Induction of Labour – is there a limit?

Posted on: May 2nd, 2018

Not all pregnancies go to plan and we all know that some mums need help with their pregnancies. This can even include encouraging babies to be born. But when should an induction be made and what are the risks of late induction?

When a labour is induced, the local NHS Trust will have policies and guidelines to follow and these should be based upon the national guidelines.

Induction of labour is a relatively common procedure. In 2004 and 2005, one in every five deliveries in the UK was induced. This includes induction for all medical reasons. When labour was induced using pharmacological methods (whether or not surgical induction was also attempted), less than two thirds of women gave birth without further intervention. About 15% required instrumental births (e.g. forceps or ventouse) and 22% had emergency caesarean sections.

Induction of labour has a large impact on the health of women and their babies and so needs to be clearly clinically justified.

NICE provides national guidelines to improve the advice and care provided to women considering and undergoing induction of labour, upon which any local policy will be based. This will cover circumstances, methods and monitoring for inducing labour in pregnant women to avoid a pregnancy lasting longer than 42 weeks, or if a woman’s waters break but labour does not start.

The guidelines make recommendations for information and advice for women being offered induction of labour, recommended methods, monitoring and pain relief, and prevention and management of complications.

An induced labour can place a greater strain on labour wards as they are carried out during the daytime when labour wards are often already busy. This leads to booking being problematic. The guidelines indicate that delivery should take place before 42 weeks expires. The question therefore arises as to when the best time would be to book an induction, as after 40 weeks there is limited time to deliver before 42 weeks, and often labour wards can be very busy. Expectant mothers should be talking with their midwives and obstetricians about how this can be managed and guaranteed before it gets too late and the 42 week barrier is broken.

The reason behind the 42 week limit is the agreed problems that arise in late gestation. That is:

  • Babies getting bigger
  • Placentas becoming less efficient
  • The level of amniotic fluid becoming less

All of these place strain on the unborn child and heighten the risk of complications.

In an ideal world, those at higher risk of requiring induction should be identified at the earliest date possible. This gives the most time for there to be a planned induction without the 42 week deadline being exceeded and the risks to the unborn child being minimized. Failure to heed the NICE Guidelines could prove substandard or negligent care and in the event of a problematic birth, a claim could be investigated for any damage or disability suffered by mum or baby. 

Douglas Miller is a Partner in the catastrophic injury and clinical negligence team.