Induction of Labour

Induction, when labour is started ‘artificially’, is quite common in Belgium, though the figures vary between the three regions. In Brussels and Wallonia, the figure is around 30%, with rates slightly increasing since 2018 in Brussels and slightly decreasing in Wallonia since 2014. In Flanders, around 27% of births in 2021 were induced, and this rate has been increasing year-on-year since 2016.

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.

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.

The Process of Induction

Membrane sweep (‘a sweep’) Your gynaecologist or independent midwife may suggest this as a way to stimulate labour if your due date has passed (or after 41 weeks of pregnancy). It involves your care provider sweeping their finger around the edge of your cervix during an internal exam. This is a medical intervention and does require your informed consent.

If your labour has not begun after a membrane sweep then the next step is to be offered more medical interventions starting with prostaglandins. You may want to ask your care giver what your Bishop score is. The Bishop score is used to assess the ripeness of your cervix and gives an indication of how likely it is go into labour. The score is based on the findings of a vaginal examination by your midwife. With a gloved finger, she’ll assess the condition and position of your cervix and work out where your baby is in relation to certain points on your pelvis.

Prostaglandins – If 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).

• Syntocinon – If a membrane sweep or prostaglandins (if needed) have not triggered labour, your labour the next stpe is to consider 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.