Overdue baby: induced labour pros and cons

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 overdue baby

Should I choose to have my labour induced if my baby is overdue?

You might want to consider some of the risks and benefits of induction before you make a decision about it. Inductions are offered for overdue babies as there is an increased risk of some complications of labour and birth if your pregnancy goes past 40 weeks (Caughey et al, 2007)

There’s still a lot of research to do on the benefits of induction and nobody really knows exactly when the best time to offer them is (Middleton et al, 2018). No test can predict whether a baby would be better to stay inside their mother or if labour should be induced. So while many women are offered induction at 41 weeks, time limits for induction do vary between different hospitals (Middleton et al, 2018).

What are the risks of induction of labour for mums?

Induction of labour may carry risks for mums, especially if they are not ready to labour. Risks might be finding labour more painful and possibly a higher risk of having an assisted vaginal birth (NICE, 2008a; Middleton et al, 2018).

One study found that more women who had a vaginal birth needed operative assistance at 40 weeks compared with at 39 weeks (Caughey et al, 2007). A birth at 40 weeks is also more likely to cause third or fourth degree perineal tears and infection of the fetal membranes (chorioamnionitis) than at 39 weeks (Caughey et al, 2007).

By 41 weeks, there’s an increased risk of haemorrhage after birth, bacterial infection (endomyometritis) and having a caesarean section (Caughey et al, 2007)

What are the risks for babies of an induced labour?

Your baby being overdue raises the risks for them. But it’s good to remember that these risks to babies are small.

Most researchers agree that there are more stillbirths as pregnancy goes past its due date (RCM, 2012; Decker, 2017). Babies who are very overdue are at higher risk of suffering from health problems and are at an increased risk of dying (Hilder et al, 2005; RCM, 2012).

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 very important and valid for decisions about your care. This includes whether you want to accept the offer of induction if you’re overdue (NICE, 2008b; Decker, 2017).

For example, a healthy first-time mum who wants an unmedicated birth might feel strongly that she wants a spontaneous labour. At the same time, it may be very important to a mum who has experienced miscarriages in the past to lower the risk of stillbirth by any means necessary.

Your midwife or obstetrician should explain why you are being offered an induction and explain the risks, benefits and alternatives. They should also encourage you to look at information about it and discuss your decision with your partner or family. Midwives or obstetricians should support you in whatever decision you make (NICE, 2008a)

What are the benefits and risks of induction at 40+ weeks?

A large study compared inducing labour to waiting for it to start naturally and it found that inducing labour meant:

  • fewer infant deaths at or around the time of birth
  • similar rates of admission to the neonatal intensive care unit
  • slightly fewer babies born with Apgar scores below seven (an indication of poor health)
  • fewer caesarean sections
  • more vaginal births involving forceps or vacuum extraction
  • no clear difference in perineal trauma, bleeding after birth, or in the length of hospital stay between the two groups.

(Middleton et al, 2018)

Rates at 40+ weeks of pregnancy

Induced babies

Waiting for labour to start

Infant deaths

1 per 1,000

3 per 1,000

Rates of admission to the neonatal intensive care unit

7.5%

8.5%

Apgar scores of below seven at birth (an indication of poor health)

1.2%

1.7%

Caesarean sections

16.3%

18.4%

Vaginal births involving forceps or vacuum extraction

20.6%

19.3%

Some critics have said that a few of the trials analysed in that study were old or could be biased (Middleton et al, 2018; Wickham, 2018).

What are the benefits and risks of induction at 42+ weeks?

Birth after 42 weeks slightly increases the risks for babies, including a greater risk of them dying before or shortly after they’re born (Rosenstein, 2012; Morken et al, 2014; Middleton et al, 2018). Estimates of the risk of stillbirth vary depending on the way rates are calculated and whether the ‘due date’ is calculated via ultrasound or the last menstrual period.

Stillbirth rates for babies born at weeks 41 and 42:

  • Babies who were not small for gestational age: 0.68 per 1,000 births at 41 weeks and 1.17 per 1,000 for births at 42 weeks.
  • Babies who are small for gestational age: 3.38 per 1,000 births at 41 weeks and seven per 1,000 births at 42 weeks.
  • Another study said 0.61 per 1,000 births at 41 weeks and 1.08 per 1,000 births at 42 weeks.

(Rosenstein, 2012; Morken et al, 2014)

What are the side effects of being induced?

Severe side effects of induction drugs such as prostaglandins are uncommon. But general side effects can include nausea, vomiting, diarrhoea, headaches (uncommon) and small blood clots (rare) (NICE, NDa)

Similarly, oxytocin often causes headaches, nausea, vomiting and an irregular heartbeat. More rarely, it causes laboured breathing, a rash and low blood pressure (NICE, NDb).

Be reassured though that induction is a very common process carried out in the UK. NHS data show that 32% of labours were induced in 2017 to 2018 (NHS Digital, 2018). Almost two-thirds (60%) of these induced women gave birth spontaneously - without forceps/ventouse or caesarean. About 18% had assisted births with forceps or ventouse and 22% had emergency caesarean sections (NHS Digital, 2018)

It is important to remember that these figures apply to all inductions for all reasons, not just those performed for being overdue. The national rates for all births in 2017 to 2018 were 58% spontaneous births, 13% assisted births and 29% caesareans (NHS Digital, 2018).

Weighing up the pros and cons…

Feeling like you have plenty of information can help you to weigh up the benefits of induction against any potential risks. And that can go a long way in helping you feel you’ve made the decision that’s best for you and your baby. For more on what actually happens with an induction, see our article Overdue baby: what happens if my baby is late.

This page was last reviewed in June 2018.

Further information

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We also offer antenatal courses which are a great way to find out more about birth, labour and life with a new baby.

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Caughey A, Stotland N, Washington A, Escobar G. (2007) Maternal and obstetric complications of pregnancy are associated with increasing gestational age at term. American Journal of Obstetrics and Gynecology. 196(2):155. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1941614/ [accessed 2nd January 2019]

Decker R. (2019) The evidence on: due dates. Available at: https://evidencebasedbirth.com/evidence-on-inducing-labor-for-going-pas… [accessed 2nd January 2019]

Middleton P, Shepherd E, Crowther C. (2018) Induction of labour for improving birth outcomes for women at or beyond term. Cochrane Database of Systematic Reviews. (5):CD004945 . Available at: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004945.pub4… [accessed 2nd January 2019]

Middleton P, Shepherd E, Flenady V, McBain R, Crowther C. (2017) Planned early birth versus expectant management (waiting) for prelabour rupture of membranes at term (37 weeks or more). Cochrane Database of Systematic Reviews. (1):CD005302. Available at: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD005302.pub3… [accessed 2nd January 2019]

Morken N, Klungsøyr K, Skjaerven R. (2014) Perinatal mortality by gestational week and size at birth in singleton pregnancies at and beyond term: a nationwide population-based cohort study. BMC Pregnancy and Childbirth. 14(172). Available at: https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/1471-… [accessed 2nd January 2019]

NHS Digital. (2018) NHS maternity statistics, England 2017-18. Available at: https://digital.nhs.uk/data-and-information/publications/statistical/nh…. [accessed 3rd January 2019].

NICE. (2008a) Inducing labour [CG70]. Available at: https://www.nice.org.uk/guidance/cg70/resources/inducing-labour-pdf-975… [accessed 3rd January 2019]

NICE. (2008b) Antenatal care for uncomplicated pregnancies [CG62]. Available at: https://www.nice.org.uk/guidance/cg62/resources/antenatal-care-for-unco… [accessed 2nd January 2018]

NICE. (NDa) Dinoprostone. Available at: https://bnf.nice.org.uk/drug/dinoprostone.html [accessed 3rd January 2019]

NICE. (NDb) Oxytocin. Available at: https://bnf.nice.org.uk/drug/oxytocin.html#sideEffects. [accessed 3rd January 2019].

Rosenstein M, Cheng Y, Snowden J, Nicholson J, Doss A, Caughey A. (2012) The risk of stillbirth and infant death stratified by gestational age in women with gestational diabetes. American Journal of Obstetrics and Gynecology. 206(4):309. Available at: https://www.ajog.org/article/S0002-9378(12)00026-9/fulltext [accessed 3rd January 2019]

Wickham S. (2018) Inducing Labour: Making Informed Decisions. 2nd ed. UK: Birthmoon

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