Within this information, we may use the terms "woman" and "women". However, we recognise that not only people who identify as women may want to access this content. Your care should be personalised, inclusive and sensitive to your needs, whatever your gender identity.
Induction of labour means starting your labour artificially. This is a common procedure, with more than 25% of births in the UK being induced.
The process of induction is recommended when your clinician (e.g. doctor or midwife) feels that inducing (starting) labour is a better option for you and/or your baby than continuing with your pregnancy.
Induction encourages the your contractions to begin and the dilation of your cervix (the neck of your womb).
The following offers general information on induction of labour. Additional information is available on outpatient induction of labour, where the process is started in hospital, then continues at home. This may be offered to you if your pregnancy is suitable.
Why is my cervix so important?
During pregnancy, your cervix is usually firm and stiff enough to help hold your baby in the uterus (womb). But in the final days before birth, the cervix starts to soften and open up to get ready for labour.
If your cervix is still closed and firm, it might need some help before induction of labour is started.
When talking about your cervix, your doctor may use the words “unripe” or “unfavourable.” The process of getting your cervix ready is called "cervical ripening".
Why might I be offered induction of labour?
In most pregnancies, labour starts naturally between 37 and 42 weeks. Induction is offered when it's felt that either the mother or the baby (or both) will benefit from an induced delivery rather than waiting for labour to start naturally.
To reduce the chance of complication, induction is offered to all women who don’t go into labour naturally by 42 weeks.
You may also be offered induction if:
- your waters break but labour doesn’t start within 24 hours
- your baby is not growing properly (growth restrictions)
- you have medical problems such as high blood pressure or pre-eclampsia
- you or your baby has a health problem
Our doctors will explain why you are being offered an induction. We will also talk to you about the possible benefits and risks, and discuss possible alternatives to help you to make an informed decision.
What do I need to do on the day of the induction of labour?
If you've been offered an induction of labour in advance, you will need to contact the delivery suite on the morning of your induction to find out what time to come into the unit. (Unfortunately we can't tell you beforehand what time to arrive.)
Good Hope Hospital
Please call the delivery suite at 08:00 on the morning of your induction.
Heartlands Hospital
Please call the delivery suite at 09:00 on the morning of your induction.
Please have your breakfast before being admitted to hospital. Please bring with you any medications you are taking regularly, any pregnancy notes you may have and an overnight bag.
Where can I have induction of labour?
You can have induction of labour while staying at either Good Hope Hospital or Heartlands Hospital. It is not possible for you to be induced at Solihull Hospital.
It is not generally possible for you to have induction of labour at home, but if our doctors or midwives decide that your pregnancy is suitable, you may be offered outpatient induction of labour. This means you have your induction started in hospital using something called Dilapan dilators, but then go home to continue with the "cervix ripening" stage of induction.
What is a membrane sweep?
A membrane sweep involves your doctor or midwife placing two fingers into the vagina, locating the cervix and making a circular, sweeping movement to separate the membranes that surround the baby or, if this is not possible, massaging the cervix. It may cause some discomfort, pain or bleeding but it makes it more likely that you will go into labour naturally.
You should be offered membrane sweeps at 40 weeks if you are having your first baby and at 41 weeks if you have already had a baby.
You may need to have labour induced earlier in pregnancy. Membrane sweeps can be effective for some women from 38 weeks. Please ask your doctor if you would like to know more about early membrane sweeps.
How will my labour be induced?
When you arrive at hospital, your baby’s heartbeat will be monitored electronically. Your midwife or doctor will need to examine your cervix internally before deciding on the most appropriate way to induce your labour.
Prostaglandins
These are drugs that act like natural hormones to kick-start labour. Prostaglandins are inserted into the vagina as a tablet or pessary with a string attached so we can remove it easily.
Prostaglandins cause your cervix to soften and open gradually. Often, contractions will start too. Once your cervix has opened up enough you will usually then be able to have your waters broken. This is called artificial rupture of membranes.
Artificial rupture of membranes (ARM)
A midwife or doctor will break your waters using something called an amniotic hook. This may be uncomfortable but shouldn't be painful. You then have a couple of hours to go into labour. If this doesn’t happen, we will start you on a drip containing oxytocin.
Oxytocin is a natural hormone that makes your womb contract. We start off small and slowly turning it up every half an hour until you have four regular contractions in 10 minutes.
Foley catheter induction
This is where a small tube is passed through your cervix. The tube has a balloon on the end, filled with a few millimetres of water.
A Foley catheter gradually stretches your cervix over several hours to open it gradually. It is usually removed after 16 hours. After a Foley catheter has been used, it should be possible to have an ARM (see above).
This method may be used if you have previously had a Caesarean section.
What happens next?
Your cervix should be re-examined after 6 hours if you have had a tablet or gel, or after 24 hours if you have had a pessary (something which is inserted into the vagina). Your baby’s heartbeat should be checked again when contractions begin.
In some women, particularly those who have had a normal labour before, your contractions may start without much delay. The process may take a few days if you have not been in labour before, and you may need several doses of prostaglandin to kick start your labour. (See "how will my labour be induced?", above.)
Can I have pain relief?
Induced labours can sometimes be more painful than labours which start without induction. However, you may ask your midwife for pain relief. They can discuss whatever pain relief is appropriate for you – exactly the same way as if your labour had not been induced.
Who can visit me during induction?
Due to COVID-19 restrictions, you may have one birth partner with you from 11:00 - 20:00. This must be the same person, and must not be swapped.
Unfortunately there are no facilities for partners to stay over. This is for the induction only.
Once you are moved to a delivery room of your own (normally when you are in established labour) you may have two birth partners who may stay with you 24 hours a day while you give birth. Again, birth partners are not to be swapped.
After delivery, one of the birth partners will need to go home. Please speak to your midwife if you need any further information.
How long does induction of labour take?
Every woman's circumstances are different and pregnancies also vary, so it's very difficult to predict how long induction will take. It may take two to three days for some women to go into labour. Others may go into labour over a few hours.
However, there are key factors that affect this:
- If you have had a vaginal delivery before, this tends to make induction quicker
- If your cervix is soft, stretchy and slightly open, this tends to make induction easier
- Your age (induction of labour tends to be more successful for younger women)
How successful is induction of labour?
Around 40% of women who give birth at our hospitals have an induction of labour.
Approximately 90% of those women who have had an induction have a vaginal birth. Around 10% deliver their baby by emergency Caesarean section.
What happens if induction of labour doesn't work?
If you don’t go into labour after induction, your midwife and doctor will discuss this with you and thoroughly check on you and your baby.
Depending on your wishes and circumstances, they may offer you another dose of prostaglandins or suggest an alternative method such as a Foley catheter. (See "how will my labour be induced?", above.) In some circumstances, you may be offered a Caesarean section.
I've had a Caesarean section before. How does this affect induction of labour?
If you've previously had a Caesarean section, induction of labour increases the chance of the scar on your womb opening up during labour. This is called uterine scar rupture. Therefore, the decision to have labour induced after 41 weeks should be carefully discussed and planned with a doctor.
Overall, the risk of scar rupture is 11 in 1,000 for women who have labour induced after a previous Caesarean section.
- If your labour is induced with prostaglandins, the risk is 16 in 1,000
- If your labour is induced with a Foley catheter, the risk is 6 in 1,000 (similar to natural labour)
- If your labour is induced with an ARM or an oxytocin drip, the risk is 7.2 in 1,000
Please feel free to speak to your midwife or your doctor if you have any questions or concerns.
Last reviewed: 16 January 2023
