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Outpatient induction of labour

Within this information, we may use the terms "woman" and "women". However, we recognise that not only people who identify as women may want to access this content. Your care should be personalised, inclusive and sensitive to your needs, whatever your gender identity.

The following information relates specifically to outpatient induction of labour, where the process is started in hospital, then continues at home. This is additional to general information on induction of labour. For details of cervical ripening and other stages of induction, please read the general information.

What is outpatient induction of labour?

If your clinicians (e.g. midwife or doctor) think your pregnancy is suitable, you might be offered the choice of an outpatient induction of labour. That means you will be allowed to spend the "cervical ripening" part of the induction process at home. It reduces the amount of time you need to stay in the hospital before your labour starts. You can usually spend a night at home with your family and continue with your normal daily activities.

How is outpatient induction of labour started?

To start outpatient induction of labour, we use Dilapan-S rods (also called dilators). These are slim rods made of synthetic, firm gel. The rods are inserted into the vagina by a doctor or midwife.

Dilapan rods do not contain any medicines or hormones. The rod expands from 4mm wide to a maximum width of 15mm in 12 to 24 hours.

Cervical ripening with Dilapan is safe for you and your baby.

Dilapan dilators
Top and side view of a dilapan dilator. Dilapan dilators are made of a firm gel. They have a holder attached, with a marker thread which is threaded through the holder.

How does Dilapan work?

The Dilapan gradually absorbs natural fluids in the cervix and expands. This dilates (opens) the cervix and encourages your body to release hormones that naturally prepare your cervix for labour.

Around 12 to 15 hours after insertion, a clinician will remove the rods and perform a repeat vaginal examination. (Rods are inserted for a maximum of 24 hours.) Usually, your clinician will be able to break your waters at this point.

In 90% of women, the cervix opens to at least 2cm to 3cm after the first set of rods.

What are the risks?

The Dilapan rods might cause discomfort or bleeding on insertion.

What are the benefits?

  • Dilapan does not contain any drugs or hormones, which means there is no chance of it over-stimulating your womb
  • It is safe to be used for women who have previously had a Caesarean section
  • There is less chance of getting uterine contractions during the cervical ripening, so there are fewer requirements for pain killers
  • You can relax/sleep during the process of outpatient induction of labour
  • You can carry on with activities like having a shower or going for a walk

What should I avoid?

  • Under no circumstances should you attempt to remove Dilapan-S
  • Avoid having a bath and sexual intercourse while Dilapan-S is in place

What should I expect?

  • The doctor or midwife will ask to perform a speculum examination to gently open your vagina and insert the Dilapan rods
    • This may briefly be a bit uncomfortable and there might be a little bit of bleeding
    • This procedure usually takes around 5 – 10 minutes
  • Your baby’s heartbeat will be monitored after the rods are inserted
  • Once your cervix has dilated (usually within 12 – 24hrs) we will be able to remove the Dilapan, break your waters and your labour will start, either on its own or we will start a hormone drip to give you contractions

If labour starts, the Dilapan may be removed earlier than 12 hours by a midwife.

What do I need to do on the day of my induction?

You will need to phone your pregnancy or maternity assessment unit on the morning of the day your induction is booked to discuss when to arrive.

Good Hope Hospital

Please call the Maternity Assessment Centre at 08:00.

Heartlands Hospital

Please call the Pregnancy Assessment Emergency Room at 09:00.

What happens next

  • When you are asked to come in you are welcome to bring one birth partner with you. Please ask a midwife for other visiting times
  • You may go home to rest for 12  24 hours after your Dilapan is inserted
  • You will be given a time to call for the next day
  • You induction may be postponed if another mother has a greater need at any point during your admission. This is to ensure the safety of all mothers and babies on the unit

You will need to return to the hospital the next day, usually 12  15 hours a following the insertion of the rods. The date and time will be specified by the midwife. You will be asked to attend either Ward 5 at Good Hope Hospital or the Labour Ward at Heartlands Hospital.

When you arrive, you will be admitted, the rods will be removed and your waters will be broken (called artificial rupture of membranes (ARM)), either at the same time as or within 4 hours following the removal of the rods, depending on activity on the labour ward. Sometimes you may have to wait longer for the ARM if the ward is very busy.

For further information on ARM and other induction techniques, please see our general information on induction of labour.

When should I call the labour ward or triage?

You should call the labour ward or triage:

  • if you experience regular contractions
  • if you are worried about baby’s movements
  • if your waters break
  • if the Dilapan dilators falls out
    • Please remember to bring the expelled (fallen-out) dilator/dilators
    • If unable to retrieve a dilator which has fallen in the toilet, try and take a picture of the dilator if possible
  • if you experience any bleeding or pain
  • if you are worried
  • after your Dilapan has been inserted for 12 24 hours

What if my cervix has not changed after the Dilapan rods have been in place for 12  24 hours?

If there has been no change in your cervix, i.e. if the cervix is not opened enough to break your waters easily, the doctor or midwife will discuss further options with you. These may include:

  • a second round of Dilapan, possibly after a break of between 12 and 24 hours
  • prostaglandin vaginal pessaries – drugs which act like your natural hormones to encourage labour
  • a Caesarean section

For further information on prostaglandin and other induction techniques, please see our general information on induction of labour.

Last reviewed: 05 January 2023