Labour Induction and Augmentation

Labour Induction: Dinoprostone Vaginal Insertion

Why might my labour be induced?

You may need help to start childbirth (induce labour). This may be because:

You have health problems (e.g., high blood pressure or diabetes).
The baby has health problems (e.g., is growing too slowly).
The pregnancy is more than 1 week past the due date.
The bag of waters has broken and your labour has not started.

Your doctor will check you and your baby. If inducing labour is an option, the doctor will discuss the ways that are possible for you. Before you are induced, your doctor will answer your questions.

How will my labour be induced?

Your labour can be induced by:

Breaking the bag of waters around your baby in the womb.
Putting a catheter into your cervix.
Putting medicine into your vagina or cervix.
Giving you medicine (e.g., oxytocin) by an I.V. (intravenous) in your arm.

What is a Dinoprostone vaginal insert?

A Dinoprostone vaginal insert looks like a very small tampon with a long string. It has medicine on it to help start labour. It is put in a vagina (birth canal) and gives off prostaglandin which is the same hormone that your body makes to start labour. It gets your cervix (bottom of your uterus or womb) ready for labour and may start contractions.

What do I need to do before I come to hospital for the vaginal insert?

You may shower and eat a light breakfast.
Don’t smoke for at least 2 hours before coming to the hospital. Nicotine can have harmful effects during the induction.
Bring your packed suitcase and your prenatal papers (the ones your doctor gave you) to the hospital. Bring your partner or someone else to support you. (if you wish)
Come to the hospital admitting department 20 minutes before your appointment.

What happens once I am at the hospital?

The doctor, nurse, or midwife will talk to you about the reason(s) for your induction of labour and find out if you have any concerns or questions. You will be asked questions about your pregnancy and your health. The doctor, nurse or midwife will:

Check your blood pressure, pulse and temperature.
Put a monitor on your belly for 20 to 30 minutes to make sure all is well with your baby.
Do a vaginal exam to check your cervix and the baby’s position. An ultrasound of your baby may be done.
Put the insert in the back of your vagina and tuck the strings just inside your vagina.

What happens after the insert is put in?

It takes 30 to 40 minutes for the insert to swell. It may fall out if you stand up too soon, so you’ll need to stay in bed for 1 hour. The nurse will check you often during this hour.

After the first hour, the checks may stop. You may walk around. Your doctor may let you go home. You may be asked to stay longer if your doctor wants you and your baby to be checked often. If you are able to go home, you will be told when you need to come back.

If your labour doesn’t start after 24 hours, the insert needs to come out. If you’re asked to take it out yourself, you will be told how to remove it.

If your labour starts, the insert also needs to be removed. If you‘re asked to take it out yourself, you will be told how to remove it. If you were not told to remove it, the insert will be taken out at the hospital.

What will I feel? Are there any side effects?

At first, you may have some cramping, backache or a warm feeling in your vagina. It usually takes a few hours before you feel contractions.

Nausea, vomiting and diarrhea may happen, but this is not common. Sometimes strong and long contractions can happen. If this happens to you, come back to the hospital. You might need medicine to relax the uterus.

Pull out the insert and come to the hospital right away if you have:

More than 5 contractions every 10 minutes.
Contractions lasting longer than 2 minutes.
More vaginal bleeding than your normal period.
Fever, chest pains, wheezing or problems breathing.

Come to the hospital right away if you:

Have contractions every 5 minutes for 30 minutes.
Have vaginal bleeding like a period.
Think your bag of waters broke.
Think that your baby is moving less.

What else should I do when I go home?

You can do your normal activities (e.g., eat, shower, walk). If you are have a midwife, phone her when you get home.

You must follow the directions you get from your doctor or hospital. You may be told to call the doctor or hospital or come back to the hospital after a certain number of hours.

If your labour has not started, the doctor may suggest:

Breaking your water to start labour.
Giving you intravenous medicine to start contractions.
Trying another vaginal insert in a few days.

If you have concerns, call your doctor, midwife, or the Labour and Delivery Unit at your hospital.

Current as of: December 10, 2019

Author: Maternal, Newborn, Child and Youth Strategic Clinical Network, Alberta Health Services

This material is not a substitute for the advice of a qualified health professional. This material is intended for general information only and is provided on an "as is", "where is" basis. Although reasonable efforts were made to confirm the accuracy of the information, Alberta Health Services does not make any representation or warranty, express, implied or statutory, as to the accuracy, reliability, completeness, applicability or fitness for a particular purpose of such information. Alberta Health Services expressly disclaims all liability for the use of these materials, and for any claims, actions, demands or suits arising from such use.