Is induction of labour right for me and my baby?

On this page:

What is induction of labour? 

Is induction of labour right for me and my baby?

When is induction of labour not recommended?

What are the risks of induction? 

Is it safe to have an induction if I have had a c-section before? 

I don't want an induction 

Can I change my mind about being induced?

How do I decide whether to be induced? 

 

What is induction of labour?

Most women and birthing people go into labour by themselves (also known as naturally or spontaneously) between 37 and 42 weeks of pregnancy. But in some cases, your midwife or doctor may offer to start labour artificially. This is called induction of labour.

You can read more about what happens during induction of labour here.

Is induction of labour right for me and my baby?

You may be offered an induction because:

  • it is hospital policy to offer induction to everyone in your situation (see below)
  • you have asked for it
  • your doctor has considered your personal situation and thinks it is right for you.  

It might be hospital policy to offer you an induction if:

  • you are ‘overdue’ (you are a week or more past your due date)
  • your waters break early
  • you or your baby have a health problem
  • scans suggest you are having a large baby
  • you are having more than 1 baby
  • you are aged 40 or over  
  • more than 1 of these things above applies to you

You may also be offered medicine to help induce labour if your baby has died in the womb. We’re so sorry if this has happened to you. You may find our information on preparing for labour with a stillborn baby more helpful.

Whether an induction is the right choice for you and your baby will depend on your individual situation.

You and your midwife or doctor should make a decision together about what is best for you and your baby. They should explain why they are suggesting an induction and the risks and benefits of all your options. This should include the risks and benefits of doing nothing and waiting for labour to start naturally. 

Some women and birthing people say they were ‘told’ they were having an induction, rather than being offered one. This is wrong. It is your decision. You should always be given the information you need to make a choice that feels right for you and your baby, based on your own situation. Read more about making decisions in pregnancy here.

It can be helpful to think start thinking about how you want to give birth before your third trimester. You may want to think about a plan B and even C, in case things do not go as expected. Thinking about this early could help you to make decisions on the day, when it will be harder to take in new information. We have more information on birth plans for induction here.

The midwife explained that baby was on the small side, what that could mean and risks associated with that. She explains what happens in the induction and you that it starts with a pessary. I said I didn't want my waters broken and she said you don't have to have that. She did give me the option to come in everyday and be monitored but we decided with two other children that probably wouldn't be sensible. So I decided I would be induced.

Shivaunne

In this film, Shivaunne explains more about what happened to her. This includes difficult conversation with a consultant, a supportive conversation with a midwife and her thoughts on whether she needed to be induced at all.

 

I am 41 or 42 weeks pregnant

A pregnancy usually lasts between 37 and 42 weeks.  Around 99 in 100 women and birthing people who choose to wait for labour to start by itself will give birth before 42 weeks.

You will usually be offered an induction if you are still pregnant at 41 weeks. This is to stop your pregnancy lasting longer than 42 weeks.  

 Risks linked to being pregnant after 42 weeks

  • People who are pregnant for longer than 42 weeks may be more likely to have a c-section. But there is no evidence to show if this is a direct cause. It may be that doctors may be more likely to recommend a c-section to people who are over 42 weeks pregnant.
  • Babies who are born after 42 weeks may need extra care in a neonatal intensive care unit (NICU).  
  • There is an increased (although still very small) risk that a baby born after 42 weeks will be stillborn or die soon after birth. The risk of this happening increases from 3 out of 10,000 (0.03%) to 30 out of 10,000 (0.3%). 

It's possible that these increases in risk may sometimes be because there is an existing problem with the baby that also causes pregnancy to go on longer.

There is some evidence that longer pregnancies may sometimes run in families. If you have given birth later than your due date in a previous pregnancy, research shows it is probably safe for you to stay pregnant for longer again.

It’s also possible that the due date you were given may not be accurate. This is because it can be hard to know exactly when you conceived. Talk to your midwife or doctor about this. They can help you understand how long you have been pregnant and whether this is in the normal range.

Induction was brought up when my notes said I was 41 weeks pregnant. But I knew the estimated due date was wrong, as I knew when I last had a period. I refused induction and my baby was born at 42 + 3 (their dates). I’ve since had 2 more babies, both of whom were born at least a week past their ‘due date’. I just have longer pregnancies than some people.

Ellie

My waters have broken

Most people are in labour when their waters break or go into labour within 24 hours afterwards. But around 3 in every 100 women and birthing people find their waters break early.

37 weeks or over

If you do not go into labour within 24 hours of your waters breaking, you will be offered an induction. This may help to lower the risk of infection for both you and your baby.

If you choose to wait, you may be offered checks for you and your baby until you give birth.

Under 37 weeks  

You may hear this called preterm prelabour rupture of membranes (PPROM). If this happens, you may choose to be induced straight away or wait until you reach 37 weeks. If it’s safe for you to wait, this will avoid your baby being premature.  

Your midwife or doctor should talk you through the benefits and risks of both options. If you choose to wait, you will be offered monitoring of you and your baby until you give birth. You may be given antibiotics to help protect against infections.

If you have had a positive Group B streptococcus (Group B strep) test during your pregnancy and your waters break early, you will be offered an induction or a c-section straight away. 16This is because Group B strep infection can occasionally make babies very unwell. Delivering your baby early will help to protect them.17

Under 34 weeks

If you are under 34 weeks, it’s usually best to try to stay pregnant for longer. You will only be offered an induction before 34 weeks if you or your baby’s health is at risk.

I was admitted to hospital at 35weeks when my waters broke. I was told that if my baby did not arrive naturally by 37 weeks, I would be induced. I was not given any other options and it wasn't spoken about in any more detail than this. 

Natasha

Watch Natasha talk about her fear of pregnancy and birth, her concerns about being induced unnecessarily, and what happened when her waters broke early.

I have a health problem

You may be offered an induction if you or your baby have certain health problems.

Diabetes

If you have type 1 or type 2 diabetes, you will be offered an induction or planned c-section from 37 weeks. This may happen sooner if you have complications, such as high blood sugar (glucose) levels, high blood pressure, or a big or small baby.

If you have gestational diabetes and live in England or Wales, you will be advised to have your baby before 41 weeks. If you don’t go into labour naturally by then, you will be offered an induction or a c-section. You may be advised to have your baby earlier than this if you have complications.

In Scotland, most pregnant women and birthing people with diabetes are advised to have labour induced within 40 weeks.

Pre-eclampsia

Some women and birthing people get a condition called pre-eclampsia. You will usually be offered an induction or c-section as soon as you reach 37 weeks of pregnancy. If your pre-eclampsia is severe, you may be advised to give birth earlier.

I saw a consultant who specialises in hypertension in pregnancy and had a fantastic conversation with her. I felt listened to and all my feelings were validated. She took me through studies and gave me statistics and made me feel like I had a choice and supported me to make my decision to go ahead with an induction. 

Bejul

High blood pressure  

If you had high blood pressure before getting pregnant, or have developed it while pregnant, you may be offered an induction or c-section after 37 weeks. You probably will not be offered an induction before then unless there are other medical reasons.

Intrahepatic cholestasis of pregnancy (ICP)

Intrahepatic cholestasis of pregnancy (ICP) is an uncommon condition that affects how the liver works, particularly during late pregnancy. You may hear it called obstetric cholestasis.  

You may be offered an induction or c-section at 38–39 weeks if you have moderate ICP. Up until 38-39 weeks the risk of stillbirth is the same as someone who does not have ICP. At 38-39 weeks it increases slightly.

You will be offered an induction at 35–36 weeks if your ICP is severe. This is because the risk of stillbirth is higher (3 out of 100) with severe ICP.

Other conditions

Other conditions that may sometimes lead your midwife or doctor to suggest inducing labour early include:

  • an infection in your placenta or amniotic fluid (chorioamnionitis)
  • the placenta separating from the inside wall of your womb (placental abruption)
  • problems with your heart or kidneys
  • your blood cells attacking your baby’s blood cells (rhesus disease).

My baby has a health problem

Your midwife or doctor may suggest an induction if they are worried about your baby’s health, including if your baby:

  • has a fast, slow or uneven heart rate
  • has stopped growing (if the doctors think they are strong enough to go through labour and a vaginal birth)
  • does not seem to have enough amniotic fluid around them.

In all cases, your midwife or doctor should explain your options for when and how to give birth, so that you can decide whether or not to have an induction.

I was induced with a pessary following very loaded conversations with my consultant about how much I was putting my baby at risk. I actually felt like accepting the pessary was putting my baby at risk as I just didn’t feel it was time. It felt rushed, unnecessarily so. I didn’t feel like I had a voice and I was worried about being labelled “difficult” so I did as I was told.

Jade

I might be having a large baby

You may be offered an induction if scans at (or after) 36 weeks show you may be having a very large baby.

There is no strong evidence to suggest induction of labour is always the best choice here. There are risks and benefits to both having an induction of labour and of waiting to go into labour naturally with a large baby.  

Having a large baby can sometimes lead to a more difficult birth, as one of the baby’s shoulders can sometimes get stuck in the birth canal (shoulder dystocia). An early induction may reduce this risk slightly.

About 4 in every 100 large babies born after an induction may have a shoulder dystocia, compared with about 7 in every 100 born after waiting to go into labour naturally.

However, induction of a labour with a large baby increases the risk of third- or fourth-degree perineal tears.

It’s not possible to know for certain that your baby will be very large. Ultrasound scans are rarely completely accurate.

I am having more than one baby

If you are having more than one baby, you will usually be offered a planned birth (by induction of labour or caesarean section). When and how you give birth will depend on how many babies you are having, their position in your womb and anything relevant to your individual situation.

Multiple pregnancies can be complicated, and it is important to discuss your own situation and risks with your doctor.

In an uncomplicated twin pregnancy, there does not seem to be any increased risk of harm in waiting for labour to start spontaneously.

I am aged 40 or over

The main guidelines followed by doctors and midwives (NICE guidelines) do not say doctors and midwives should offer induction of labour in women and birthing people aged 40 or over.

Some hospitals do offer women and birthing people who are aged 40 or over an induction when they are 39 weeks pregnant.  

This may be because women and birthing people who are over 40 years of age have the same risk of stillbirth at 39-40 weeks pregnant as someone in their mid-twenties has when they are 41 weeks pregnant (2-3 in 1000 or 0.3%). The guidelines do recommend induction for all people who are 41 weeks pregnant. You may find it helpful to read this section too.

When is induction of labour not recommended?

You will not usually be offered an induction if:

It also may not be suitable if you have had lots of bleeding during your pregnancy. This is because it may not be possible or safe for you to have a vaginal birth.

What are the risks of induction?

There are lots of ways to induce labour. Some risks are linked to specific ways of inducing labour. Our page on what happens during induction has more information about specific risks.  

This is a list of general risks. Talk to your doctor or midwife about how these risks relate to your individual situation.

  • It might not work. For every 100 people who have an induction, about 15 do not go into labour. If this happens and your waters have already broken, it is not usually possible to stop the process and you may need a c-section.
  • More pain than a natural labour – Many people find induced labour more painful. You may be more likely to need an epidural or other types of pain relief.
  • You are more likely to have an assisted birth. This is where the doctor uses instruments to help deliver the baby. It can increase your risk of a perineal tear. The risk of this happening will depend on other things too, such as the size of your baby.
  • Your womb might contract too much (hyperstimulation). This happens in up to 5 in every 100 women and birthing people who have an induction. It usually happens because of the medicines used. It could cause changes in your baby’s heart rate. This is why your baby is monitored all the way throughout an induced labour.
  • Increased risk of infection. There is a small chance of you or your baby getting an infection, particularly if you have your waters broken artificially. Internal examinations and putting in vaginal treatments might also slightly increase your risk of infection.
  • Your womb could tear (uterine rupture). This is very rare, but you will need an emergency c-section if it happens. Our page on what happens during induction has more detail about the risk of this happening.

Is it safe to have an induction if I have had a c-section before?

You may be able to have an induction and a vaginal birth after a previous c-section. But it may not be suitable if your c-section was done in a certain way.  

You may not have as much choice in the way your labour is induced. Our page on how labour is induced has more information about which methods might be best for you. 

Speak to your midwife or doctor if you have had a c-section before. They can talk you through your options for giving birth safely.

I don't want an induction

It is your choice whether you have an induction. Your midwife or doctor should explain all your options for giving birth. Depending on your situation, these may include:

  • waiting for your labour to start on its own
  • an induction now  
  • a c-section
  • waiting for now and coming back to your decision later.

You might find it helpful to look at our information on talking to your doctor or midwife about induction.

If you decide to wait, you will be offered extra check-ups to monitor your baby’s health. How often these checks happen will depend on why you were offered an induction and how many weeks pregnant you are. You can choose whether to accept these check-ups.

Your midwife or doctor should give you a number to call if you have any concerns at any time. If you notice any changes, such as your baby getting less active, contact your midwife or maternity team straight away.

Can I change my mind about being induced?

Yes. You can choose whether to have an induction, and if you say yes, you can still change your mind at any point before you are induced. Once induction has started, it may not be possible to stop the process, especially if your waters have broken.

Get in touch with your midwife or doctor if you change your mind about how and when you give birth – you do not have to wait for your next planned appointment.

How do I decide whether to be induced?

Doctors and midwives have guidelines to follow. These guidelines are based on research evidence that shows overall risks and benefits for all women and birthing people, or all women and birthing people in a particular group.

Guidelines and pregnancy information cannot tell you all the risks and benefits for you as an individual, with your personal medical history and situation. It is important to ask healthcare professionals about anything that could make something more or less likely to happen to you. Read more about understanding risks and benefits.

‘I wanted an induction at 37 weeks because my mental health was in a bad state due to a previous ectopic pregnancy, emetophobia and agoraphobia. It was agreed with my healthcare professionals that an induction at full term (37wks) was the best thing for both me and baby. I am glad I was eventually listened to, although it wasn't easy to get people to listen.’

Alex

As well as the information below, you might find it helpful to look at our information on how labour is induced and making decisions in pregnancy Our page on talking to your doctor or midwife about induction has lots of suggested questions that you might find helpful.

Being induced could affect where and how you have your baby, as well as your experience of giving birth. You may want to think about how important this is to you.  

For example:

  • Your midwife or doctor will need to examine you inside your vagina, before and during the induction. If you do not want regular examinations of your cervix and vagina, for whatever reason, talk to your midwife or doctor. Most forms of induction involve regular examinations, so you may need to think about other options.
  • Some ways of inducing and monitoring labour can only happen in a hospital. These include a synthetic oxytocin drip, continuous electronic monitoring, and epidurals for pain relief.
  • Some hospitals do not have continuous monitoring equipment that can be used in a birth pool. This would mean you would not be able to have a water birth.
  • You may need to spend longer in hospital before your baby’s birth than if your labour starts on its own. Your partner may not be able to stay all of the time.
  • There may be practical impacts on your family and day-to-day life. For example, having your labour induced often means spending more time in hospital. This could mean finding extra childcare if you already have children. There may also be extra costs involved for anyone visiting you in hospital, especially if they do not live nearby.

You might also find it helpful to speak to our midwives on 0800 014 7800 (Monday to Friday, 9am to 5pm), or email us at [email protected].

Norgine provided a Grant to support the development of this material. Norgine had no editorial control or scientific input into this material.

National Institute for Health and Care Excellence (2021). Inducing Labour. NICE Guideline 207.

National Institute for Health and Care Excellence (2019). Twin and triplet pregnancy. NICE guideline 137.   

NHS England (2023). Saving Babies’ Lives Version 3: A care bundle for reducing perinatal mortality. https://www.england.nhs.uk/wp-content/uploads/2023/05/PRN00130-Saving-babies-lives-version-three-a-care-bundle-for-reducing-perinatal-mortality-v3.1-july-23.pdf [accessed April 2024) 

Recommendations | Inducing labour | Guidance | NICE 

Induction of labour at or beyond 37 weeks' gestation - Middleton, P - 2020 | Cochrane Library

Muglu J, Rather H, et al. (2019). Risks of stillbirth and neonatal death with advancing gestation at term: A systematic review and meta-analysis of cohort studies of 15 million pregnancies. PLOS Medicine. 16(7):e1002838. https://doi.org/10.1371/journal.pmed.1002838  

 Middleton P, Shepherd E, et al. (2018). Induction of labour for improving birth outcomes for women at or beyond term. Cochrane Database of Systematic Reviews. (5). https://doi.org/10.1002/14651858.cd004945.pub4

Schierding W, O’Sullivan JM, et al. (2014). Genes and post-term birth: late for delivery. BMC Res Notes. 7:720. https://doi.org/10.1186/1756-0500-7-720 

Kortekaas JC, Kazemier BM, et al. (2015). Recurrence rate and outcome of postterm pregnancy, a national cohort study. European Journal of Obstetrics & Gynecology and Reproductive Biology. 193:70–4. https://doi.org/10.1016/j.ejogrb.2015.05.021 

Royal College of Obstetricians & Gynaecologists (2019). When your waters break prematurely. https://www.rcog.org.uk/for-the-public/browse-our-patient-information/when-your-waters-break-prematurely/ [accessed March 2024] 

Coates D, Makris A, et al. (2020). A systematic scoping review of clinical indications for induction of labour. PLoS One. 15(1):e0228196. https://doi.org/10.1371/journal.pone.0228196

Royal College of Obstetricians & Gynaecologists (2017). Group B Streptococcus (GBS) in pregnancy and newborn babies. https://www.rcog.org.uk/for-the-public/browse-our-patient-information/group-b-streptococcus-gbs-in-pregnancy-and-newborn-babies/ [accessed March 2024] 

National Institute for Health and Care Excellence (2015). Diabetes in pregnancy: management from preconception to the postnatal period. NICE guideline 3 [updated 2020]. 

Scottish Intercollegiate Guidelines Network (SIGN) (2010). Management of diabetes: national clinical guideline 116 [updated 2017].  

 National Institute for Health and Care Excellence (2019). Hypertension in pregnancy: diagnosis and management. NICE guideline 133.  

 Royal College of Obstetricians & Gynaecologists (2022). Intrahepatic cholestasis of pregnancy. https://www.rcog.org.uk/for-the-public/browse-our-patient-information/intrahepatic-cholestasis-of-pregnancy/ [accessed March 2024] 

 Royal College of Obstetricians & Gynaecologists (2011). Antepartum Haemorrhage (Green-top Guideline No. 63). 

National Institute for Health and Care Excellence (2019). Intrapartum care for women with existing medical conditions or obstetric complications and their babies. NICE guideline 121 [updated April 2019].   

National Institute for Health and Care Excellence (2021). Inducing Labour. NICE Guideline 207. Appendices A, B and C.  

National Institute for Health and Care Excellence (2021). Inducing labour. [A]: Induction of labour for suspected fetal macrosomia. Evidence review underpinning recommendations 1.2.24 and 1.2.25 of NICE guideline 207 

 Recommendations | Twin and triplet pregnancy | Guidance | NICE [Accessed April 2024]

Elective birth at 37 weeks’ gestation for women with an uncomplicated twin pregnancy - Dodd, JM - 2014 | Cochrane Library

Reddy UM, Ko CW, Willinger M. Maternal age and the risk of stillbirth throughout pregnancy in the United States. Am J Obstet Gynecol 2006;195:764–70.  

Wyatt PR, Owolabi T, Meier C, Huang T. Age-speciflc risk of fetal loss observed in a second trimester serum screening population. Am J Obstet Gynecol 2005;192:240–6 

RCOG - Induction of Labour at Term for Older Mothers. Scientific Interest Paper no.34. Layout 1 (rcog.org.uk) Feb 2013 

Khan H, Buaki-Sogo MA, et al. (2023). Efficacy of pharmacological and mechanical cervical priming methods for induction of labour and their applicability for outpatient management: A systematic review of randomised controlled trials. European Journal of Obstetrics & Gynecology and Reproductive Biology. 287:80–92. https://doi.org/10.1016/j.ejogrb.2023.05.037 

Grobman WA, Rice MM, et al. (2018). Labor Induction versus Expectant Management in Low-Risk Nulliparous Women. New England Journal of Medicine. 379(6):513–23. https://doi.org/10.1056/NEJMoa1800566

Royal College of Obstetricians & Gynaecologists (2016). Birth after previous caesarean. https://www.rcog.org.uk/for-the-public/browse-our-patient-information/birth-after-previous-caesarean/ [accessed March 2024] 

NHS website (2023). Inducing labour. https://www.nhs.uk/pregnancy/labour-and-birth/signs-of-labour/inducing-labour/ [accessed March 2024]

National Institute for Health and Care Excellence (2021). Inducing labour. [C]: Induction of labour for prevention of prolonged pregnancy. Evidence review underpinning recommendations 1.1.3, 1.1.6, 1.2.3 to 1.2.5, 1.2.8, 1.2.9 and research recommendations in NICE guideline 207.  

 

Review dates
Reviewed: 10 May 2024
Next review: 10 May 2027