Knowing what to decide about the offer of an induction can be hard. Here we look at the pros and cons of induction for you and your baby.
Should I choose to have my labour induced?
You might want to consider some of the risks and benefits of induction before you make a decision about it. Inductions are offered for various reasons, which include:
- longer pregnancy
- pre-labour rupture of membranes (PROM) after 37 weeks
- a baby that's expected to be larger
- health complications for the mother or baby
- when the baby has died
- when the baby is unable or unlikely to survive outside the womb.
(NHS, 2020; Fisher, 2021; NICE, 2021a)
Many hospitals offer inductions from 41 weeks of pregnancy, or earlier if there are other medical conditions or complications for either mother or baby (NICE, 2021a). No test can predict whether an individual baby would be better to wait for labour to start or if labour should be induced (Middleton, 2020).
Your healthcare providers will provide you with information, so read below to find out what questions to ask.
Why the concern about a longer pregnancy?
Most pregnancies come to a natural end with birth between 37 and 42 weeks. Some end earlier and some are a little longer. Over 80 in 100 babies arrive before 41 weeks of pregnancy and 99 in 100 by 42 weeks of pregnancy (NICE, 2021a). The length of pregnancy can be a family trait. So you may want to consider how long your previous pregnancies and those of your female relatives were (Oberg et al, 2013).
Induction is offered in longer pregnancies because, after 41 weeks, there is a higher chance of a baby being admitted to a neonatal intensive care unit, and the rate of stillbirth increases from less than one in 1,000 at 40 weeks to three in 1,000 (Middleton, 2020; NICE, 2021a). After pregnancies lasting over 41 weeks, more women have a caesarean birth (NICE, 2021a).
While these risks are still comparatively low at 41 weeks, some research has found that the increased risk of stillbirth is higher for people from a minority ethnic background or those who live in deprived areas. So you may wish to discuss this with your healthcare provider (NICE, 2021a).
In mothers over 40 years old, induction is likely to be offered earlier, although this does not form part of national guidance. This is because as we age, we can accumulate other health conditions that may affect pregnancy. Such offers should be individualised, because for example, a fit and healthy 42-year-old may have a healthier pregnancy than a woman of 35 with additional health issues. If someone declines an induction, they will be offered additional monitoring of the baby, which can also be declined (NICE, 2021a).
Why is induction offered if my waters go?
Depending on when the waters break during pregnancy, an induction may be offered. When the amniotic sac of waters around the baby ruptures before contractions have started, it slightly increases the chance of infection for the baby, and giving birth reduces this risk (NICE, 2021a).
It is unlikely that an induction would be offered before 34 weeks of pregnancy unless there is an additional complication for the baby. Your carers may recommend waiting until 37 weeks for an induction if there are no other complications and the baby is doing well (NICE, 2021a).
If someone is over 37 weeks pregnant and their waters break with no signs of labour, they may be offered the choice of an induction or 24 hours to wait and see if labour starts (NICE, 2021a). It always remains the woman’s decision to accept or decline an induction. If you decline, then your carers will explain how to reduce the chance of infection.
Why is induction offered for a larger baby?
Induction may be offered if a baby seems to be growing larger than expected, although there is little evidence around the benefits and risks of induction in this situation (NICE, 2021a). A larger baby in this situation is considered to be one with an estimated weight in the largest five in 100 babies (NICE, 2021a). However, the baby’s size is difficult to determine accurately (RCOG, 2012).
When a baby may be larger, it slightly increases the chance of the mother finding it harder to birth them without injury to herself. For this reason, caesarean birth may also be considered as an option (NICE, 2021a).
Shoulder dystocia is where the baby’s shoulders are not born by the mother’s efforts in the next contraction after the head is born (Menticoglou, 2018). For women who do not have diabetes, there is a slightly increased chance of this happening with expectant management of a longer pregnancy (NICE, 2021a). (See our articles on diabetes in pregnancy if that applies to you.) It’s useful to know that almost half of the cases of shoulder dystocia occur in smaller babies (RCOG, 2012), which is why there is no national guidance to always induce or move to a caesarean birth when the baby is suspected to be larger.
When might an induction be offered due to health complications?
There are many reasons why an induction could be considered. For example, if a pregnant woman has high blood pressure or if a baby is not growing as expected (NHS, 2020). There may be many factors to consider, and you could ask why an induction is being recommended.
Induction for a baby that has died or is unable or unlikely to survive outside the womb
Sometimes a baby has died before being born, or tests show that they will be unable or unlikely to survive outside the womb. In this situation, an induction may be offered as an option for birth, alongside waiting for labour to start or giving birth by caesarean (NICE, 2021a).
In these difficult circumstances, maternity units offer specialist support to the family (NICE, 2021a). There is plenty of time for the different options to be explored, and suggestions for how to say goodbye to the baby are offered.
What are the pros and cons of membrane sweeps?
A ‘membrane sweep’ or ‘stretch and sweep‘ might make it more likely that labour starts without a formal induction (NICE, 2021a). It involves a midwife inserting one or two fingers into the vagina and using a circling motion sweeping the cervix to free the membranes (Finucane et al, 2020). The risks of this are pain, discomfort and possible vaginal bleeding, along with irregular or regular contractions that may not lead to established labour (Madeley, 2021; NICE, 2021a). You can ask the midwife for a vaginal examination before proceeding with the sweep, as that may tell you that labour is already starting.
In three studies that asked the question, the majority of women found a sweep to be an acceptable way to prevent a formal induction of labour (Finucane et al, 2020). However, a systematic review showed that seven women would need sweeps to prevent a single induction (Boulvain et al, 2005).
Women may experience repeated sweeps as physically and emotionally exhausting (Madeley, 2021). The procedure could also cause an accidental rupture of the membranes protecting the baby, which would lead to an offer of induction within 24 hours as there would then be a risk of infection (Avdiyovski et al, 2019; NICE, 2021a).
What happens when labour is induced?
To begin with, you will be offered a vaginal examination and monitoring of your baby’s heart rate (NICE, 2021a). This may be a good time to ask any further questions that you have. Different forms of inductions may be offered depending on your NHS trust and how dilated your cervix is.
A chemical induction involves the use of artificial hormones inserted as a gel, tablet or ‘tampon’ into the vagina. A mechanical induction instead uses a catheter or small rods placed in the cervix which slowly expand, stretching it open (NICE, 2021a). These methods are both known as cervical ripening and can take several days. Women often describe this as a negative experience, particularly if they were staying on their own in hospital or were unsure what to expect (Brown and Furber, 2015).
If labour is progressing, the midwife may suggest breaking the waters, and then setting up a drip of synthetic oxytocin to stimulate stronger contractions (NICE, 2021a). You can postpone or decline these suggestions (NICE, 2021a).
What are the disadvantages of induced labour?
A chemical induction can cause the uterus to contract strongly in a way that the mother or baby find difficult, so both you and your baby will be continuously monitored using a machine connected to straps around the abdomen (NICE, 2021a). This may affect your ability to move and might be uncomfortable.
Induction of labour will affect your birth options (NICE, 2021a). Birth will be arranged for a hospital setting and it may not be possible to use a birth pool. This could be because your NHS trust doesn’t have the facilities to monitor you in the pool, or because your labour is more complicated, so the pool is not recommended.
Some people report an induced labour to be more painful, and the hospital stay during and after birth may be longer. It is also associated with a more negative birth experience (Adler et al, 2020; NICE, 2021a).
There may be a higher chance of complications during an induced labour if it is your first baby (Dahlen et al, 2021). One sixteen-year study has found that babies whose birth was induced were more likely to experience hospitalisation for infections up until 16 years of age, particularly if born before 41 weeks gestation (Dahlen et al, 2021).
Do I have a say in the decision to have an induction?
Yes, it’s good to remember that your views, beliefs and values are central to decisions about your care. This includes whether you want to accept the offer of induction (Dekker, 2020; NICE, 2021a,b). You can also talk to your healthcare provider if you wish to request an induction for any reason (Dekker, 2020; NICE, 2021a).
For example, a healthy first-time mum who wants an unmedicated birth might feel strongly that they want a spontaneous labour. At the same time, it may be very important to someone who has experienced miscarriages in the past to lower the risk of stillbirth by any means necessary.
You may have preferences over what methods are used during induction, and you can talk to your healthcare professional about this (NICE, 2021a). Some hospitals offer outpatient induction where the start of the process can happen at home. Current research has found this to be as safe and effective as being in hospital and may cause less discomfort, but it may not be offered everywhere (Dong et al, 2020).
Your midwife or obstetrician should explain why you are being offered an induction and the methods, risks, benefits and alternatives. They should also encourage you to look at information about it and give you time to discuss your decision with your partner or family. Midwives or obstetricians should support you in whatever decision you make (NICE, 2021a).
Take a look at Dr Sara Wickham’s Five Questions to ask if you’re offered induction of labour (Wickham, 2022).
What are the side effects of being induced?
Severe side effects of the drugs used for cervical ripening are very rare. But general side effects can include nausea, vomiting, diarrhoea and headaches (uncommon) (NICE, 2022a).
Similarly, syntocinon, which is given by drip to augment or strengthen labour, can cause headaches, nausea, vomiting and very occasionally a rash. It can also have a negative effect on breastfeeding (Cadwell and Brimdyr, 2017).
Induction is an increasingly common process carried out in the UK. NHS data show that 34% of labours were induced in 2020 to 2021 (NHS Digital, 2021). Almost two-thirds (60 in 100) of these induced women gave birth without forceps/ventouse or caesarean. About 17 in 100 had births assisted with forceps or ventouse and 22 in 100 had an unplanned caesarean birth (NHS Digital, 2021).
These figures apply to all inductions for all reasons, not just those performed for longer pregnancies. The national rates for all births in 2020 to 2021 were: 54 in 100 births did not involve forceps/ventouse or caesarean sections; 13 in 100 were assisted births; and 33 in 100 were caesarean births (which includes planned and unplanned caesareans) (NHS Digital, 2021).
Weighing up the pros and cons…
Feeling like they have plenty of information can help some people to weigh up the benefits of induction against any potential risks. Other people can find it a bit overwhelming.
With most decisions about giving birth, you only have to decide one small thing at a time. One of the things you can ask your healthcare providers is: 'Can I stop at this point if I change my mind?' and 'Which avenues am I closing by making this decision?'
You can consider what kind of information will help you feel you’ve made the decision that’s best for you and your baby.
This page was last reviewed in September 2022.
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