Induction of labour means using medicines or a procedure to help labour start. It may be recommended when giving birth is thought to be safer than continuing the pregnancy. The decision should include your health, your baby’s health, the timing, the available options and what matters to you.
Being offered an induction can bring relief, uncertainty or disappointment. It helps to understand why it is being suggested in your situation and what each step might involve.
Why might induction be recommended?
Common reasons include a pregnancy continuing beyond 41 weeks, concerns about your baby’s growth or wellbeing, a condition such as high blood pressure, or waters breaking without labour beginning. The timing depends on the particular concern; a due date alone is not a deadline that automatically requires induction.
For pregnancies continuing beyond term, the risk of stillbirth remains low but increases with time. Evidence comparing a policy of induction with waiting longer shows fewer baby deaths and probably fewer caesarean births with induction. This does not mean everyone needs the same plan or that these results predict one person’s outcome.
If there is a concern about you or your baby, birth may be recommended earlier. Sometimes a caesarean is safer than induction, particularly when vaginal birth is unsuitable. Ask your team to explain which options apply to you.
Questions to ask before deciding
- What is the reason for recommending birth now, and how urgent is it?
- What are the likely benefits and risks of induction and of waiting in my situation?
- Can you explain the size of those risks using numbers, where evidence is available?
- Which method would you use first, and what would happen after that?
- If I choose to wait, what checks, review date and safety advice will I need?
- What would we do if induction did not establish labour?
You should have information and an opportunity to ask questions before giving consent. You can decline a recommendation and discuss an alternative care plan. If there is an urgent concern, ask the team to explain what delay could mean. Monitoring while waiting cannot remove every risk.
What happens before an induction?
Your team will assess you and your baby and, with permission, examine the cervix. Its softness, length and opening help determine whether it needs preparation, called cervical ripening. You may hear the term Bishop score for this assessment.
The starting method also depends on your pregnancy history, whether your waters have broken and your baby’s position. Tell the team about any previous caesarean or other uterine surgery because this affects which methods are suitable.
The main induction methods
Preparing the cervix
A balloon catheter is a narrow tube passed through the cervix. A small balloon, or pair of balloons, is filled with fluid to apply pressure and help it open. Insertion can be uncomfortable.
Prostaglandin medicines help soften and open the cervix and may bring on contractions. Depending on the medicine and local service, they may be given as a vaginal gel or pessary, or an oral tablet. These medicines are not suitable for everyone; a previous caesarean requires particular care and changes the options.
Breaking the waters
Artificial rupture of membranes, or ARM, means making an opening in the sac around the baby during a vaginal examination. Your clinician first checks that it is appropriate and safe. Contractions sometimes begin afterwards, but an oxytocin drip may also be needed.
An oxytocin drip
Synthetic oxytocin is given into a vein and adjusted to encourage contractions. Your contractions and baby’s heartbeat are monitored continuously. If contractions become too frequent or there are concerns about your baby’s heartbeat, the team can reduce or stop the drip and assess what to do next.
One method may be enough, or you may need several steps. Induction can take more than a day, especially when the cervix needs ripening. Ask about the expected sequence rather than relying on a promised birth time.
Is a stretch and sweep the same thing?
A membrane sweep may be offered near the due date or before a planned induction. During an internal examination, a clinician uses a finger to separate the membranes from the area around the cervix, encouraging the release of hormones that may start labour.
It requires your consent, can be uncomfortable and may cause cramping or light spotting. It may not work and is not appropriate in every pregnancy. You can ask for it to stop. It is a different procedure from deliberately breaking the waters.
Risks and practical trade-offs
The risks vary with the method and your circumstances. Medicines can produce contractions that are too close together or prolonged, which may affect the baby. Breaking the waters carries risks including infection and, rarely, the cord slipping down ahead of the baby. Some methods can cause discomfort, bleeding or medicine side effects.
A uterine scar needs specialist consideration because labour and some induction methods can increase the risk of the scar opening, called uterine rupture. Your obstetrician should discuss this before induction after a previous caesarean.
Induction does not inevitably lead to a caesarean. The relevant comparison is induction now versus continuing the pregnancy under a care plan, rather than assuming labour would otherwise begin immediately without complications.
Contractions may become intense quickly, and you may need more examinations or monitoring. Pain-relief options, including an epidural when suitable, remain available. Ask how a drip or monitor may affect movement, showering and your preferred birth position.
Some services offer outpatient balloon ripening for selected low-risk pregnancies. Go home only under your maternity team’s agreed plan, with clear return instructions and a contact number. If labour does not establish, the next step may be reassessment, another attempt or a caesarean, depending on how you and your baby are doing.
When to get help while waiting
Contact your maternity unit immediately for reduced, absent or changed baby movements. Do not wait for your induction appointment, use a home Doppler for reassurance or delay until the next day. If you cannot reach the team, go to a hospital maternity or emergency department.
Call the unit promptly if your waters break, you have bleeding, fever, persistent abdominal pain or contractions, and follow its return instructions. For heavy bleeding, collapse, severe headache or blurred vision, or an imminent birth when you cannot reach care safely, call 000 in Australia.
For what happens once labour is established, see our labour and birth guide.
Sources and further reading
- Pregnancy, Birth and Baby: baby movements
- Pregnancy, Birth and Baby: when to call during labour
- Queensland Health: induction of labour
- Queensland Health: cervical ripening
- Queensland Health: breaking your waters and oxytocin
- NSW Health: induction of labour policy and clinical practice guide
- Pregnancy, Birth and Baby: induction of labour
- The Royal Women’s Hospital: induction methods and risks
- Pregnancy, Birth and Baby: stretch and sweep
- Cochrane: induction at or beyond 37 weeks compared with waiting
This is general information for readers in Australia. Your maternity team can help you make an informed decision about your own care.