Pregnancy and baby

Inducing labour

When would I be induced and what's involved?

Media last reviewed: 12/04/2012

Next review due: 12/04/2014

When is labour induced?

An induced labour is one that is started artificially. It's fairly common for labour to be induced. Every year in the UK, one in five labours are induced.

Sometimes labour can be induced if your baby is overdue or if there is any sort of risk to you or your baby's health. This risk could be if you have a health condition such as high blood pressure, for example, or if your baby is failing to grow.

Induction will be planned in advance. You'll be able to discuss the advantages and disadvantages with your doctor and midwife, and find out why they think your labour should be induced. It's your choice whether to have your labour induced or not.

Most women go into labour spontaneously by the time they are 42 weeks pregnant. If your pregnancy lasts longer than 42 weeks and you decide not to have your labour induced, you should be offered increased monitoring to check your baby's wellbeing.

Why you might be induced

  • If you are overdue
  • If your waters have broken
  • If you or your baby has a health problem

If you are overdue

Induction is offered to all women who don't go into labour naturally by 42 weeks, as there is a higher risk of stillbirth or problems for the baby if you go over 42 weeks pregnant.

If your waters break early

If your waters break more than 24 hours before delivery, there is an increased risk of infection to you and your baby. You may need a caesarean, and your baby may be vulnerable to problems associated with being premature if your waters break before 37 weeks of pregnancy.

If your waters break before 34 weeks, you will be offered induction only if there are other factors that suggests that it's the best thing for you and your baby.

If your waters break between 34 and 37 weeks, your doctor and midwife should discuss your options with you before you come to a decision about having an induction. They should also discuss the neonatal (newborn) special care hospital facilites in your area with you.

If your waters break at 37 weeks or over, you should be given the choice of induction or expectant management. Expectant management is when your healthcare professionals monitor your condition and your baby's wellbeing, and your pregnancy can progress naturally as long as it's safe for both of you.

If you have a health condition or your baby isn't thriving

You may be offered an induction if you have a condition that means it will be safer to have your baby sooner, such as diabetes, high blood pressure or obstetric cholestasis.

If this is the case, your doctor and midwife will explain your options to you so that you can decide whether or not to have your labour induced.

Membrane sweep

Before inducing labour, you will be offered a `membrane sweep' also known as a 'cervical sweep' to bring on labour.

What happens is that during an internal examination, your midwife or doctor sweeps their finger around your cervix. This action should separate the membranes of the amniotic sac surrounding your baby from your cervix. This separation releases hormones (prostaglandins) which may kick-start your labour

Having a membrane sweep doesn't hurt, but expect some discomfort or bleeding afterwards.

If labour does not start after a membrane sweep, you'll be offered induction of labour. Induction is always carried out in a hospital maternity unit. You will still be looked after by midwives, but doctors will be available if you need their help.

Watch this video which shows you what it's like to have a membrane sweep

How labour is induced

If you're being induced, you'll go into the hospital maternity unit.

Contractions can be started by inserting a tablet (or pessary) or gel into the vagina. Induction of labour may take a while, particularly if the cervix (the neck of the uterus) needs to be softened with pessaries or gels.  

If you have a vaginal tablet or gel, you may be allowed to go home while you wait for it to work. You should contact your midwife or obstetrician if:

  • your contractions begin
  • you have had no contractions after six hours

If you've had no contractions after six hours, you may be offered another tablet or gel.

If you have a controlled-release pessary inserted into your vagina, it can take 24 hours to work. If you aren't having contractions after 24 hours, you may be offered another dose.

Sometimes a hormone drip is needed to speed up the labour. Once labour starts, it should proceed normally, but it can sometimes take 24-48 hours to get you into labour.

What induced labour feels like

Induced labour is usually more painful than labour that starts on its own, and women who are induced are more likely to ask for an epidural. Your pain relief options are not restricted by being induced. You should have access to all the pain relief options usually available in the maternity unit.

Women who are induced are also more likely to have an assisted delivery, when forceps or ventouse suction are used to help the baby out.

If induction of labour doesn't work

Induction isn't always successful, and labour may not start. Your obstetrician and midwife will assess your condition and your baby's wellbeing, and you may be offered another induction or a caesarean section. Your midwife and doctor will discuss all your options with you.

Side effects of induction of labour

One in every five births in the UK in 2004-5 were induced, according to NICE. Among these induced births, when labour was started using drugs:

Natural ways to start labour

There are no proven ways of starting your labour yourself at home.

 You may have heard that certain things can trigger labour, such as herbal supplements and having sex, but there is no evidence that these work. Other methods that are not supported by scientific evidence include: acupuncture, homeopathy, hot baths, castor oil and enemas.

Having sex won't cause harm, but you should avoid having sex if your waters have broken as there is an increased risk of infection.

For more information on induction, you can read NICE guidelines on induction of labour (PDF, 132kb). NICE also has guidelines on the quality of care you should expect to receive if you're induced.


Page last reviewed: 20/02/2013

Next review due: 20/02/2015

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Comments

The 22 comments posted are personal views. Any information they give has not been checked and may not be accurate.

LaurenT19 said on 22 January 2014

If the midwives and doctors suggest that you should be induced it is purely for you and your baby's health. As a pregnancy becomes overdue (40-42 weeks +), there is a higher risk of stillbirth. The BBC made a report a couple of years ago about there being evidence of a number of children showing behavioural problems such as ADHD if they were born overdue. Please remember that the midwife is only suggesting it in the best interests of you and baby. If pregnancy is overdue or there are medical conditions of the pregnant woman present e.g. preeclampsia, diabetes etc. then sometimes it is safer to get baby out before any problems arise. I do understand how women want natural labours and they feel that being induced is an invasive procedure, but you have to think about your baby and what is best for them and also for yourself. Pregnant women know that if a baby is born prematurely, then it's not good, so why aren't women questioning the long-term effects of when a baby is born too late. You can decline the offer of a membrane sweep or an induction, but you and baby will have to be closely monitored. There are side effects to almost every drug that you take, but being induced is safe as you will be under the watchful eye of the midwives and doctors of the maternity unit. It is a highly stressful job being a midwife and sometimes women can feel as though their care has been rushed or they haven't been cared for adequately and had their questions answered. If this is the case, then just ask. Keep asking until you know the answers and feel comfortable with the situations. No question is a silly question. They are there to help you and make you feel at ease and you shouldn't feel like you have walked out of that door not knowing something or feeling nervous about a particular procedure or anything else regarding your pregnancy.

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tery507 said on 21 January 2014

I just want to say that I had 4 babies and in 2 cases the hospital wanted to induce labour. I refused on both counts as I knew that my baby would come when the time is right and that it's easier and more convenient for the maternity unit to have me give birth to their timetable - my baby in each case was not yet ready! My son was born 2 weeks late and my daughter 4 weeks late. The hospital didn't like me not playing ball with them so I cut a deal and suggested weekly hopital ante-natal visits with blood tests etc and if they could prove that something was wrong - I would agree to induction. Each test came but fine so no need for induction. When I went into labour, I had less pain, needed no painkillers and had less than 4 hour labours. My daughter was a peachy, chubby, pink 9llb girl. They needed that extra time in the womb to grow. I think mothers should think carefully about giving their baby the best and easiest birth experience possible, nevermind the convenience of everyone. Baby is no.1 in all this.

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Miffcollins said on 23 August 2013

I think each hospital runs their induction process differently? So maybe this website isn't the place for that kind of detailed information. I've just had my induction appt today and had a sweep. I attended the free parent education classes run by my hospital which gave plenty of information about induction. Today's appointment was fantastic (although sweep a bit uncomfortable!) and the midwives have given me excellent care, plus encourage you to call them with any questions. I'm obviously lucky to be at St Mary's in Manchester.

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Clairerj said on 08 April 2013

I'm booked in for an induction in two days and I found this article helpful. I don't really see how it's possible for the NHS to provide information on every possible circumstance as seems to be expected by other reviewers here. My experience, my friend's experiences and the those described here are extremely varied, hence why we expect midwives and doctors to obtain medical degrees rather than Googling or referring to the NHS website for solutions. Can't expect text book answers from a website designed for the general public.

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MrsHaytobe said on 17 November 2012

I agree with everyone! This page doesn't have any actual information about the pros and cons! It doesn't have any information about the side effects that can occur! Also, why aren't illnesses included in the leaflets? it only covers things like being 40 weeks+, waters breaking early etc. What about conditions such as Obstetric Cholestasis and the like? Also, what is the procedure for induction? Aren't we supposed to be given all available information to make an informed decision? Or, are we just expected to do as we're told?

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Susie said on 24 September 2012

We're planning to update this page, and would like to answer your questions about induction. What information would you like to see on this page? We'd like to make it as useful as possible, so any comments welcome!

Thanks,
Susie at NHS Choices

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Beeps said on 08 September 2012

I am 43 and having my first baby and have been monitored closely throughout my pregnancy due to my age. I have been very lucky and have had no medical problems at all and baby is all within normal limits and I am now 39 weeks tomorrow. I was told by the consultant that I would be induced on my due date 16/9 40 weeks but not given any reason for this intervention and must admit that after reading up on all the information - not on the NHS site I might add as I agree this site does not give enough informative information - I am growing more concerned about being induced purely because I believe that our bodies should be able to go into natural labour to enable the natural occuring pain relievers to kick in. When the placenta stops working so well, this sends a signal enabling your body to naturally go into labour. Of course, if there is a medical reason that either affects me or my baby then I would want to be induced straight away, but agree that it seems that being induced seems these days to be the norm which then begs the reason why?

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tinawaynebrown said on 07 June 2012

I was induced at 42 weeks with my 4th child, it took 3 attemps and a drip was put up, it took me 3 days to have my baby and he wasn,t breathing when he was born, my aunty who is a retired midwife said i should not have been allowed to go over due and should of had a c section as i was so big, fortunately it was a happy ending and my baby was whisked of to resus and was bought back to life and also weighing 10lb 3 oz but myself and my husband are still traumatise about this still and its been 14 years now, my thought is my daughter is 38 weeks pregnant with her 3rd child and she is petrafied of going over due as she saw what we went through, she already has 2 healthy children one born a week early and the other on the due date, she has already taken castor oil twice with no effect, i real feel for her. She rand her midwife today asking for a membrane sweap but midwife said she will see her next week to have a chat with her, her midwife doesn,t seem very good at all and sort of shrugs you off the care is not as good as it use to be due to midwife shortages. My whole point is i think you should never be allowed to go over due, my neighbour went to 42 weeks and had a still birth and is pregnant again she is being induced at 37 weeks which i think is wise.

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nere said on 30 May 2012

Went to see my midwife this Monday at 40 weeks pregnant with my first child.
Without previously given me any information at all, midwife suggested to do a sweep that was done on the spot. She didn't find the cervix (not sure if it can be found in less than 30 seconds!) and booked me for an induction on the 10th of June. When asked how I'm going to be induced, the response was: "it depends". Gave me a leaflet and off you go.
Really upset about the whole thing, I haven't received any information at all apart from leaflets from my midwife all through my pregnancy.
Not sure if that's the way things are in the NHS or is my midwife that is completely useless. Thinking of raising concerns about the care she is providing me with, but I just can't wait to lose sight of her!

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beccyb73 said on 29 May 2012

I would recommend going here for info instead:

http://www.babycentre.co.uk/pregnancy/labourandbirth/labourcomplications/inducedlabour/

This NHS page isn't very helpful. I have had a (painful) sweep done today and I am booked in to be induced on Saturday. Even at the appointment today, the information given was vague.

Good luck to all :-) xx

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pammyd26 said on 13 May 2012

i think it would be silly for enyone to think about going hat things started ging wrongover 42 weeks i had a still birth at 41 plus6 i felt this was to late and i truly belive my child was starved of oxegen as the whom is only desinged to work for 40wks i think they should induce you on the due date i had mo problems before 40 wks perfectly healthy baby if my baby was born then she would have been alive now.

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Koyah1970 said on 04 May 2012

Hi,

Thanks that really helpful and I will take a look at the link you suggest. Its good to hear other experiences, as there is so limited information especially for inducing early.

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lotty mays said on 26 April 2012


Hi, I agree that there is not enough info on this site with regards induction. I went to 42 weeks pregnancy with several of my pregnancies, and 43 weeks with my last pregnancy. I was not induced, even for maternal age (42) Two of my daughters also went to 42 weeks before going into labour. You do not have to be induced, and you should be offered expectant management if you do not want to be induced in accordance with NICE guidelines 2008. There are risks to induction, and these are not listed here. There is no evidence to suggest that the placenta packs up at 40+ weeks. Your baby will not suddenly grow huge in a fortnight. Recent research finds no difference in outcomes whether women choose induction or further monitoring. There are many reason why women may go 'overdue' including ethnicity, familial tendencies ( runs in the family) male fetus,etc.
another good site is AIMS ( Association for improvements in maternity services) and you may be able to link to the site below. Just copy and paste into the search link.
Induction of Labour balancing risks - Midwife Thinking.
Hope you all find some useful info and good luck with your pregnancies.

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Koyah1970 said on 23 April 2012

Early induction at 38 weeks due to age:
I am 41 years old and 34 weeks pregnant with my first child. (following 4 IVF attempts).
At my 20 week scan I was found to have a posterior placenta covering my cervix. I was scanned again at 32 weeks and the placenta is now 7.5mm from my cervix and they baby is currently in the breech position. I am due to be scanned again at 36 weeks.
Because of my age I have been seeing a consultant who we first saw after the 20 week scan.
He has recommended the following: if the placenta doesn't move enough I should have a C-section at 38 weeks.
If the placenta does move I should be induced at 38 weeks. The reason being that he states that in older women the placenta can stop working at 38 weeks and there is a small risk of sudden fetal death.
I have read the NICE guidleines on Induction and ealry induction due to age of mother is not listed as a reason for early induction.
I am not very happy with the prospect of an induction due to what I have read, potential stresses etc on the baby etc.
At our last appointment with our consultant he states that if I don't want an induction, (and obvioulsy that I don't need a C-section as my placenta has moved) they would monitor me regulary to check the baby was okay and wait for the baby to come along naturally.
I asked if I could have a c-section anyway at 38 weeks if he believes there is such a risk to the baby instead but my consultant said no.
I feel that we are left with no choice but to have an early induction, even though I don't want one, as albeit a small risk I am now really worried that something may happen to the baby.
I would appreciate any other thoughts / opiions and knowledge on this advice we have been given as I am now feeling quite distressed about the whole process.

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Martiali said on 09 November 2011

I have been told that I will need to induse labor at week 39 because of Gestational Diabetes. I was forwarded from the GD page to this to understand what the induction implies and:

a) No information about early induction at all
b) Insuficient information on induction anyway.

This article is woefully incomplete, unclear, does not provide numbers and statistics or alternatives. Very bad indeed!!!

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Letetia said on 06 November 2011

Morning Ladies, i was induced with my first baby as my waters broke at 36 weeks. The midwives/doctors at our hospital were very reassuring and said the reason they needed to induce me (in 24 hours if nothing had happened) is that if your waters break, the baby is no longer protected against infection, so they gave me antibiotics until they took me for induction. I never felt that I was kept in the dark, or was being pushed into anything and the whole thing went smoothly. It wasn't a really long labour either, only 7 3/4 hours from start to finish which is pretty good for a first baby, i think. I'm now due my second baby on Thursday, really thought this one was going to be earl y too, but no such luck!! I hope that this makes those of you being induced feel a little more comfortable about things, I would give anything for this birth to have gone the same as my first and I'm sure I will find out soon. Good luck to you all. x

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littleacceb said on 10 October 2011

"Induction is always planned in advance, so you'll be able to discuss the advantages and disadvantages with your doctor and midwife, and find out why they think your labour should be induced. It's your choice whether to have your labour induced or not."

This is not true. My hind waters broke, and I was frightened into induction by a registrar who kept calling the placenta "afterbirth", and insisted that if I went home, I'd get an infection and risk my baby's life.

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BHamel said on 04 May 2011

Hi Lara,

I hope your pregnancy is going well! I'm a medical student revising for finals and came across this article. I feel that it is best supplemented by a link to this leaflet giving information about the NICE guidelines (instead of the link to full guidelines provided here).

www.nice.org.uk/nicemedia/pdf/CG70publicinfo.pdf

or google

nice cg70 publicinfo (without the space)

As for the comment from someone else about why induction is recommended after 42 weeks....

There is a lot of evidence to say that the risks of continuing a pregnancy beyond this date are greater than the risks of induction. A post-term baby can often be quite large, making it difficult for them to come through the birth canal - the baby may end up with a dislocated shoulder and the mum may get a tear. There is a greater chance of instrumental delivery.

There is also a risk of infection to the baby due to meconium aspiration. The placenta becomes inefficient after 42 weeks because it is not designed to work for that long. A 2010 study published in the Journal of the American Medical Association also demonstrated an increased risk of cerebral palsy in babies born >42 weeks in comparison to those born at 40 weeks (the risk is also higher in pre-term deliveries <36wks).

Induction of labour is almost routine these days, for many different reasons. If you have any concerns then discuss them fully with your midwife. I hope this information helps and good luck with your pregnancies!

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laralambert said on 15 April 2011

i have 3 children already one 20yr one19yr & one 9yr, i am with a new partner and we are having a little boy in august, as im 41yr i have been told i will not be allowed to go over my date as it can be dangerous, i have been told i will be given a sweep but i know people that have had a sweep and it hasnt done anything for them so bit worried now if it doesnt work what they will doand how long they will wait after the sweep

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M2B11 said on 30 March 2011

The guidelines say ' sometimes it can be best to induce labour if a pregnancy lasts longer then 42 weeks'. Why????? Come on Nhs, we need reasons, not just an arbitrary timeline. What are the issues with going longer than 42 weeks? How are we supposed to make informed decisions with no information? Very poor indeed.

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Marisa1979 said on 24 February 2010

Not very useful information at all for any expectant mother. I was told that my labour will be inducted on my due date, was given a leaflet and referred to this website. I must say I am more worried now than I was before I looked at this because of the distinctive lack of information on risks, advantages and disadvantages. I was briefly explained that labour could be longer when inducted and that i might need more pain relief - where is the information on this? Thumbs down to the NHS.

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User31703 said on 02 May 2009

This article doesn't say much that is useful. What about studies on the advantages/disadvantages of different forms of induction? What about the connection with needing additional forms of pain relief? What are your rights re: induction? If you choose not to proceed, what will happen i.e. monitoring etc. Can you go overdue or be induced and still have a home or birth centre birth? Many many babies are overude - how many? Does the UK have a higher than average induction rate? Is there a correlation with cesarians/assisted births? This article is suspicious in its lack of useful information or re-direction to other sources.

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