Induction

Induction of labour means starting labour artificially rather than waiting for it to begin on its own. You may be offered an induction because your pregnancy has continued beyond your due date, your waters have broken without labour starting, or there is a health reason why your maternity team thinks giving birth sooner may be safer.

Being offered an induction does not mean there is only one possible plan. NICE says your care team should explain why induction is being offered, the benefits and risks in your circumstances, how it could be carried out and what alternatives are available. The decision should involve your preferences as well as the clinical information relevant to your pregnancy.

What is induction of labour?

Induction is the medical process of starting labour artificially.

Labour normally begins through changes in the cervix and contractions of the womb. During an induction, medicines or mechanical methods can be used to encourage some of these changes.

The exact process varies. Your cervix may first need to soften and open before contractions can be encouraged. For other people, the cervix may already be ready enough for the maternity team to discuss breaking the waters or using an oxytocin drip.

Induction takes place under maternity care, with the method chosen according to your individual circumstances.

Why might induction be offered?

There are several reasons why a doctor or midwife may discuss induction with you.

According to the NHS, induction may be offered if your pregnancy is overdue, if your waters have broken but labour has not started, or if you or your baby has a health problem.

For example, certain conditions such as diabetes or high blood pressure may lead your maternity team to discuss whether giving birth sooner would be appropriate.

The NHS says induction is offered if labour has not started naturally by 41 weeks because risks to the baby increase as pregnancy continues beyond this point.

Your individual reason matters. Ask your doctor or midwife to explain why induction is being suggested in your pregnancy and what the alternatives would be if you chose not to proceed at that point.

Is induction your choice?

Yes. NICE states that people should be given clear information and supported to make decisions about induction.

Your maternity team should discuss the reason induction is being offered, its possible benefits and risks, the methods that may be used, pain relief, and what could happen if induction does not work.

They should also explain alternatives if you choose not to have an induction or decide later that you no longer want to continue with the process.

You can ask questions and take time to understand your options. If something is unclear, ask your midwife or doctor to explain it again in plain language.

What happens before an induction?

Before a formal induction, you may be offered a membrane sweep.

During a membrane sweep, a midwife or doctor carries out an internal examination and uses a finger to sweep around the cervix. The NHS says this is usually offered after 39 weeks.

A membrane sweep may help labour begin without further methods of induction, although it does not always work. It can be uncomfortable or painful, and some cramping or vaginal bleeding can happen afterwards.

You should be asked for your consent before a membrane sweep or any internal examination.

If a formal induction is planned, your maternity team will explain when and where to attend and what method they recommend.

How is labour induced?

There are several methods, and you may need more than one.

The NHS describes two main approaches for preparing the cervix. Hormonal medicines can be given as a vaginal pessary or gel, or as tablets taken by mouth. Mechanical methods, such as a balloon catheter or osmotic dilator, can also be used to help open the cervix.

Which option is appropriate depends on factors including how ready your cervix is, your medical and pregnancy history, and your preferences.

Once the cervix is ready, your maternity team may offer to break your waters artificially. An oxytocin hormone drip may also be used to start or strengthen contractions.

Not every method is suitable for every pregnancy. Your doctor or midwife should explain what they recommend and why.

How long does induction take?

There is no fixed timetable.

Methods used to prepare the cervix often take many hours to work. Tommy’s explains that induction can sometimes progress quickly but can also take several days, particularly if the cervix is not yet ready for labour.

This waiting can be one of the less expected parts of induction. Depending on the method and your circumstances, you may stay in hospital or, in some situations, be able to go home for part of the process.

Your maternity team should explain what is usual at your hospital and when you should contact them if you are at home.

Is induced labour more painful?

The NHS states that induced labour is usually more painful than labour that begins on its own.

This does not mean you have fewer pain relief choices. The NHS says the usual pain relief options should remain available during an induced labour, although the induction method and your individual circumstances may affect where or how you can give birth.

If pain relief is important to you, ask about your options before induction begins. You can also change your mind about pain relief during labour.

Will induction change your birth options?

It can.

NICE advises that induction may affect choices about where and how you give birth. Some induction methods require closer monitoring or hospital-based care.

The NHS also notes that induction may mean a longer hospital stay and more examinations, and that assisted birth using forceps or ventouse is more likely after induction.

The effect on your birth options depends on why you are being induced, the method used, your response to induction and your individual clinical circumstances.

If there is something particularly important to you, such as mobility during labour, using water, specific pain relief or who you want with you, discuss it with your maternity team before the induction if possible.

What if induction does not work?

Induction does not always result in labour starting or progressing as hoped.

If this happens, the NHS says your obstetrician and midwife will assess you and your baby. Depending on your circumstances, options may include trying another induction method, waiting and reassessing, or having a caesarean birth.

NICE recommends that the possibility of unsuccessful induction and what it could mean for your options should be discussed when induction is offered.

There is no need to treat an induction that does not work as something you have personally failed at. It is a medical process, and bodies respond differently.

Can you start labour naturally at home instead?

There are many popular suggestions online for starting labour, but the NHS says there are no proven ways to start labour yourself at home.

Methods you may hear about include certain foods or drinks, hot baths, sex and herbal supplements. The NHS says there is no evidence that these methods start labour and notes that the safety of herbal supplements may be uncertain.

If you are considering anything intended to bring on labour, discuss it with your midwife first, particularly if you have been offered induction for a medical reason.

Questions you may want to ask about induction

An induction conversation can involve a lot of information. It is reasonable to ask for explanations more than once.

Useful questions can include:

Why are you recommending induction in my pregnancy?
What are the benefits and risks of induction for me and my baby?
What happens if I wait instead?
Which induction method are you recommending and why?
What might happen if the first method does not work?
How could induction affect my birth options?
What pain relief will be available?
Will I need continuous monitoring?
Could I go home during any part of the induction?
What are my options if I decide not to proceed?

NICE recommends discussing the reasons for induction, how it will be carried out, support and pain relief, alternatives, benefits and risks, and what happens if induction is unsuccessful.

When to get professional advice

If you have been offered induction and are uncertain about why it is being recommended, what the process involves or what alternatives you have, speak to your midwife or obstetrician. They can explain how the general guidance applies to your pregnancy.

If you are waiting for a planned induction, do not wait for the appointment if you develop symptoms that need maternity assessment. Contact your maternity unit urgently if your waters break, you have vaginal bleeding, your baby is moving less than usual, or you think labour may be starting before 37 weeks.

If you are already going through induction, follow the instructions given by your maternity team and tell them about symptoms, concerns or changes in how you or your baby feel.

If you cannot contact your maternity team and need urgent medical advice, call NHS 111. Call 999 for a life-threatening emergency or if you think your baby is coming immediately and you have a strong urge to push.