When is labour induced?
Sometimes labour can be induced (started artificially) 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 offered induction
If you are overdue
There is a higher risk of stillbirth or foetal compromise (your baby's health being put at risk) if you go over 42 weeks pregnant, but not every pregnancy over 42 weeks is affected this way. At the moment there is no way of knowing which babies might be at risk, so induction is offered to all women who don't go into labour by 42 weeks.
Before formal induction of labour, you will be offered a vaginal examination with membrane sweep to encourage labour to start. Membrane sweeping increases the chance that you will go into spontaneous labour, and so reduces the need for induction. A membrane sweep will usually be done twice after 41 weeks. There is a chance you may have some discomfort or bleeding after having a sweep.
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.
Read guidelines produced by the National Institute for Health and Clinical Excellence (NICE) about the care you can expect to receive during labour (PDF, 213kb).
If your waters break early (premature rupture of membranes)
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.
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.
If the induction works
When your contractions start, your baby will be monitored to check his or her heart rate.
Induced labour is usually more painful than spontaneous labour (labour that starts on its own), and women who are induced are more likely to need epidural anaesthesia. 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 more likely to have an assisted delivery, when forceps or ventouse suction are used to help the baby out.
If the induction 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.
For more information on induction, you can read NICE guidelines on induction of labour (PDF, 132kb).
Side effects of induction
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:
- less than two-thirds of these women gave birth without further intervention
- about 15% had instrumental births (forceps, ventouse)
- 22% had emergency caesarean sections
Induced labour can also be more painful than spontaneous labour.
NICE advises that induction of labour has a large impact on the health of women and their babies, and so needs to be clearly clinically justified.
How effective is induction at protecting the baby?
A review in 2012 of studies into the effectiveness of induction at reducing infant mortality found that:
- inducing labour was associated with fewer perinatal deaths (foetus or newborn deaths) and fewer caesarean sections, compared with expectant management (monitoring without induction)
- some problems in the baby, such as breathing meconium and amniotic fluid into the lungs (meconium aspiration), were reduced with a policy of induction after 40 weeks, but there wasn't a significant difference in the number of babies admitted to neonatal intensive care units
The review authors point out that the risk of perinatal death is small, and suggested that women should be counselled appropriately so that they can make an informed choice between induction or expectant management.
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 castor oil or having sex, but there is no evidence that these work. Other methods that are not supported by scientific evidence include: herbal supplements, acupuncture, homeopathy, hot baths 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.
