Overview

An induction of labour or induced labour is when we try to start labour artificially. This means we use a tablet (pessary), gel or other medicines to start your labour. In the UK, about 1 in 5 labours are induced.

There are different ways your labour can be induced. How we induce labour depends on different things, like:

• your pregnancy and medical background
• a vaginal examination which will tell us how soft and open your cervix is

It is important to remember that your waters might break, or your contractions might start, naturally at any time during induction.

Why we might induce labour

We might induce your labour when:

• your pregnancy goes beyond its due date by 10 to 14 days or more (prolonged pregnancy) 
• your pregnancy is affected by a medical condition, such as high blood pressure, diabetes or obstetric cholestasis (a condition of the liver)
• you are expecting 2 or more babies
• you are aged 40 or older

We prefer labour to start naturally. However, we offer induction when the benefits for you and your baby are greater than the risks. Our priority is the continued wellbeing and safety of you and your baby. The decision to induce is never taken without discussing it fully with you.

Benefits of induction if you are overdue

After 42 weeks of pregnancy (2 weeks after your due date):

• the very small risk of stillbirth increases
• babies are more likely to pass meconium (baby’s first poo) during labour. This rarely causes a problem, but if your baby breathes meconium into their lungs, it can cause a serious breathing problem (meconium aspiration)
• the placenta might not function as well, and this can reduce the oxygen and nutrients available to your baby

Having induction 10 to 13 days past your due date reduces these risks.

Bringing labour on naturally

Before labour, the neck of the womb (cervix) softens. This process can take several days, and you can have irregular painful contractions before going into labour. 

You might see a mucus discharge that might be blood-streaked or pink. This is called a 'show' and is a sign that labour has begun. 

Exercise and keeping active

Being mobile and active can also help encourage your body to start labour, as the baby’s head might move down, placing gentle pressure on the cervix and encouraging it to dilate (open).

Membrane (cervical) sweep

A membrane (cervical) sweep makes natural labour more likely and reduces the need for induction. We usually offer a membrane sweep at 40 weeks.

A membrane sweep is where we ‘sweep’ the neck of your womb using a finger inserted into your vagina. This is to separate the membranes from the cervix. This process can encourage your body to release a hormone (prostaglandin) and start labour naturally over the next 48 hours.

You might feel some discomfort from the procedure and notice a show of blood or small amount of vaginal bleeding. A small amount of bleeding is OK and is nothing to worry about.

We strongly recommend that everyone has a membrane sweep if they are still pregnant at about 41 weeks. Please ask your midwife if you have not been offered a membrane sweep before induction of labour.

Going to hospital for your induction

We call you on the morning of your induction to tell you what time you should come in.

If you have not received a telephone call by 12 midday, please contact the team where your induction is meant to be done.

When you arrive, please go to the reception of your induction venue. It is important you bring your maternity notes with you.

We cannot give you a time in advance because it depends on how busy the centre is on that day. We try to keep you updated about any changes to when you can come in.

Delays to your induction

Sometimes, the maternity unit can get very busy. We understand that delaying your induction can be very upsetting and distressing, but our priority is to provide a safe unit for you and your baby.

We might have to delay your induction by 24 to 48 hours, or ask you to come in at a later time in the day. If your baby needs a neonatal cot, the delay can even be a few days until a cot becomes available.

If your induction is delayed and you have questions about this, please ask to speak with a senior midwife or obstetrician on duty.

Birth partners

You can bring your birth partner with you when you have your induction. However, if you are not in established labour during the evening, we would encourage them to go home to rest overnight. Established labour means that your cervix has dilated to about 4cm and you have regular contractions.

If your labour does start during the night, they can be contacted and asked to return to the unit to support you.

Induction by softening your cervix

To get your cervix to soften, we can insert a hormone (prostaglandins) or a balloon catheter.

There are 2 types of hormones. The method we choose will depend on the reason you are being induced, as well as your pregnancy history.

Propess^® pessary (10mg dinoprostone)

This is a tablet that is attached to a ribbon, similar to a tampon, which is placed inside your vagina. The pessary slowly releases prostaglandins over 24 hours, and prepares the cervix for labour.

Once the pessary is inserted, we like you to walk around to help encourage labour, and you can also still shower, eat and drink normally.

Prostin gel^® (1mg or 2mg dinoprostone)

This prepares the cervix for labour. It is inserted into the back of the vagina and works over 6 hours. You might need more than 1 dose of the gel (up to a total of 4mg) if your cervix is still not dilated enough.

This can take a long time and you might require both a Propess pessary and Prostin gel to get your cervix ready for labour.

Balloon catheter

When the use of prostaglandins (hormones) is not be recommended, such as birth after a caesarean section (BAC), or if your baby has a growth restriction condition, we might use a balloon catheter.

A balloon catheter is used to mechanically stretch your cervix open, without using medicines. The small, plastic balloon is inserted into your cervix, and inflated with a small amount of water. It is left inside you for several hours, to stretch open your cervix and encourage your body to release natural labour hormones. During this time it might fall out if it has stretched open your cervix enough.

Induction by breaking the waters

‘Breaking the waters’ is also known as artificial rupture of membrane (ARM). We do a vaginal examination and make a small hole in the membranes. It might be uncomfortable for you but it does not hurt the baby.

After this, you will feel a gush of warm fluid which confirms your waters have been broken. Sometimes this might not be obvious and we may need to repeat this.

Induction by intravenous (IV) hormone drip

If your labour does not start with the prostaglandin or ARM, we will use oxytocin. This will start the contractions, or make them stronger and more frequent. This medicine is given through a drip into a vein in your arm.

During this process, your baby’s heart rate will be monitored continuously using electronic monitoring (CTG). This is important as the contractions can cause changes in the baby’s heart rate.

Induction if you have had a caesarean section

Your consultant’s team will discuss with you the risks and benefits of induction in this situation. We might induce you if you've had a caesarean previously by breaking the waters and waiting 24 hours for the labour to start.

Sometimes we offer to place a Foley catheter in your cervix to slowly encourage it to soften. This should allow us to break the waters after 24 hours.

How long induction takes

This will be different for everyone and depends on how ready your cervix is for birth. In general, it can take 2 to 5 days from the start of the induction to the birth of your baby.

Sometimes the ward and hospital birth centre are very busy, and this can delay parts of your induction. 

If your induction does not work

If you do not go into labour after these different methods, your midwife and obstetrician will discuss the options with you.

Depending on your pregnancy and overall health, the options will be different but can include caesarean section. Sometimes, we stop the induction, rest your body for 24 hours, and then start the induction process again.

Pain relief

If you are having your labour induced, you might want to make some changes to your birth plan, such as pain relief.

All the pain relief options for labour can be used during your induction.

The early labour pain, during the Propess pessary and Prostin gel, can last for a longer time. You can ask for painkillers (analgesia) during this time, or consider a TENS machine to help you. A TENS machine is a small, battery-operated device that has leads connected to pads (electrodes) that stick to your back.

There is no evidence that labour after induction is more painful. However, more epidurals are requested after induction, compared to those who go into labour naturally.

Risks of inducing labour

There are no major risks to you or your baby. The benefits of the induction are greater than waiting for natural labour to happen. These will be discussed with you by the midwife or doctor before your induction is booked.

There are some small risks related to being induced. The hormones might cause your uterus to contract too much. If this happens, we would try to reduce the contractions by:

• removing the Propess
• turning down (or off) the oxytocin drip
• giving you medicine

Your baby’s heart rate will also be monitored continuously throughout labour. If your uterus over-contracts it can affect the baby.

Inducing your labour at term does not increase the need for a caesarean section. 

Not being induced

If you choose not to be induced, we will offer you an appointment with your link obstetrician to discuss management of your pregnancy.

You will have regular checks of your baby’s heartbeat using a CTG machine which gives us an indication of your baby’s wellbeing at that time. We might offer you a scan to check the blood flow in the umbilical cord and placenta, and to check the amount of amniotic fluid around the baby.

These checks cannot predict how your placenta will continue to function, and complications might still happen. You can discuss this at the appointment with your consultant.

Support and more information

NHS website has lots of information about the induction of labour.

Royal College of Obstetricians and Gynaecologists provide patient information about all aspects of pregnancy.