What is induction of labour?

Labour normally starts naturally any time between 37 and 42 weeks of pregnancy.

During labour:

• your cervix softens and starts to open
• you will have contractions
• your waters break

In an induction of labour (induced labour) these labour processes are started artificially. It might involve:

• mechanically opening your cervix (see options for induction below)
• using medicines to start off your contractions
• breaking your waters

Sometimes, a combination of these methods is used.

What are some of the differences between an induced and a natural labour?

An induced labour can be more intense than a natural labour. But this is not true for everyone. In natural labour, the contractions build up slowly, but in induced labour they can start more quickly and be stronger.

There are pain relief options available, and there is usually no restriction on the type of pain relief you can have if your labour is induced.

It may be more difficult to move around with some types of induction. That’s because your baby will be monitored more closely than during a natural labour. You can request wireless monitoring if it’s available at your hospital to allow you to move more.

When is an induction of labour recommended?

You may be offered an induction of labour if there is a risk to your or your baby's health.

Your doctor or midwife might recommend inducing your labour if:

• you are overdue (41 to 42 weeks pregnant)
• there is a concern the placenta is not working as it should
• you have a health condition like diabetes, kidney problems, high blood pressure or pre-eclampsia
• the baby is making fewer movements, showing changes in its heart rate or not growing well
• your waters have broken but contractions have not started naturally

How do I decide whether to have an induction of labour?

Your doctor or midwife will explain the risks and benefits of induction of labour. You will be able to discuss the options to help you decide. The decision to have an induction is always up to you. You can change your mind at any time.

Do not be afraid to ask lots of questions like:

• Why do I need an induction?
• How will it affect me and my baby?
• What will happen if I do not have the induction?
• How will you induce my labour?
• How will you care for me and my baby?
• What are the risks of an induction?
• What are my options for pain relief?

If you are overdue, you might decide to wait and see if labour will start naturally. However, if there is a chance you or your baby are at risk of complications, you might need to consider induced labour before your due date.

You might need to consider that there is a higher risk of stillbirth or other problems the longer your pregnancy goes past term.

Are there any reasons why I might not be offered an induction?

Not everyone can have an induced labour. It may not be an option if:

• you have had a caesarean section before and are planning on a repeat caesarean for this birth
• you have placenta praevia
• your baby is breech or lying sideways
• you or your baby have serious medical complications
• you have an active herpes infection

What can I expect with an induction of labour?

During the late stages of your pregnancy, your healthcare team will carry out regular checks on your health and your baby's heath. These checks help assess whether it is better to induce labour or to keep your baby inside.

Always tell your doctor or midwife if you notice your baby is moving less than normal.

If you and your doctor or midwife agree on an induction of labour, they will do an internal examination. They will feel your cervix to see how ready it is for labour. This examination will also help work out the best method of induction for you.

Once the induction has started, it can take from a few hours to more than 24 hours until your baby is born. It depends how your body responds to the induction.

What options are there for induction of labour?

There are different ways to induce labour. Your doctor or midwife will recommend the best method for you when they examine your cervix.

You may need a combination of these induction methods to start labour. You will need to give written consent for the procedure.

Prostaglandins

A synthetic version of the hormone prostaglandin can be inserted into your vagina to soften your cervix and prepare your body for labour. It can be in the form of:

• a gel, which may be given in several doses (usually every 6 to 8 hours)
• a pessary and tape (like a tampon), which slowly releases the hormone over 12 to 24 hours

You will need to lie down temporarily after having the prostaglandin inserted. You’ll need to stay in hospital until the birth of your baby.

Prostaglandins are often the preferred method of inducing labour since it is the closest to natural labour. An oral prostaglandin tablet has also recently been approved. It may depend on what your hospital has to offer you.

Tell your midwife or doctor straight away if you start to experience painful, regular contractions 5 minutes apart for your first baby, or 10 minutes apart for subsequent babies, or if your waters break. These are signs that your labour is starting.

Risks: Some women find their vagina is sore after prostaglandin gel or tape, or they might experience nausea, vomiting or diarrhoea. These side effects are rare and there is no evidence that induction using prostaglandin is any more painful than a natural labour.

Very rarely, the contractions can come too strongly, which can affect the baby's heart rate. This can be controlled by giving you another medicine or removing the pessary.

You need to let your doctor or midwife know straight away if you start bleeding, or if your baby is moving less, because this could be a sign that something is wrong.

Balloon catheter

A cervical ripening balloon catheter is a small tube attached to a balloon that is inserted into your cervix. The balloon is inflated with saline, which usually puts enough pressure on your cervix for it to open. It stays in place for up to 15 hours, and then you will be examined again.

Tell your midwife or doctor straight away if you start to experience painful, regular contractions 5 minutes apart for your first baby, or 10 minutes apart for subsequent babies, or if your waters break, because these are signs that your labour is beginning.

Risks: Inserting the catheter can be a bit uncomfortable but not painful.

You also need to let your doctor or midwife know straight away if you start bleeding, or your baby is moving less, because this could be a sign that something is wrong.

Artificial rupture of membranes (releasing or breaking your waters)

Artificial rupture of membranes (ARM) is used when your waters do not break naturally. Your doctor or midwife inserts a small hook-like instrument through your vagina to make a hole in the membrane sac that is holding the amniotic fluid.

This will increase the pressure of your baby's head on your cervix, which may be enough to get labour started. Many women will also need oxytocin medicine (see below) to start their contractions.

Risks: ARM can be a bit uncomfortable but not painful. There is a small increased risk of a prolapsed umbilical cord, bleeding, or infection.

Oxytocin

A synthetic version of the hormone oxytocin is given to you via a drip in your arm to start your contractions. When the contractions start, the amount of oxytocin is adjusted so you keep on having regular contractions until the baby is born. This whole process can take several hours.

Risks: Oxytocin can make contractions stronger, more frequent, and more intense than in natural labour, so you may need pain relief.

It may be more difficult to move around because of the drip in your arm, as well as a fetal monitor around your abdomen to monitor your baby. However, it is still possible to move around with help from your midwife.

Sometimes the contractions can come too quickly, which can affect the baby's heart rate. This can be controlled by slowing down the drip or giving you another medicine.

Are there any risks with inducing labour?

There are some risks if you have an induced labour. The risks depend on:

• the reason for your induction
• the method of induction
• your individual circumstances

Some of the risks are:

• it will not work
• your uterus may contract too much or too strongly
• your baby may become distressed
• bleeding
• infection

What happens if the induction does not work?

Not all induction methods will work for everyone. Your doctor may try another method, or you might need to have a caesarean. Your doctor will discuss all these options with you.

Resources and support

Talk with your midwife or doctor if you’d like more information on induction of labour.

The Royal Women’s Hospital has information on induction of labour in different languages.