Labour induction in Warsaw - consultation and diagnostics before induction
Inducing labour, or induction, is considered when continuing to wait for labour to start on its own may carry a greater risk than ending the pregnancy. This applies, among others, to a pregnancy lasting more than 41 weeks, some maternal conditions, fetal growth disorders and other obstetric complications. Before a decision is made, an assessment of the course of the pregnancy, the wellbeing of the baby and the indications and contraindications for induction of labour is necessary.
At OpenMed Warsaw Wola we provide obstetric consultations and diagnostics in the final stage of pregnancy. Depending on the indications, the doctor can assess CTG results, perform an ultrasound scan, check the position and growth of the baby and plan further follow-up. We also help patients prepare for assessment for induction of labour. The induction of labour itself is a procedure carried out in a hospital setting.
What is induction of labour and when is it considered?
Induction of labour means starting labour medically before it begins on its own. Its aim is to achieve a vaginal birth when there are indications to end the pregnancy and the condition of the mother and baby allows this approach.
In a normally progressing pregnancy, labour usually starts on its own. However, this does not always happen before the due date, which corresponds to completed week 40 of pregnancy.
The decision about induction is preceded by an assessment of several important factors:
- Gestational age - established by dating the pregnancy, most often using an early ultrasound scan.
- The health of the mother - taking into account, among others, blood pressure, chronic conditions and any obstetric complications.
- Fetal wellbeing - assessed on the basis of the indicated tests, such as CTG and ultrasound.
- The position of the baby - because not every position allows a vaginal birth to be managed safely.
- Cervical readiness - its length, dilation, consistency and the other parameters assessed with the Bishop score.
- The course of previous births - especially if the patient has had a caesarean section or uterine surgery.
It is worth distinguishing induction from cervical ripening (pre-induction). Cervical ripening involves preparing an unripe cervix for the start of labour. It may involve mechanical or pharmacological methods used in hospital.
Going one day past the estimated due date does not automatically mean that immediate induction is needed. What matters is the current week of pregnancy, its course and the results of the obstetric assessment.
What are the indications for inducing labour?
Induction may be indicated when continuing the pregnancy carries an increased risk for the woman or the baby. Some indications only appear at the end of pregnancy, while others result from conditions or complications diagnosed earlier.
The most important include:
- A pregnancy lasting more than 41 weeks - as the pregnancy goes on, the risk of certain complications gradually increases, which is why the option of induction is discussed.
- Premature rupture of membranes - after the amniotic fluid has leaked without labour starting, inducing labour in hospital may be indicated.
- Gestational hypertension and pre-eclampsia - depending on the severity of the condition and the week of pregnancy, ending the pregnancy earlier may be necessary for the safety of the mother and baby.
- Pre-existing or gestational diabetes - especially with poor blood glucose control or additional complications.
- Fetal growth disorders - when ultrasound and Doppler results indicate that the baby staying in the uterus any longer may be unfavourable.
- Oligohydramnios - a reduced amount of amniotic fluid may be a reason to consider ending the pregnancy.
- Obstetric cholestasis - the timing of birth is set based on, among others, bile acid levels and other risk factors.
- Certain chronic maternal conditions - e.g. specific kidney or cardiovascular conditions, if they affect the safety of continuing the pregnancy.
Not every one of these diagnoses automatically means induction is necessary. For example, gestational diabetes that is well controlled with diet may need a different approach than diabetes with abnormal blood glucose values and additional complications.
Similarly, a suspected large baby does not mean that labour should always be induced. The doctor takes into account the estimated weight of the baby, the presence of diabetes, the course of previous births and the risks associated with each mode of birth.
Indications for induction are assessed together with contraindications to vaginal birth. In some situations, a caesarean section is a safer option than attempting to induce labour.
Overdue pregnancy - when is an obstetric consultation needed?
The estimated due date is set at the day corresponding to completed week 40 of pregnancy, i.e. 40+0. It is an approximate date, not the day on which labour must begin.
In obstetrics, several stages of the final period of pregnancy are distinguished:
- 39+0-40+6 - full-term pregnancy.
- 41+0-41+6 - late-term pregnancy.
- From 42+0 - post-term pregnancy in the strict medical sense.
In everyday language, the term "overdue pregnancy" is often used as soon as 40+0 has passed.
After the due date, further assessment of fetal wellbeing and the course of the pregnancy becomes important. The doctor reviews previous results, the baby's movements, any symptoms and the indications for follow-up tests.
From 41+0 weeks of pregnancy, the option of induction should be discussed, because as the pregnancy continues, the risk of some complications increases, including problems related to placental function and the condition of the fetus.
During an obstetric consultation, the doctor can assess:
- whether the gestational age was established correctly,
- whether the baby is moving in its usual way,
- whether previous CTG tests were normal,
- what fetal growth and the amount of amniotic fluid look like,
- whether there are additional risk factors,
- whether another follow-up or a hospital consultation is needed.
In patients with an uncomplicated pregnancy, further monitoring according to the agreed plan is possible. However, you should not postpone a recommended assessment or induction on your own just because you feel well.
Doctors consulting patients before induction of labour at OpenMed
In the final weeks of pregnancy, it is important not only to have tests done but also to interpret the results correctly in the context of the earlier course of the pregnancy and the current condition of the patient. OpenMed gynaecologists and obstetricians see women in advanced pregnancy, including patients who need more frequent check-ups, those with previous obstetric complications and those preparing for assessment for induction of labour. During the consultation, the doctor can review earlier tests, assess current indications for further diagnostics and discuss a plan of management before the patient goes to hospital.
What does a consultation before a planned induction of labour look like?
The consultation starts with a review of the course of the pregnancy and the medical records so far. The doctor establishes why induction is being considered and whether there are factors that call for more urgent action.
In the medical history, the following are particularly important:
- the current week of pregnancy and how the due date was set,
- the course of previous pregnancies and births,
- previous caesarean sections or uterine surgery,
- diagnosed maternal conditions,
- CTG and ultrasound results so far,
- the baby's movements,
- contractions, bleeding or leaking fluid,
- medications taken and previous obstetric recommendations.
The doctor then assesses the patient's condition, including blood pressure and any symptoms that may indicate pregnancy complications.
Depending on the situation, an obstetric examination or ultrasound may be performed or a CTG may be planned. If there are indications to assess cervical ripeness, the doctor may discuss the need for an internal examination and further assessment in hospital.
An important part of the visit is also discussing the benefits and potential risks of waiting for labour to start on its own and of induction.
For example, for a patient at 41 weeks of pregnancy with a normal CTG and ultrasound, the doctor may set a further schedule of check-ups and indicate the need to contact the hospital. A different approach will be needed if the results show oligohydramnios, fetal growth disorders or a condition requiring urgent assessment.
The outpatient consultation helps prepare a plan for further management. The final decision on induction and the choice of method rest with the hospital team, who assess the condition of the mother and baby before starting the procedure.
What tests are done before deciding on induction of labour?
Diagnostics before induction are mainly meant to answer whether there are indications to end the pregnancy and whether the current condition of the baby and mother allows the planned approach.
The basic elements of the assessment include:
- CTG - recording of the fetal heart rate and uterine contractions.
- Obstetric ultrasound - assessment of the position of the baby, its growth, the amount of amniotic fluid and the position of the placenta.
- Obstetric examination - assessment of the mother's condition, her symptoms and, where appropriate, cervical readiness.
- Blood pressure measurement - particularly important when gestational hypertension or pre-eclampsia is suspected.
- Review of previous test results - among others, ultrasound records, laboratory results and CTG traces.
In addition, depending on the indications, the doctor may recommend a full blood count, a urine test, kidney and liver function tests, diabetes-related tests or other laboratory tests.
The availability of results of tests performed earlier in the pregnancy also matters, e.g. blood group or the GBS swab result, which is important for preventing infection during labour.
There is no single identical set of tests for all patients. For an overdue pregnancy without additional complications, the scope of diagnostics will be different from that for a woman with hypertension, cholestasis or suspected fetal growth disorders.
CTG before labour - assessing the wellbeing of the baby
CTG, or cardiotocography, is one of the basic tests used to assess the condition of the fetus in the final stage of pregnancy. It records the baby's heart rate and the contractile activity of the uterus.
The test is performed using sensors placed on the patient's abdomen. One records the fetal heart rate and the other records changes in uterine tension associated with contractions.
A standard trace often lasts about 20-40 minutes, although in certain situations longer observation is necessary.
When interpreting a CTG, the following are assessed, among others:
- Baseline fetal heart rate - usually in the range of about 110-160 beats per minute.
- Heart rate variability - reflecting natural fluctuations in the baby's heart rate.
- Accelerations - temporary increases in heart rate.
- Decelerations - temporary drops in heart rate, whose significance depends on the nature and context of the trace.
- Uterine contractile activity - the frequency of contractions.
A normal CTG trace is reassuring information about the baby's current condition, but it does not guarantee that complications will not occur in the following days. For this reason, some pregnant women need the test repeated according to an agreed schedule.
If the result is ambiguous or abnormal, the doctor may recommend further monitoring, an ultrasound scan or urgent assessment in hospital.
CTG is not used on its own to decide on induction. The result is analysed together with the week of pregnancy, the condition of the patient, the ultrasound and the other obstetric indications.
Ultrasound in the final stage of pregnancy - what does the doctor assess?
An ultrasound scan in the final weeks of pregnancy makes it possible to assess several parameters that are important for planning further obstetric management.
Position of the baby
The doctor checks whether the fetus is in a cephalic (head-down), breech or transverse position.
The cephalic position is the most common and in many cases allows a vaginal birth. A transverse position, on the other hand, is a major contraindication to planning a vaginal birth for as long as it persists.
If an abnormal position is suspected, ultrasound makes it possible to confirm the position of the baby and plan further assessment.
Estimated fetal weight and growth
During the ultrasound, the doctor may take biometric measurements, including, among others:
- BPD - biparietal diameter of the head,
- HC - head circumference,
- AC - abdominal circumference,
- FL - femur length.
Based on these parameters, the estimated fetal weight (EFW) is calculated.
Bear in mind that this is an approximate value. In practice, the error in estimating weight may be about 10-15%, and in some situations larger. A result of 4000 g does not therefore mean that the baby weighs exactly that much.
Assessing growth helps detect both suspected macrosomia, i.e. excessive fetal weight, and fetal growth restriction.
Amount of amniotic fluid
The volume of amniotic fluid can be assessed, among others, by measuring the deepest vertical pocket (DVP) or with the AFI.
With the single deepest vertical pocket method:
- a value below 2 cm suggests oligohydramnios,
- a range of 2 to 8 cm is usually considered normal,
- a value above 8 cm may indicate polyhydramnios.
The result needs to be interpreted in the context of the whole pregnancy, especially when leaking amniotic fluid or placental dysfunction is suspected.
Position of the placenta and Doppler flows
Ultrasound makes it possible to assess the location of the placenta. This is particularly important because placenta praevia may be a contraindication to vaginal birth.
In patients with specific indications, Doppler studies are also performed, e.g. of the flow in the umbilical artery or the fetal middle cerebral artery.
At OpenMed, pregnancy ultrasound diagnostics, including Doppler studies, are available and are used to monitor the course of the pregnancy and assess selected abnormalities.
How is cervical readiness for labour assessed?
The state of the cervix is one of the elements of assessment for induction. In the final stage of pregnancy, the cervix gradually softens, shortens, moves forward and begins to dilate.
Its readiness is assessed using the Bishop score, which covers five parameters:
- Dilation of the cervix.
- Shortening or effacement of the cervix.
- Consistency of the cervix - from firm to soft.
- Position of the cervix - e.g. pointing backwards or forwards.
- Station of the presenting part of the fetus relative to the pelvic structures.
In the classic Bishop score, a result of 0 to 13 points is possible.
A score of 6 points or less indicates a less favourable cervix and may mean that cervical ripening methods are needed. With a score above 6 points, the cervix is usually better prepared for induction.
The score influences the choice of approach, but it does not guarantee that induction or vaginal birth will be successful.
For example, a patient with a long, firm and closed cervix may need it to be prepared first. For a woman with a soft, shortened cervix and dilation of a few centimetres, management may look different.
The assessment is carried out during an obstetric examination with the patient's consent. The examination is not necessary at every outpatient visit at the end of pregnancy. The final Bishop score and the decision on the method of induction are made in hospital, taking into account the current obstetric situation.
Natural and medical methods of inducing labour - how do they differ?
Many women who have gone past their due date look for ways to bring on labour themselves. However, it is worth distinguishing between methods whose effectiveness has been confirmed in clinical trials and popular home remedies.
Natural ways to induce labour
The most commonly mentioned include walking, physical activity, warm baths, sex, massage, nipple stimulation and eating certain foods or herbs.
There is not enough evidence that most of these methods can start labour effectively and predictably.
Walking and moderate activity may improve how you feel, but they are not an effective method of medical induction.
A warm bath may help you relax, but it has not been shown to start labour.
Sexual intercourse has no confirmed effectiveness as a method of inducing labour. What is more, in certain situations, e.g. with bleeding or after the waters have broken, it may be contraindicated.
Castor oil, herbal preparations and other home mixtures are not recommended ways of inducing labour. Castor oil can cause diarrhoea, nausea and dehydration, and the safety of some herbs in pregnancy has not been adequately confirmed.
You also should not use intense nipple stimulation on your own as an attempt to bring on contractions, especially in a pregnancy with complications.
Separating the membranes - membrane sweep
Separating the membranes from the lower segment of the uterus is a procedure performed by suitably qualified staff during an internal examination.
It may increase the likelihood of labour starting on its own without the need for additional pharmacological or mechanical methods.
According to NICE guidelines, the option of this procedure can be discussed after completed week 39 of pregnancy.
The procedure may cause discomfort, contractions and slight bleeding. It requires the patient's consent and prior assessment of contraindications. It is not a method meant to be done by yourself.
Medical methods of induction of labour
In hospital, the methods used are chosen according to cervical readiness and the obstetric situation.
Mechanical methods include, among others, a balloon catheter, which helps to gradually dilate the cervix.
Pharmacological methods may include prostaglandin preparations, e.g. dinoprostone, or appropriately chosen misoprostol regimens. Their role may be cervical ripening and stimulating contractions.
Amniotomy involves controlled breaking of the amniotic sac under appropriate obstetric conditions.
Intravenous oxytocin is used to start or strengthen uterine contractions. It requires appropriate monitoring of the mother and baby.
Not all methods can be used in every patient. For example, a previous caesarean section affects the choice of medication and the risk assessment.
Induction and cervical ripening procedures require a hospital setting with the ability to provide continuous supervision and respond quickly to complications. OpenMed provides consultations and diagnostics before a possible induction, not the induction of labour itself.
What are the contraindications and possible risks of induction of labour?
Before induction starts, it is necessary to check that there are no contraindications to the planned mode of birth.
Situations in which induction of vaginal labour is contraindicated or may be inappropriate include, among others:
- Placenta praevia, which covers the internal opening of the cervix.
- Vasa praevia, which carry a risk of serious fetal bleeding.
- A persistent transverse fetal position.
- Some types of scars after uterine surgery, especially after a classical caesarean section.
- Active genital herpes at the time of labour.
- Selected situations of fetal compromise, in which the pregnancy needs to be ended quickly and conditions do not allow safe induction.
A previous low transverse caesarean section is not always an absolute contraindication to vaginal birth. It does, however, require individual risk assessment and appropriate preparation by the hospital.
Induction may also be associated with certain complications, such as:
- excessively frequent uterine contractions, known as tachysystole,
- fetal heart rate abnormalities,
- the need for additional obstetric interventions,
- labour failing to start effectively or to progress,
- the need for a caesarean section,
- infection in certain clinical situations,
- uterine rupture, especially in patients with certain surgical scars.
This does not mean that induction is in principle more dangerous than waiting for labour to start on its own. In many situations, it reduces the risk associated with continuing the pregnancy.
What matters most is establishing whether the benefits of ending the pregnancy outweigh the risks of the specific procedure and choosing the appropriate approach.
When do you need to go to hospital urgently?
A planned obstetric consultation is used to monitor the pregnancy and prepare further management. However, some symptoms require immediate assessment at the admissions unit of a maternity hospital.
These include:
- Reduced or absent fetal movements - especially when the baby's activity is clearly different from its usual pattern.
- Waters breaking or leaking amniotic fluid - regardless of whether contractions have started.
- Vaginal bleeding - especially heavy bleeding or bleeding with abdominal pain.
- Regular, increasingly strong labour contractions.
- Severe, persistent abdominal pain.
- Severe headache, visual disturbances or upper abdominal pain, especially with raised blood pressure.
- A sudden deterioration in the patient's general condition.
Do not wait until the next day to have the baby's movements checked if its activity has clearly decreased. A normal result from an earlier CTG does not rule out a new problem.
If leaking amniotic fluid is suspected, you also should not wait for contractions to start on their own without a hospital assessment.
In the case of severe symptoms, such as heavy haemorrhage, loss of consciousness or seizures, call for medical help on 112.
What happens after the consultation and diagnostics before induction?
After reviewing the course of the pregnancy and the test results, the doctor sets a further plan of management. Not every consultation has to end with a referral for immediate induction.
Possible scenarios include:
1. Further monitoring of the pregnancy
If the condition of the patient and baby is normal and there are no indications to end the pregnancy urgently, the doctor may recommend another check-up on a specific date.
Depending on the gestational age and the clinical situation, it may include a CTG, an ultrasound or another obstetric consultation.
2. Extending diagnostics
If the results are ambiguous, additional tests may be needed, e.g. Doppler ultrasound, laboratory tests or monitoring of fetal wellbeing in hospital.
3. Consultation at a maternity hospital
When there are indications to end the pregnancy, the patient may be referred to the appropriate hospital, where the final assessment is carried out.
The hospital team reassesses the condition of the mother and baby, cervical readiness and possible methods of induction.
4. Urgent referral to hospital
An abnormal test result or symptoms suggesting a complication may require urgent diagnostics without waiting for the next appointment.
Bear in mind that an induction date set during the consultation may need to change depending on the current obstetric situation and the hospital assessment.
How to prepare for an obstetric consultation?
Before a consultation about inducing labour, it is worth gathering records from the whole pregnancy, especially from the last few weeks. This allows the doctor to assess not only the patient's current condition but also changes seen in successive tests.
It is worth bringing to the visit:
- your pregnancy record card with information about the course of the pregnancy so far,
- the first-trimester ultrasound result used to establish the gestational age,
- reports of recent ultrasound scans, especially assessment of fetal growth and amniotic fluid,
- previous CTG traces and reports,
- laboratory test results, including blood group and the GBS swab,
- records relating to diabetes, hypertension or other diagnosed conditions,
- hospital discharge summaries, if complications occurred during the pregnancy,
- records of previous caesarean sections or uterine surgery,
- a list of medications you are currently taking.
It may also be helpful to prepare information about the baby's movements, any contractions and any new symptoms.
If induction has previously been recommended for a specific date, it is worth bringing the written referral or recommendation together with the reason for it.
You do not need to fast for a standard consultation. Before a CTG, it is a good idea to allow time for the test to be done calmly, because the trace may need to be extended.
If a patient has been advised to go straight to hospital, she should not replace this with a planned outpatient visit.
Consultations and diagnostics before induction of labour at OpenMed Warsaw
At OpenMed Gynaecology and Obstetrics at ul. Wschowska 8 in the Wola district of Warsaw we provide obstetric consultations and diagnostics in the final stage of pregnancy.
We help patients who have gone past their estimated due date, need closer monitoring of the baby's wellbeing or have been advised to have a consultation before a possible induction.
The scope of care may include:
- a consultation with an obstetrician-gynaecologist,
- assessment of the course of the pregnancy and possible indications for ending it,
- review of CTG results,
- an obstetric ultrasound scan,
- assessment of fetal position, growth and the amount of amniotic fluid,
- Doppler ultrasound as indicated,
- discussion of laboratory test results,
- planning further monitoring of the pregnancy,
- establishing whether hospital assessment is needed.
Patients using pregnancy care at OpenMed can discuss the results of successive tests with their attending doctor, who knows how the pregnancy has gone so far.
Consultations are also available for women whose pregnancy is managed at another facility and who need an additional obstetric assessment or a discussion of recommendations about induction.
As part of obstetric care at OpenMed, it is possible to plan the necessary tests and further follow-up, taking the patient's health situation into account.
The induction of labour itself, the administration of medication to induce labour and the hospital stay for the birth take place in hospital. OpenMed provides the consultation and diagnostic care that comes before this stage.
How much does a consultation before induction of labour cost?
The cost of the consultation depends on the scope of the visit and the additional tests needed.
Depending on the indications, an obstetric consultation, CTG, an ultrasound in the final stage of pregnancy or additional diagnostics may be needed.
Not every patient has to have the full set of tests during one visit. The scope is set on the basis of the medical records, gestational age and current indications.
Current prices for consultations and tests can be checked in the OpenMed price list or obtained from reception on 22 100 45 20.
Labour induction - frequently asked questions
The timing of induction depends on the medical indications. In an uncomplicated pregnancy, the option of induction is usually discussed from 41+0 weeks. With certain maternal conditions or obstetric complications, the pregnancy may need to be ended earlier. The final date is set by the doctor, taking into account the condition of the mother and baby.
No. The estimated due date is not the date on which the pregnancy has to end. In many women labour starts on its own after 40+0. It is important, however, to attend the recommended check-ups and follow the individual plan of management.
At 41 weeks, the benefits and risks of induction and of further waiting should be discussed. Many guidelines recommend offering induction from 41+0 because of the gradually increasing risk of complications. Management is decided individually, taking into account test results and the preferences of the patient.
Before medical induction starts, the fetal heart rate must be assessed, and CTG is a standard part of the hospital assessment. The test also shows whether there are uterine contractions. An earlier normal outpatient trace does not replace the assessment carried out immediately before induction.
No. Ultrasound makes it possible to assess, among others, the position and estimated weight of the fetus, the amount of amniotic fluid and the placenta, but it does not show the exact date when labour will start on its own. Even a normal picture of the baby does not make it possible to predict the day contractions will begin.
A score of 4 points suggests that the cervix is not yet favourably prepared for induction. In this situation, the hospital team may consider cervical ripening first, i.e. pre-induction. The score should, however, be assessed together with the other obstetric factors.
Cervical ripening (pre-induction) is used to prepare the cervix for labour, especially if it is long, firm and closed. Induction, on the other hand, is meant to start regular labour. Some pharmacological methods can both ripen the cervix and bring on contractions at the same time.
No. Induction is most often carried out with the aim of achieving a vaginal birth. A caesarean section may become necessary if induction does not have the expected effect, labour does not progress or there are indications related to the condition of the mother or baby.
Induction can take from a few hours to more than a day, and sometimes longer. Cervical readiness, the method used, the number of previous births and how the body responds all matter a great deal. In patients who need cervical ripening, the whole process may take longer than in women with a ripe cervix.
Induction can lead to more frequent and more intense contractions, especially when oxytocin is used. However, the experience of pain is individual. Various methods of pain relief are available in hospital, and the approach should be discussed with the staff.
There is no reliable home method of induction that is effective and safe for all patients. Walking, warm baths or sex do not guarantee that labour will start. Using castor oil or herbal preparations to bring on contractions is not recommended.
In selected cases it is possible, but it requires particularly careful assessment. The type of uterine scar, the course of the previous birth, the current indications and the availability of immediate surgical help all matter. Some medications used for induction, including misoprostol, are contraindicated in patients who have had a previous caesarean section.
A positive GBS swab result alone is usually not an indication for induction. It is, however, important information for the labour team, because it usually means that appropriate antibiotic prophylaxis is needed during labour.
Not always. The degree of reduction in amniotic fluid, the gestational age, the condition of the fetus, Doppler results and the cause of oligohydramnios all matter. In some situations ending the pregnancy is advisable, while in others further monitoring is possible. The appropriate management is decided by the doctor.
A normal CTG is a reassuring result regarding the current condition of the fetus, but it does not guarantee that continuing the pregnancy will be free of risk. The decision about further monitoring is made on the basis of the full clinical picture, not a single trace.
Yes. The patient has the right to receive information about the indications, benefits, risks and available alternatives, and then to make an informed decision. If she does not agree to the proposed induction, the risks of further waiting and a possible monitoring plan need to be discussed.
OpenMed Warsaw provides obstetric consultations and diagnostics before a possible induction. The patient can have her test results reviewed, have the indications for further management assessed and receive recommendations about her care. The induction of labour itself takes place in hospital after assessment by the obstetric team.