Induction of Labour: Why, When, and What Happens

Why induction might be recommended

The most common reason for induction is going past your due date. NICE guideline NG207 recommends that induction be offered at 41 weeks of pregnancy because the risk of stillbirth, although still small, increases after 41 weeks.

Other reasons include your waters breaking without contractions starting within 24 hours, pre-eclampsia or high blood pressure, gestational diabetes where blood sugar is difficult to control, concerns about the baby's growth, reduced amniotic fluid, or a specific medical condition in you or the baby that makes continued pregnancy higher risk.

You have a choice

Induction is a recommendation, not an instruction. You have the right to accept, decline, or ask for more time. If you decline induction, your maternity team should offer increased monitoring to check on the baby's wellbeing. Ask your midwife or consultant to explain the specific risks and benefits in your individual situation.

How induction works

There are several methods, and the approach depends on how ready your cervix is.

Membrane sweep. Often offered from 40 weeks. Your midwife inserts a finger through the cervix and makes a circular sweeping motion to separate the membranes. This releases prostaglandins which can trigger labour. It can be uncomfortable but is quick and increases the chance of labour starting within 48 hours.

Prostaglandin pessary or gel. A tablet, gel, or slow-release pessary containing prostaglandins is placed in the vagina near the cervix. This softens and opens the cervix. You may need one or two doses, given 6 to 24 hours apart.

Cervical balloon. A small balloon is inserted through the cervix and filled with water. The gentle pressure helps the cervix dilate mechanically. It is removed once the cervix has opened to about 3 centimetres. This method has fewer side effects than prostaglandins.

Artificial rupture of membranes (ARM). Once the cervix is sufficiently dilated, a midwife or doctor can break your waters using a small hook-like instrument. Breaking the waters often triggers stronger contractions.

Oxytocin drip. If contractions do not establish after the cervix has been opened and waters broken, an oxytocin drip is started through a cannula in your arm. The drip is increased gradually until regular contractions are established. You will need continuous monitoring while on the drip.

What to expect

Induction can take time. The process from the first pessary to established labour can take 24 to 48 hours or more, particularly with a first baby. This is normal.

Most hospitals start induction on the antenatal ward. Your birth partner may not be able to stay overnight at this stage. Once you are in established labour, you will be moved to a delivery room.

Induced contractions can feel more intense than spontaneous ones, particularly with an oxytocin drip. All pain relief options remain available to you, including epidurals.

When induction does not work

In some cases, the cervix does not respond to induction methods. Your medical team will discuss your options, which may include trying a different method or recommending a caesarean section. You will be involved in this decision at every stage.