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Induction - what's involved?

Induction

Induction - i.e. when labour is started 'artificially' - is quite common in Belgium, and figures from 2010 show that in Belgium, around 30% of births are medically induced in hospital (1, 2, 3).

While one of the most common reasons is that the estimated due date has passed, there may be other reasons why induction is suggested, and your care provider will discuss the options open to you.

Informed consent 

Under the Belgian Law of 22 August 2002 on Patients' Rights, midwives and physicians must have your free and informed consent before beginning any intervention or procedure.

They should therefore be explaining the purpose and urgency of any intervention or procedure, what is involved, as well as any potential risks or side-effects.

 

This section looks at:

Have you thought about attending an antenatal class?

Antenatal classes provide an opportunity to discuss labour and birth in a safe and supportive environment, so that you can explore your own feelings and wishes, feel more confident about making informed decisions and feel better able to communicate with your care provider(s).


KCE guidelines on induction

The Belgian Health Care Knowledge Centre (KCE) publishes guidelines on induction in its Guideline to low risk birth (in English). In general, they recommend that induction not be carried out until after 41 weeks of pregnancy, with 42 weeks being considered as 'overdue'. 

Additional monitoring once due date has passed

If your due date has passed, your gynaecologist or independent midwife will probably arrange more regular checks on your baby, and will explain ways that you yourself can observe your baby's movements in the run-up to the birth.

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Methods of induction

The below methods are often attempted in the order presented:

    • Membrane sweep (non-medical induction) - When you have reached term (40 weeks), your gynaecologist or independent midwife may suggest a 'membrane sweep' as a way to stimulate labour. 

      This involves your care provider sweeping their finger around the edge of your cervix during an internal exam. Although your care provide should never do this without your permission, discuss it with him/her so your wishes are clear.

    • Medical induction If your labour has not begun naturally, and together with your doctor you have taken the decision to induce labour, how this induction begins will depend on how 'ripe' your cervix is (according to the Bishop score - a method used to assess the ripeness of the cervix).

        • ProstaglandinsIf your cervix is not ripe, an artificial hormone - prostaglandin - may be used to ripen the cervix, and possibly stimulate contractions. This involves having a prostaglandin tablet, pessary or gel inserted in your vagina. 

          In Belgium, if your medical induction begins like this, you will typically be admitted to hospital late at night, when the prostaglandins will be inserted. This itself may trigger labour - if not, provided that your cervix ripens sufficiently, the next morning, labour may be induced using a drip of artificial oxytocin (syntocinon - see below).

        • SyntocinonIf a membrane sweep or prostaglandins (if needed) have not triggered labour, your labour may be induced using syntocinon - an artifical version of oxytocinon, the natural hormone that causes the uterus to contract. 

          Syntocinon is given via an IV drip in your arm. The dosage can be increased or lowered depending on how you and your baby react.

          As syntocinon can lead to stronger contractions than you might have naturally, your baby will probably be monitored continuously during labour to make sure that he/she is coping well with the contractions.  

Read more about induction of labour (though note that artificial breaking of waters is not used as a method of induction in Belgium - though it may be used to accelerate labour once it has begun).

Have you thought about attending an antenatal class?

Antenatal classes provide an opportunity to discuss labour and birth in a safe and supportive environment, so that you can explore your own feelings and wishes, feel more confident about making informed decisions and feel better able to communicate with your care provider(s).

Back to top 


References

  1. Cammu, H., Martens, E., Van Mol, C., Jacquemyn, Y. (2013) Perinatale activiteiten in Vlaanderen 2012. Brussels: Studiecentrum voor Perinatale Epidemiologie (SPE)
  2. Leroy, C., Van Leeuw, V., Minsart, A-F., Englert, Y. (2012) Données périnatales en Région bruxelloise – Année 2010. Brussels: Centre d’Épidémiologie Périnatale
  3. Leroy, C., Van Leeuw, V., Minsart, A-F., Englert, Y. (2012) Données périnatales en Wallonie – Année 2010. Brussels: Centre d’Épidémiologie Périnatale  

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