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Induction of Labor (Labour): Why It Is Offered and How It Works

Common reasons for induction, the methods used and questions to ask.

Before you use this guide: This is general educational information, not an individual medical assessment. We do not identify a clinician reviewer on this page, so please confirm personal health decisions with your doctor, midwife or paediatrician.

Induction means starting labour artificially rather than waiting for it to begin on its own. It is offered when the benefits of having your baby soon are thought to outweigh the benefits of waiting. It is a common procedure, and many women who are induced have a straightforward birth.

Common reasons for induction

• Your pregnancy has gone past the due date. Induction is typically offered between 41 and 42 weeks, because the risks to the baby rise slowly after that.
• Your waters have broken but contractions have not started, particularly if it has been a day or so.
• Health conditions such as high blood pressure, pre-eclampsia, diabetes or obstetric cholestasis
• Concerns about your baby's growth, movements or the amount of amniotic fluid
• A twin pregnancy, or certain other risk factors, where birth is planned a little before the due date
• In some places, healthy first-time mothers are offered induction at 39 weeks as an option. Ask your doctor about the benefits and drawbacks for you.

How induction works

Induction is usually a process in stages, not a single step. You will be told which methods are suitable for you, depending on how ready your cervix is, whether you have had a caesarean before and your own preferences.

• Membrane sweep: your midwife or doctor sweeps a finger around the cervix to separate the membranes from it. It can be uncomfortable and cause some spotting, and it may start labour within a day or two. It is often offered before a formal induction.
• Hormone gel, tablet or pessary (prostaglandin): placed in the vagina near the cervix to soften and open it. More than one dose may be needed.
• Balloon catheter: a small, soft balloon is passed through the cervix and inflated to open it gradually. It is useful if hormone methods are not suitable, for example after a previous caesarean.
• Breaking the waters (amniotomy): once the cervix is open enough, the midwife makes a small break in the membranes using a thin hook.
• Oxytocin drip: a hormone given through a vein to start or strengthen contractions. The dose is adjusted gradually, and your baby's heartbeat is monitored.

What to expect

• Induction can take a long time, sometimes a day or two, particularly if it is your first baby and your cervix is not yet soft.
• You may be asked to stay in hospital, or in some units you may go home for a period after the first dose. Ask what is offered.
• Contractions can feel stronger or closer together than in spontaneous labour, and an epidural is more commonly used. See our guide to pain relief in labour for the options.
• Your baby's heart rate is usually monitored throughout, sometimes continuously, and you may need to stay near the bed or use a wireless monitor so that you can keep moving.
• You can still use many of the same comfort measures, such as a birth ball, a bath or shower if allowed, breathing exercises and support from your birth partner.

Possible risks

Induction can lead to contractions that are too frequent or too long, which can affect your baby's heart rate. It is also more likely to lead to an epidural or an assisted delivery. If it does not work, your team will talk to you about options: more time, a further dose of medication or a caesarean. Large studies of healthy first-time mothers induced at 39 weeks have not shown higher caesarean rates than waiting. Your own risks and benefits depend on why you are being induced, so ask for the figures that apply to you.

You have a choice

Induction is a recommendation, not an order. You can ask for time to think, to wait and have extra monitoring, or to decline. A useful set of questions to ask your team is known as BRAIN:

• Benefits: what will induction achieve in my situation?
• Risks: what are the risks for me and my baby?
• Alternatives: what else could we do?
• Intuition: how do I feel about it?
• Nothing: what happens if we wait or do nothing for now?

Getting ready

• Pack your hospital bag and arrange childcare or pet care, since timing can be unpredictable. Our hospital bag checklist can help.
• Eat and drink normally before you go in unless told otherwise.
• Bring your birth partner, snacks, things to pass the time and a charger.
• Write down your preferences for pain relief and monitoring, and talk them through with your midwife.

Natural ways to start labour

A membrane sweep is the only method with good evidence. Walking, sex, spicy food, pineapple, nipple stimulation, acupuncture and raspberry leaf have little reliable evidence, and some herbal products or castor oil can be harmful. Do not use home remedies to start labour without asking your midwife or doctor.

Tell your midwife straight away if

• Your baby moves less than usual
• You have strong, constant pain that does not ease between contractions
• You have heavy bleeding or a gush of fluid that is green, brown or smells unpleasant
• You feel unwell, with a fever, severe headache or changes in your vision

Where to check current advice

Recommendations differ between countries, so check the latest advice from your own health service, such as NICE and the NHS in the UK, the HSE in Ireland, ACOG in the US, the SOGC in Canada and RANZCOG in Australia.

This content is for general information only and is not medical advice. Every pregnancy and every baby is different. Always talk to your doctor, midwife or paediatrician about your own situation, and seek urgent care if you are worried.