Outpatient Induction of Labour

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What is an outpatient cervical ripening induction of labour?
An outpatient induction allows you to return home once the induction of labour process has been started in hospital to ripen the cervix only. You will stay at home for 24 hours, or until your labour starts, whichever is sooner. In order to have an outpatient induction, you will be induced using Prostaglandins ( Propess® or Prostin).

Why have an outpatient induction?
There are many benefits for you if you have an outpatient Induction. These include:

• The amount of time you will need to spend in hospital before you go in to labour is much less
• You may be more relaxed and comfortable in your own home and are therefore more likely to go in to labour sooner
• This induction of labour process may feel more natural to you, like you are going in to labour yourself.

What is Propess®?
Propess® is a hormone compound (prostaglandin) which induces labour by encouraging the neck of the womb (cervix) to soften and shorten (known as ripening). It is like a very small tampon which is placed high in to the vagina behind the cervix. It slowly releases the hormone prostaglandin over a period of 24hours. Propess® will be inserted by the midwife.

What is Prostin?
The Prostin gel has the same hormone combound (prostaglandin) as the Propess but it works slightly differently. The gel is inserted close to your cervix using an applicator. Your baby’s heart beat will be monitored for 30 minutes before Prostin and at least an hour following the Prostin.

Who can have an outpatient induction?
You may be offered an outpatient induction if:
• Your pregnancy is ‘low risk’. This means you have generally been healthy during your pregnancy, your baby is head down and is well grown
• You have no medical or obstetric problems
• You have no uterine surgery,
• You have four or less babies.
• You have a good understanding of English
• You have a birth partner who will stay with you whilst you are at home after insertion of the Propess®
• You are over 18
• You have access to a phone with credit
• You have transport available to bring you to and from hospital within 30 minutes.
• Your BMI is less than 35 (your BMI tells us if you have a healthy weight for your height)
• You are happy to have an outpatient induction

If you think you may be suitable to undergo Induction of Labour as an outpatient and would like to be considered please speak to your Midwife or doctor, who can advise you further.

What happens on the day of my Induction?

On the day of your induction you will be given an appointment time to attend the Antenatal Day Assessment Unit (ADAU). You will be seen by a Midwife who will perform your antenatal check up.
The Midwife will monitor your blood pressure, temperature and pulse and will require a urine sample from you too. She will then monitor your baby’s heartbeat with a machine called a CTG. Once the Midwife is happy with your observations and the CTG monitoring she will ask your permission to perform an internal examination to assess the neck of your womb (cervix) and to insert the Propess® or Prostin.

The Propess® has a ribbon attached to it in order to remove it easily. This will be tucked up inside your vagina once it has been inserted. Please take care not to dislodge the Propess® when wiping yourself after you have been to the toilet or after washing. If this happens, the Propess® will no longer be in the correct place, and will not work. If you think you have dislodged it, please contact the Hospital.

ADAU Phone: 01908 996481
Labour Ward Phone: 01908 996471

When can I go home?
Once the Propess® or Prostin has been inserted, the Midwife will continue to monitor your baby’s heartbeat with the CTG monitor, for 60 minutes. If your baby remains well, she will stop the monitoring after this time. You will be asked to return to ADAU, 6 hours after insertion of Prostin to have a second Prostin inserted. If you remain well after the second Prostin, you could go home to return the next morning for review. We will perform the same checks on you as we did at your initial visit and if all well you will be able to return home until the following morning.

The Midwife will check she has the correct telephone number for you, as she will contact you 6 hours after the Propess® has been inserted to check you are feeling well. There may however be occasions when circumstances have changed and you will be advised it is no longer appropriate to go home. The reasons for this will be explained to you.

What should I expect when I’m at home?
Prostaglandins (Propess® or Prostin) affect everyone slightly differently. You may start to feel some period type pains, mild backache or maybe even a dull ache at the tops of your legs. You may also notice some mild, irregular tightening of the muscles in your womb. These are all positive effects of the prostaglandin working as it ripens your cervix. Whilst you are at home, you can continue with your normal day to day activities and you should eat and drink well, this means eating little and often.

Over a period of time, you may notice that the period pains and mild tightening that you have been having become more regular. If this is the case, 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 all feel as intense as each other. Once you are having 3 regular contractions in a 10 minute period, you should contact the hospital where you are booked for advice. During this time, it is okay for you to have a bath or shower with your Prostin or Propess® in situ and use a TENS machine if you would like to as you mobilise or rest. Being as upright and as active as possible will encourage your labour to progress well.

Things to look out for:
Prostin or Propess® can occasionally produce mild side effects such as feeling or being sick, diarrhoea, a raised temperature or vaginal irritation. Rarely, the Prostaglandins may make you have contractions which are very frequent and strong:

• More than 5 times in 10 minutes
• A run of contractions each lasting more than 2 minutes
• Severe abdominal pain

If you experience any of these side effects, please contact the hospital for advice:

ADAU Phone: 01908 996481
Labour Ward Phone: 01908 996471

You may find that your Propess® falls out. This isn’t very common, but if it does happen, you should contact the hospital to arrange to come back and have it reinserted or reviewed. You should also contact the hospital where you are booked if you experience any of the following:

• Any fresh red bleeding from your vagina, that is not part of your show (the sticky mucousy plug).
• If you think your waters have broken
• If you have severe, constant pain in your stomach
• If you are concerned that your baby is not moving as much as they normally would
• If you have any questions about your induction of labour

On some occasions when you contact the hospital for advice, the Midwife may ask you to remove the Propess® yourself. If you need to do this we will guide you on when and how to do it.

What if my labour doesn’t start?
You may think that nothing much has happened at all whilst you have been at home. This can be normal too, it doesn’t mean that the Prostaglandin has not been working, it can often ripen your cervix without you even realising it. You will be given an appointment time to return to the hospital where you are booked in 24hours after the Propess® was inserted or the next morning after your second Prostin was adminstered. The Midwife will examine your cervix and remove the Propess®.

If you had Prostin then she will assess you for suitability of breaking your waters and will ask a doctor to review if required. She will discuss with you her findings, and continue with your induction process on the ADAU or arrange for you and your birth partner to be transferred to the Labour Suite.