Monitoring and pain relief for induction of labour
Monitoring
Wherever induction of labour is carried out, facilities should be available for continuous electronic
fetal heart rate and uterine contraction monitoring.
Before induction of labour is carried out, Bishop score should be assessed and recorded, and a
normal fetal heart rate pattern should be confirmed using electronic fetal monitoring.
After administration of vaginal PGE2, when contractions begin, fetal wellbeing should be
assessed with continuous electronic fetal monitoring. Once the cardiotocogram is confirmed as
normal, intermittent auscultation should be used unless there are clear indications for continuous
electronic fetal monitoring as described in ‘Intrapartum care’ (NICE clinical guideline 55).
If the fetal heart rate is abnormal after administration of vaginal PGE2, recommendations on
management of fetal compromise in ‘Intrapartum care’ (NICE clinical guideline 55) should be
followed.
Bishop score should be reassessed 6 hours after vaginal PGE2 tablet or gel insertion, or 24 hours
after vaginal PGE2 controlled release pessary insertion, to monitor progress (see Section 5.1.1).
If a woman returns home after insertion of vaginal PGE2 tablet or gel, she should be asked to
contact her obstetrician/midwife:
• when contractions begin, or
• if she has had no contractions after 6 hours.
Once active labour is established, maternal and fetal monitoring should be carried out as
described in ‘Intrapartum care’ (NICE clinical guideline 55).
Pain relief (Section 7.2)
Women being offered induction of labour should be informed that induced labour is likely to be
more painful than spontaneous labour.
Women should be informed of the availability of pain relief options in different settings (see
Sections 3.1 and 7.1).
During induction of labour, healthcare professionals should provide women with the pain
relief appropriate for them and their pain (as described in ‘Intrapartum care’ (NICE clinical
guideline 55)). This can range from simple analgesics to epidural analgesia.
Birth attendants (carers and healthcare professionals) should offer women support and analgesia
as required, and should encourage women to use their own coping strategies for pain relief.
The opportunity to labour in water is recommended for pain relief.