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In the UK, nearly 1 in 3 women are induced. Induction isn’t usually on your radar until you’re pregnant, when it becomes a confusing hot topic.

In this blogpost, I aim to help you navigate the information available, so you can make an informed choice about your own birth. This is for you whether you are currently in discussions about being induced or doing some research in advance.

I myself was induced for my first birth and had a difficult time, but I’ve taught enough people over the pas decade to know that induction can be an empowering experience.

Later, I’ll write a blogpost about how to manage induction, including Hypnobirthing tools and techniques you can use to cope and stay resourceful.

For now, whether you decide to be induced or not (if it comes to that), my advice is to stay open. Let go of pressure to do things a certain way and do things your way.

Knowing you have options and can make choices based on information and instinct rather than fear. So that whatever decision you make, you can have a positive birth experience.

I’ve distilled the 6 key points I think every woman and her partner should know about induction, with recommendations for further reading, so you can find the way that feels right for you.

This information is from a conference I attended at the Royal College of Medicine called ‘The Seduction of Induction,’ my training course with Sara Wickham, midwife, advocate and educator, as well as further research.

What is induction?

Induction of labour rates are increasing in the UK, with around a third of women now being induced. But what is it?

The aim of induction is to trigger your body going into labour, Methods of induction include some or all of the following:

Cervical Assessment:

A vaginal examination is performed to assess the cervix's readiness for labor (Bishop score).

Induction Options:

Healthcare professionals discuss various induction methods which can include some or all of the following:

Membrane Sweeps: An internal examination where the midwife or doctor separates the amniotic membranes from the cervix, potentially stimulating labor.
Cervical Ripening: Methods to soften and thin the cervix, such as:
- Prostaglandins: Hormones (like Prostin or Propess) that can be administered vaginally to ripen the cervix.
- Cervical Ripening Balloons: A balloon catheter inserted into the cervix to apply pressure and promote dilation.
- Dilapan-S Rods: A hydrogel rod that absorbs fluid from the cervical tissue, promoting cervical softening and dilation.
Artificial Rupture of Membranes (ARM): Breaking the amniotic sac (waters) to encourage labor.
Oxytocin Augmentation: Using a synthetic hormone (oxytocin) to stimulate contractions, often administered intravenously.

Fetal heart rate monitoring is crucial during induction to ensure the baby's well-being.

so you won’t necessarily need all these stages.

For more information on these procedures, please see the bottom of this article.

Why might induction be offered?

There are many different reasons a woman might be offered induction. Either be for medical reasons (e.g. diabetes, pre-eclampsia, obstetric cholestasis), because of ‘advanced maternal age’ (40 or over) or the waters breaking and no labour within 24 hours. Below are some resources I’ve compiled for some of the most common reasons women are offered induction:

If you are being offered induction due to gestational diabetes, please read this article.
If you’re being offered induction due to advanced maternal age, please read this as well as the extra links at the bottom of this article.
Info on pre-labour rupture of membranes is here.
Info on the evidence around inducing labour for going past your due date is here

Why are so many post-date women offered induction?

Firstly, lets remember that the idea of a ‘prolonged pregnancy’ is in itself somewhat problematic as due dates are an inexact science. Research suggests that gestation varies woman by woman by up to five weeks. Please see my blogpost for a more in-depth discussion of due dates.

Dr Rachel Reed has written much on this topic. She notes that “In theory after term (ie. 42 weeks) the placenta starts to shut down. There is no evidence to support this notion.”

Another reason might be that baby will grow too big. However, nature has designed women’s pelvis’s to be flexible to accommodate the birth of her baby and scans are inaccurate in estimating baby’s size. I recommend you read the article on the ‘Evidence based birth’ website in which they’ve reviewed the evidence on big babies.

In discussing A woman’s options, the language midwives and obstetricians use is key.

If a woman is told that the risk of stilbirth doubles if she isn’t induced, she will of course feel compelled to agree to induction. For example, a relative risk increase of 50% might sound alarming, but if the absolute risk of the event was already very low, the actual benefit of the intervention might be small.

It is extremely important to remember the distinction between relative and absolute risk and to ask your caregivers for facts and figures so that you can understand for yourself what the risk level is and make an informed decision based on that.

What are the risks and benefits of induction?

First let us recognise that induction for medical reasons can be lifesaving. We are lucky to have it as an option.

But there are risks, as there are with any intervention. The National Institute for Clinical Excellence guidelines state that induced labour has an impact on the birth experience of women. It may be more painful than spontaneous labour and the choice of place of birth will be limited. You can read the NICE guidelines here.

Being induced means you are more likely to be continuously monitored on the labour ward (and definitely if you are given Syntocinon). Some units offer monitoring by telemetry, enabling women to be free from belts, to move around without the restriction of being attached to a bedside cardiac monitor.

place of birth

If you’re induced, you will probably be on the labour ward. Unless you’ve only had sweeps, you won’t be able to give birth at home and it’s less likely you’ll be able to give birth in a Midwife Led Unit, though it’s worth checking if this might be possible as it depends on the individual circumstances, including your hospital’s protocols and whether you and your baby are considered low-risk

Dr Rachel Reed’s excellent blog post on the Induction of Labour – balancing the risks is worth reading, especially when considering the risks associated with waiting, as well as the risks associated with induction.

How can you make an informed decision about being induced?

Each woman must feel able to make her own decision about being induced and should be supported in doing so. The aim is to balance instinct with information, so that a woman feels empowered to make a decision that feels right for her.

As I’ve mentioned, language plays an important role. In particular, an offer of induction should be just that; an offer, not an order. Some women feel they have no other option but to say yes, which simply isn’t the case.

Of course, if a woman decides to consent to the offer because she has had adequate information to inform that decision, that is fine. But she should also know that she can decline the offer and it is useful for her to be aware of her birth rights, more on which can be found here: http://www.birthrights.org.uk/

Reframing induction as an ‘offer,’ not an order is a very helpful place to start.

use your brains

The BRAINS mneumonic is extremely useful for helping a woman and her partner find out what their options are and what the evidence says. It stands for: Benefits, Risks, Alternatives, Instincts, Nothing, Smile.

Asking for the benefits, risks and alternatives to be set out, with relevant research findings supplied, will help you make an informed decision.

Please avoid making a decision in the room. Take the findings away and read in your own time, ideally sleeping on it – things often feel different in the morning.

Follow your instincts.

A woman’s instincts are a vital part of the decision-making process. Julie Frohlich, the Consultant Midwife from Guys and St Thomas who spoke at the RCM conference, made this very clear to all the medical professionals in the room.

Julie argued that in deciding about whether a woman might need to be induced, caregivers and parents-to-be must consider what the mother’s instincts are telling her. The mother has closest contact with unborn baby, and a woman’s instinct is often right.

I find this very heartening. It would be wonderful if all caregivers took the same tailored approach.

What alternatives are there to induction?

If you decline induction, you’ll be offered expectant management. This means your wellbeing, and your baby’s wellbeing will be monitored. Essentially, the midwife or obstetrician keeping an eye on you and your baby until you go into labour naturally.

expectant management

This means you’ll be offered regular ultrasound scans and CTG monitoring in the hospital, assessing your baby’s heartbeat, movements and the levels of your amniotic fluid. It will be explained to you that an ECG or scan gives a snapshot in time; it cannot show what might or might not happen afterwards.

At any time during expectant management, you can choose to be induced, so you needn’t think it’s one or the other.

Foetal movements are one of the most important indicator for wellbeing of the baby, so it’s very helpful to know how to measure baby’s movements. The website ‘Count the Kicks’ provides useful information on this.

An elective caesarean section is another option you could explore, as is a modified induction, including some but not all elements of standard induction pathway, with the option of a lower threshold for caesarean. This might mean for example, no syntocinon (oxytocin on a drip).

I’d like to finish with this

If you do decide to be induced, please know that your hypnobirthing tools and techniques will help. I have taught plenty of women who have had positive induction experiences and you can read Jade’s and Shoko’s here. But remember too, being induced is very different to going into labour spontaneously, and therefore I hope you’ll feel able to ask for whatever help and support you need, including pain relief.

And please remember…

Be kind to yourself, particularly if you are in the midst of induction conversations with your caregivers.

Give yourself time and space to consider your options.

Trust that there is no ‘right’ or ‘wrong’ decision to make, but simply the decision that feels best for you, based on the information you’ve read and what those instincts of yours are telling you.

Zoe x

P.S. You’ll find lots more information and resources below, including some information on the different types of induction.

Further resources:

Contact the Association for Improved Medical Services helpline
http://www.nhs.uk/conditions/pregnancy-and-baby/pages/induction-labour.aspx
Midwife Thinking - Induction of labour - balancingrisks (Dr Rachel Reed)
Midwive Thinking - Pre-labour rupture of membranes - impatience and risk
Maternity Choices information sheet for parents.
Recent (Oct 2019) publication of a debate in the British Journal of Obstetrics and Gynecology, on whether induction should be offered to all women at term. Here is the "for" article and the "against" article. Worth reading both.
Sara Wickham – post-term pregnancy and induction of labour resources
Sara Wickham – ten things I wish every women knew about induction of labour
Dr Rachel Reed’s blog post titled ‘Induction of labour: balancing risks’ is an excellent source of information for any woman wanting to balance risks and benefits of being induced. For example, she explains that “if this is her first baby, induction significantly increases her chance of a c-section. If this is a subsequent baby then her chance of c-section is not

Articles questioning induction for advanced maternal age can be found here and here
Sara Wickham – How to cancel a labour induction?

Further information on Induction of labour methods

Membrane Sweep

A sweep; vaginal examination where the midwife inserts gloved fingers into the cervix (the neck of the uterus), and ‘sweeps’ it around the edges to try and separate the membrane of the amniotic sac from the lower uterus, releasing prostaglandins.

Membrane sweep effectiveness is inconclusive, with the certainty of the evidence found to be low. A Cochrane review on Sweeps from 2005 can be found here

Pessary induction

Artificial prostaglandins, usually administered on the cervix in a pessary, gel or tablet inserted into the vagina. Depending on the woman’s response and hospital protocol, she may be allowed to go home, or be asked to stay in hospital to be monitored. especially if it's an outpatient induction, but it depends on your individual situation and the hospital's protocols

Breaking your waters

Artificial rupture of membranes (AROM), involving the use of an amnihook to break the waters. [1] You can find an article titled ‘in defence of the amniotic sac’ here.

Synthetic Oxytocin

Synthetic oxytocin (Pitocin - or Syntocinon) is administered with a drip.

This will stimulate intense contractions that build more quickly than most natural labours, without the accompanying feel good factor that natural oxytocin creates.

Since Syntocinon can cause strong and very frequent surges, called hyperstimulation and the intensity of these can be too much so women are more likely to need an epidural, which is a welcome relief but can lengthen the second stage of labour and you’re much more likely to need a forceps or vacuum delivery to help the baby come out at the end.

For an interesting article on the evidence around synthetic oxytocin and birth, you can read Sara Wickham’s article

Induction of Labour - 6 things you need to know