Induction of Labour: What to Expect
Understanding induction of labour helps you feel informed, prepared, and in control of your birth experience.
Induction of labour is one of the most common obstetric interventions in the UK, with around one in three labours now being induced. Yet for many women, receiving a recommendation for induction can feel unexpected or even concerning. Understanding what induction involves, why it may be recommended, and what to expect at each stage can make a significant difference to how you experience the process and help you feel genuinely prepared for your birth.
What is induction of labour?
Induction of labour is the process of artificially starting labour before it begins naturally. It is carried out using a variety of methods that either prepare the cervix, stimulate contractions, or both. The aim is to achieve a vaginal birth in circumstances where continuing the pregnancy poses a greater risk to you or your baby than delivering.
Induction is always a clinical decision made in discussion with you. You have the right to understand the reasoning, ask questions, and in many non-urgent situations, take time to consider your options before agreeing to proceed.
Why might induction be recommended?
There are several clinical situations in which induction may be offered or recommended:
Post-dates pregnancy
The most common reason for induction is a pregnancy that has gone beyond 41 to 42 weeks. After 42 weeks, the risk of stillbirth increases, and the placenta may begin to function less effectively. In the UK, most units offer induction between 41 and 42 weeks, though many women choose to be induced earlier.
Pre-labour rupture of membranes
If your waters break but labour does not start spontaneously within 24 hours, induction is usually recommended to reduce the risk of infection to you and your baby.
Gestational diabetes
Women with gestational diabetes are often offered induction between 38 and 40 weeks, as there is an increased risk of complications including macrosomia (a larger than average baby) and stillbirth if the pregnancy continues beyond this point.
Fetal growth restriction
If scans show that your baby is not growing adequately, induction may be recommended to deliver the baby into an environment where they can receive neonatal support if needed.
Large for gestational age fetus
If scans show that your baby is growing larger than anticipated, induction may be recommended to deliver the baby between 39 and 40 weeks.
Pre-eclampsia or high blood pressure
Pre-eclampsia can rapidly become serious for both mother and baby. Depending on its severity and gestation, induction is often the safest course of action.
Obstetric cholestasis
This liver condition, which causes intense itching in late pregnancy, carries an increased risk of stillbirth. Induction is typically recommended between 37 and 40 weeks, depending on your blood results.
Maternal request
In some private settings, induction may be offered at maternal request from 39 weeks. This is a personal decision that should be made in full discussion with your consultant, weighing the benefits and risks in the context of your individual circumstances.
Important: Induction is not appropriate in all situations. If you have had a previous caesarean section, there are additional considerations around the method used, as certain induction agents carry a small risk of uterine scar rupture. Always discuss your obstetric history fully with your consultant.
Methods of induction
Induction is not a single procedure but a series of steps, each designed to move your body closer to established labour. Which methods are used, and in what order, depends on the state of your cervix at the start.
Membrane sweep
A membrane sweep is often offered as a first step, at 39 to 41 weeks, to try to encourage labour to begin naturally and avoid the need for formal induction. During the procedure, your midwife or consultant inserts a finger into the cervix and makes a sweeping circular motion to separate the membranes from the cervix. This releases prostaglandins, hormones that can trigger contractions.
- It takes only a few minutes and is performed during a vaginal examination
- It can be uncomfortable, and you may experience cramping or a small amount of bleeding afterwards
- It does not always work, and more than one sweep may be needed
- It is only possible if the cervix is accessible. In very early pregnancy or a closed, unfavourable cervix, it may not be possible
Prostaglandin pessary or gel
If the cervix is not yet ready for labour (unfavourable, meaning it is closed, firm, and not effaced), prostaglandins are used to ripen it. These are inserted vaginally as a pessary, gel, or slow-release device.
- Pessary (Propess): A slow-release device worn like a tampon for up to 24 hours, releasing prostaglandins gradually
- Gel (Prostin): Inserted behind the cervix; may need to be repeated every 6 hours
- After insertion, you will be monitored, and your baby's heartbeat will be checked
- You may be able to move around during this stage and are not confined to bed
- Contractions may start during this phase, or the cervix may simply soften ready for the next step
Misoprostol oral medication
Misoprostol is a synthetic prostaglandin that can be taken orally to help ripen the cervix and stimulate contractions. It is taken at a low dose every 2 hours until contractions are established.
Balloon induction of labour
A balloon catheter can be used to mechanically dilate the cervix. A small balloon is inserted into the cervix and inflated with saline, applying pressure to encourage dilation. This method can be used alone or in combination with prostaglandins. Typically the baloon is left in place for 12 to 24 hours.
Artificial rupture of membranes (ARM)
Also known as breaking your waters, ARM is performed once the cervix has dilated sufficiently, usually to at least 2 to 3 cm. Using a small instrument called an amnihook, your midwife or consultant makes a small hole in the membranes surrounding your baby.
- The procedure itself is not painful, though the examination beforehand may be uncomfortable
- You will feel a warm rush of fluid as your waters release
- This alone may be sufficient to establish contractions in some women
- Your baby's heart rate will be monitored closely afterwards
Oxytocin (Syntocinon) drip
If contractions do not start or are not strong enough following ARM, a synthetic form of the hormone oxytocin, called Syntocinon, is administered intravenously through a drip. This is the most controlled method of induction and allows the rate of contractions to be carefully adjusted.
- You will be on continuous electronic fetal monitoring throughout
- The drip is started at a low dose and gradually increased until contractions are regular and effective
- Syntocinon-induced contractions can feel more intense than natural contractions and may come with less warning
- Discuss your pain relief preferences in advance, as an epidural is often requested during this stage
How long does induction take?
This is one of the most common questions women ask, and unfortunately it does not have a single answer. Induction can take anywhere from a few hours to several days, depending on:
- How favourable your cervix is at the start
- Whether you are having your first baby (induction typically takes longer in first pregnancies)
- How your body responds to prostaglandins
- Whether ARM alone is sufficient to establish labour
It is worth arriving at hospital mentally prepared for a process that may take more than one day. Many women find the waiting between steps harder than the induction itself. Bringing things to keep you comfortable and occupied during the early stages is genuinely helpful.
Bishop Score: Before induction begins, your midwife or consultant will assess your cervix and calculate a Bishop Score, a numerical rating based on its position, consistency, effacement, dilation, and the station of your baby's head. A higher score indicates a more favourable cervix and a greater likelihood of a successful, shorter induction.
Pain relief during induction
Induced labour can feel more intense than spontaneous labour, particularly when oxytocin is involved, as the body has not had time to build up its own endorphin response gradually. It is important to be aware of your pain relief options before you arrive:
- TENS machine: Can be used during the early stages and at home before admission
- Gas and air (Entonox): Available in most maternity units throughout labour
- Opioid injections (diamorphine or pethidine): Can take the edge off strong contractions but may cause drowsiness
- Epidural: The most effective form of pain relief; particularly recommended if you are in labour or on an oxytocin drip
- Remifentanil PCA: A patient-controlled opioid option available to women in labour
Discuss your preferences with your midwife or consultant in advance so that your pain relief choices are understood and documented in your birth plan.
Monitoring during induction
Once labour is established, and particularly once an oxytocin drip is in place, continuous electronic fetal monitoring (CTG) is required. This means you will be connected to a monitor throughout active labour.
Some women find this restrictive, but modern wireless telemetry monitors are available in many units and allow more freedom of movement. Ask about this option when you arrive. Staying as upright and mobile as possible can help labour progress and manage discomfort.
Risks and considerations
Induction, like any medical intervention, carries some risks. Your consultant will discuss these with you in the context of your individual situation:
- Hyperstimulation: The uterus contracts too frequently, which can temporarily distress the baby. Depending on the clinical scenario, this is managed by removing the prostaglandin pessarie, giving an injection into your arm or leg, called Terbutaline, reducing or stopping the oxytocin drip
- Failure to progress: If labour does not establish despite induction, a caesarean section may be recommended
- Increased risk of instrumental delivery: Induced labours carry a slightly higher rate of forceps or ventouse delivery
- Infection: Once the membranes have been ruptured, the risk of infection increases with time
- Uterine rupture (rare): Relevant primarily in women with a previous caesarean section scar
What if induction fails?
In a small number of cases, induction does not result in established labour, or complications arise during the process that make it safer to deliver by caesarean section. This is not a failure on your part. It is simply the outcome that best protects you and your baby in the circumstances.
If there is any possibility that induction may not succeed, it is worth preparing yourself mentally for a caesarean section as a possible outcome, so that the decision, if it comes, does not feel sudden or distressing.
How to prepare for induction
Being well prepared for induction can make the experience considerably more manageable:
- Pack your hospital bag well in advance, including entertainment, snacks, and comfort items for a potentially long process
- Discuss your birth preferences with your midwife and note that some of these may need to be adapted if induction takes a different course than expected
- Talk to your birth partner about what to expect, as their support is especially valuable during the early waiting stages
- Ask your consultant questions before the day: how long might it take, what are the options if prostaglandins do not work, what monitoring will be in place
- Eat a good meal before admission, as you may be asked not to eat once the oxytocin drip is started
- Rest as much as possible in the early stages of induction, even if you feel well enough to be up and about
Induction and private maternity care
For women receiving private care, induction can be planned with greater flexibility in timing and setting. In a private context, there is more opportunity to discuss the Bishop Score and cervical readiness in detail, to explore all available methods, and to have a genuine conversation about the risks and benefits in your specific situation rather than following a standard protocol alone.
Mr Myriknas is experienced in managing induction of labour in both high-risk and straightforward pregnancies, and takes a considered, individualised approach to every birth. If you have questions about induction in the context of your pregnancy, or wish to discuss your options in more detail, he is happy to advise at consultation.
Frequently asked questions
Induction itself is not inherently more painful than spontaneous labour, but the experience varies depending on the method used and how your body responds. A membrane sweep can be uncomfortable. Prostaglandin pessaries may cause cramping. Once an oxytocin drip is in place, contractions can feel more intense and come with less build-up than natural labour, because your body has not had the gradual hormonal preparation it would normally experience. Discussing pain relief options in advance, particularly the epidural, is strongly recommended if you are expecting to need an oxytocin drip.
Yes. Induction is a recommendation, not a requirement. You have the right to decline or to request more time to consider. If you do decline, your medical team should discuss the risks of continuing the pregnancy and offer increased monitoring as an alternative in some circumstances. It is important to make any decision with a full understanding of the clinical reasoning behind the recommendation, so ask questions and take the time you need.
Progress is assessed through regular vaginal examinations to check cervical dilation and effacement. You will also notice contractions becoming more regular, stronger, and longer as labour establishes. Your midwife will monitor your baby's heart rate throughout and will keep you informed of progress. It can be slow, particularly in the early stages, so try not to measure success by the clock. Focus on each step as it comes.
This depends on how labour is induced and how it progresses. If your labour is being augmented with an oxytocin drip, continuous CTG monitoring is required, which is not compatible with a pool birth in most units. However, if labour establishes well following ARM alone and you and your baby are both well, some units may allow water birth at that stage. Discuss this preference with your midwife on admission.
Induction after a previous caesarean section is possible but requires careful consideration. Prostaglandin agents carry a small but increased risk of uterine scar rupture in women with a previous caesarean, so they are often avoided. Oxytocin may be used cautiously once the cervix is ready. In some cases, if the cervix is favourable, ARM alone may be sufficient. This is a situation where a detailed conversation with your consultant is essential before making any decisions.
An unfavourable cervix, meaning one that is closed, firm, and not effaced, means induction will take longer and will begin with cervical ripening using prostaglandins. This phase can take 12 to 24 hours or more before the cervix is ready for the next step. It is one of the key reasons induction can be a lengthy process in some women. A Bishop Score assessment before induction begins will give your care team a clear indication of how your cervix is likely to respond.
The relationship between induction and caesarean section rates is nuanced. Evidence suggests that elective induction at term does not increase, and may actually slightly reduce, the overall caesarean section rate compared with expectant management in some circumstances. However, induction failure does exist, and in some cases labour does not progress adequately, making caesarean section the safest option. Having a realistic and open attitude to all possible outcomes is the best preparation.
Final thoughts
Induction of labour is a well-established, safe, and frequently used procedure in modern obstetric care. For the majority of women, it results in a successful vaginal birth and a healthy baby. Feeling informed about the process, including the reasons for it, the steps involved, and how to prepare, is one of the most effective ways to approach it with confidence rather than anxiety.
Every induction is different, and the experience will be shaped by your individual circumstances, your cervix on the day, and how your body responds. What remains constant is that your care team is there to support you at every step.
If you have questions about induction in the context of your pregnancy, or would like to discuss your birth options in more detail with a consultant, Mr Myriknas offers comprehensive antenatal consultations at The Kensington Wing and The Chelsea Wing, Chelsea and Westminster Hospital.