy it is recommended that Syntocinon® is commenced as soon as we have broken your waters as it is often a lengthy process. If you have had a baby before it is recommended that if labour hasn’t started between 2-4 hours after your waters have been broken, the Syntocinon® drip is started. However, if you have any concerns or questions about this, please speak to your midwife.

How long will my induction take?The induction process can vary a lot from person to person ranging from a few hours to a few days (if the cervix is very unfavourable and you require more than one pessary).

Once the process has started, however, we aim to continue the induction until your baby is delivered.

13

At times when the Delivery Suite is very busy and there are no labour rooms, it would be unsafe to continue and a delay may occur in the induction process. On these occasions, the senior clinicians give priority to those women in established labour. Please be assured that the induction process will re-commence as soon as possible and the midwife/doctor will keep you updated. You will be monitored closely on the ward and transferred to Delivery Suite when a room becomes available. Should a delay occur, we apologise in advance and thank you for your patience.

What if my waters have already gone?Sometimes, your waters may break on their own. In this case you have a choice between trying to start the labour off straight away, or waiting for labour to start naturally, as long as you are well and the fluid is clear. If you want it to be started straight away we would commence the Syntocinon® drip in order to start the contractions. Labour will start naturally within 24 hours in around 60% of women, but if it does not we would recommend starting the Syntocinon® drip after 24 hours. This is to reduce the risk of serious infection to the baby which doubles to 1% after waters have ruptured for over 24 hours.

What if I do not want you to start my labour?Induction of labour will only be recommended because it is believed to be of benefit to either you or your baby. You will be given information about induction of labour, and why this has been recommended for you but it will then be your choice as to whether you want to go ahead with the induction.

If you decide not to be induced following discussion with your doctor or midwife, we advise additional monitoring for you and

14

your baby depending on your circumstances. If the induction has been offered because of going overdue this additional monitoring (such as a scan or heart rate monitorings of the baby) would usually start at 42 weeks of pregnancy.

This additional monitoring can provide some reassurance that the baby is growing normally and the placental function is normal, but it is important to note that this additional monitoring can be falsely reassuring and should not be relied upon if induction of labour has already been recommended. It does not reduce the risk of stillbirth.

What should I bring with me?It is difficult to predict how long your stay in hospital is likely to be. We suggest you bring your hospital bag, toiletries, books or magazines. Please do not bring valuables in to hospital with you and should only bring in a car seat when you are due to be discharged.

Is car parking available?Car parking is limited and expensive. We would advise that you ask a family member or friend to bring you to the hospital and likewise arrange for someone to take you home.

15

Will I get any meals provided?Meals are provided for you at the following times. You will be asked about your food preference and dietary requirements.

Breakfast: 08.00 - 08.30Lunch: 12:15 - 12:30Tea: 17:15-17:30

We do not provide meals for partners, however there are several cafés and shops where refreshments can be purchased.

There are kitchen facilities on the ward where you can help yourself to tea, coffee and water with a pot provided for any donations.

Visiting Times on the Ward

Friends and Family: 2pm - 4pm and 6pm - 8pmBirth Partner: 24 hours* (*rules apply)

Due to the increased risk of infection, we only allow your own children onto the ward and they must be supervised at all times.

Once admitted to Delivery Suite, you may have two birth partners with you. Please be aware we do not have a waiting area on Delivery Suite and any other visitors will not be allowed on to Delivery Suite before your baby is born. If you have any concerns or questions regarding this information please speak to the Midwife in charge.

16

Personal planner:I had my membrane sweep on: …………... . . . . . . . . . . . . . at: …….…….

I had my second membrane sweep on: …... . . . . . . . . . . at: ……... . . . . .

My date for induction is: ……...…………………... . . . . . . . . . . . . . . . . . . . . . . .

At: ………………………………………... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

I had my first pessary on: ……….…... . . . . . . . . . . . . at: . . . . . . . . . . . . . . . . . . . . . .

I had my second pessary on: ……………... . . . . . at: . . . . . . . . . . . . . . . . . . . . . . .

CTG monitoring times . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

My next assessment is due at: ….………… on: …………... . . . . . . . . .…

My next assessment is due at: …….……… on: …………... . . . . . . . . .…

My next assessment is due at: …….……… on: ………..…... . . . . . . .…

My next assessment is due at: ………….… on: ………..…... . . . . . . .…

My waters broke spontaneously on: ….……….…. at: …….…..….

My water were broken on: …………... . . .… at: …….……... . . . . . . .….

17

My contraction record:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18

Please use this page to write down any questions for discussion: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

19

Contact Details

Antenatal Ward - St James’s University Hospital

• Telephone: 0113 206 9104

Antenatal Ward - Leeds General Infirmary

• Telephone: 0113 392 7444

Further reading: • https://www.nice.org.uk/Guidance/CG70

• https://www.nhs.uk/conditions/pregnancy-and-baby/pages/induction-labour.aspx

LN000726Publication date

05/2020Review date

05/2023

© The Leeds Teaching Hospitals NHS Trust • 4th edition (Ver 1)

Developed by: Jonathan Nelson (Consultant Obstetrician and Antenatal Lead), Amy Riach (Clinical Leadership Fellow and O&G Trainee), Debbie Daly and Patricia Holland (Antenatal Team Leaders). Cover image created by Yanalya - Freepik.com

Produced by: Medical Illustration Services • MID code: 20200420_003/BP

What did you think of your care?Scan the QR code or visit bit.ly/nhsleedsfft

Your views matter