Royal Watch: Etienne Horner on the Induction of Labour


With the world on tenterhooks for the impending royal birth, Etienne Horner – obstetrician and gynaecologist at the Lindo Wing and Portland Hospital – discusses induction.

Some women tell me that in the first few weeks of pregnancy they don’t want to be induced as they have heard horror stories. Some even ask at what stage of pregnancy I would consider an induction and how often induction of labour ends in caesarean section for my patients. At the other end of the scale there are women who want to be induced on a particular date because it suits them better.
There is a huge difference in how women experience induction; those pregnant for the first time often have a different experience to women who have previously given birth.
The aim of induction is to achieve a safe vaginal delivery. The process is usually started with a specialised vaginal gel that softens and dilates the cervix. The gel acts slowly on the cervix to cause a cramp-period-like pain. It is important to mobilise whilst the gel is working as this helps to dilate the cervix. The gel can be repeated every six hours, for up to 24 hours, but most women do not require more than one or two doses.
Once the cervix has dilated a little, we can break the waters and start a syntocinon drip to keep the contractions going. If the patient experiences strong and regular contractions early on then the drip may not be needed, but it is almost always required for first-time births. Once labour has started properly, the induction has done its job, and we can then continue to assess the labour as it progresses.
Women can be induced from 39 weeks onwards (but ideally not any earlier if there is no medical indication to do so). Induction can be a positive experience culminating in a vaginal delivery if there are realistic expectations about the process, timelines and good pain relief (epidural). With all of that in mind, I feel induction of labour is a good way of achieving a vaginal birth.