The prostaglandin gel, or pessary, is placed behind the woman's cervix in her vagina, by the caregiver during a vaginal examination. This is usually done on the antenatal ward (the floor in the hospital that cares for pregnant women with complications). The medication is kept in the fridge (and is usually left out for 20 or 30 minutes before insertion) so it comes to room temperature before being given. In some cases it may still feel cold.
After the prostaglandins are inserted, the woman is usually requested by the caregiver to stay in bed for about 40 minutes, to one hour, afterwards. This enables the absorption of the prostaglandins. In addition, the baby's heart rate is usually
monitored for this time with a
CTG Machine. Prostaglandins have the potential to overstimulate the woman's uterus (or make it contract too much). The baby can react to this by becoming distressed, due to a reduced oxygen supply. The chances of hyperstimulation happening are more likely if the woman's waters are broken, if it is not her first baby, or her cervix has already started to dilate. Women having their second or subsequent labour, are usually given lower doses of prostaglandins, to avoid overstimulating the uterus. In rare cases, the uterus can experience
tonic contractions, stressing the baby to the point that an emergency Caesarean operation is needed. (In extremely rare cases the
uterus can rupture).
When the labour starts the woman is usually transferred to the delivery suite or birth centre (or back home for a home birth). The labour should ideally start within 6 hours after the prostaglandins have been inserted. Sometimes a second dose is required.