Induction of labour means starting labour on purpose, with medicine or a small procedure, instead of waiting for it to begin. In England the NHS describes it as common, and the reasons are usually simple: you have reached 41 weeks, your waters have broken without contractions, or a health problem makes an earlier birth safer for you or your baby.
This guide covers why induction is offered and when, how staff decide which method to use, what each method involves, how long it takes and how it feels, the real risks and outcomes, and the choices that stay yours throughout.
The short answer. Induction of labour means starting labour with medicine or a procedure instead of waiting for it to begin. It is offered from 41 weeks, after your waters break without contractions, or when a health problem makes an earlier birth safer. It usually takes many hours, often hurts more than spontaneous labour, and you can accept, delay or decline it.
Why Induction Is Offered
Reaching 41 weeks
Most babies arrive before 42 weeks, but some risks rise the longer a pregnancy continues past 41. NICE guideline NG207 (2021) lists a higher chance of caesarean birth, of the baby needing neonatal intensive care, and of stillbirth or neonatal death, and tells clinicians to discuss with women that induction from 41+0 weeks may reduce those risks. The NHS puts it plainly: induction will be offered if you have not gone into labour by 41 weeks.
The World Health Organization's 2022 recommendations go one step further: WHO recommends induction for women known with certainty to have reached 41+0 weeks (moderate-certainty evidence), and recommends against routine induction before 41 weeks in an uncomplicated pregnancy (low-certainty evidence). The German, Austrian and Swiss guideline (AWMF 015-088) uses three steps: induction can be offered from 41+0, should be recommended from 41+3 and is strongly recommended from 42+0. Our guide to overdue pregnancy sets out the stillbirth figures behind those dates and what is offered week by week after 40.
Waters breaking before labour
If your waters break at or after 37 weeks without contractions, NICE says you should be offered a choice: induction straight away, or waiting. If you wait and labour has not started after about 24 hours, you should be offered induction, because the infection risk to your baby rises while the membranes are open. If you have tested positive for group B streptococcus in this pregnancy, NICE advises immediate induction or a caesarean. Our water breaking guide covers how to tell, what the colours mean and what happens in those 24 hours.
A health reason
The NHS lists diabetes, high blood pressure and intrahepatic cholestasis of pregnancy as examples where a birth sooner may be safer, along with a baby who is not growing well. Some situations call for a different discussion. NICE does not generally recommend induction for a breech baby, does not recommend it to avoid a fast unattended birth after a previous quick labour, and advises a caesarean rather than an induction when a small baby already shows signs of distress.
Induction at 39 weeks. The US ARRIVE trial (2018) randomised 6,106 low-risk first-time mothers to induction at 39 weeks or to waiting. Caesareans were less common with induction (18.6% against 22.2%), and serious problems for the babies were 4.3% against 5.4%, a difference too small to be certain about. WHO still recommends against routine induction before 41 weeks, so if a 39-week induction is suggested without a medical reason, ask why and weigh it with your team.
How the Team Decides Where to Start: the Bishop Score
Before an induction, a midwife or doctor feels your bump to check the baby's position, runs a short CTG heart-rate trace, and with your consent does a vaginal examination. That examination gives the Bishop score, which describes how ready your cervix is for labour. It is built from five things: how open the cervix is, how thin or short it has become, whether it points backwards or forwards, how soft it feels, and how far down the baby's head sits in the pelvis.
A low score means a closed, firm cervix that needs softening first. A high score means it is already opening. NICE describes a score of 8 or more as a cervix generally ready to dilate, and uses 6 as its dividing line: 6 or less starts with a prostaglandin or a balloon, above 6 starts with breaking the waters and an oxytocin drip.
Induction Methods, Step by Step
Most inductions use one or two of these, in this order. You will not necessarily have all of them.
| Method | What it is and how it is given | What to expect |
|---|---|---|
| Membrane sweep | During an internal examination the midwife runs a finger around your cervix to separate the membranes, which releases prostaglandins. Offered at antenatal visits from 39 weeks, before any formal induction. | NICE warns of possible pain, discomfort and some bleeding. It may help labour start on its own and can be repeated. |
| Dinoprostone (prostaglandin E2) | A hormone that softens and opens the cervix, placed in the vagina as a tablet, a gel or a controlled-release insert on a tape. | The NHS says it usually takes many hours to work. NICE notes the insert is easier to remove than gel or tablets if contractions come too fast. |
| Misoprostol | A synthetic prostaglandin. NICE recommends low-dose (25 microgram) tablets taken by mouth; other guidelines, including the German one, also describe vaginal use. | Works in the same way as dinoprostone. NICE warns that overstimulation from misoprostol may be harder to reverse, so you stay under monitoring once contractions start. |
| Balloon catheter (mechanical) | A thin tube with a small water-filled balloon passed into the cervix during an examination. It presses the cervix open from inside. An osmotic dilator works in a similar way. | NICE says mechanical methods are less likely to overstimulate the womb. It is offered if hormones are unsuitable, for example after a previous caesarean, or if you prefer it. |
| Breaking the waters (amniotomy) | Once the cervix has opened, the midwife or doctor opens the membranes with a small hook during an examination. | Labour sometimes follows on its own. NICE says you can choose whether and when to add oxytocin, but delaying may make labour longer and raise the infection risk for your baby. |
| Oxytocin drip | A synthetic version of the hormone that drives contractions, given into a vein and turned up gradually until contractions are regular. | Used after the waters are broken; NICE lists oxytocin on its own as unsupported. Contractions can build faster than in a labour that starts by itself, and your baby's heart rate is monitored. |
The sweep, how well it works and when it is repeated are covered in detail in our overdue pregnancy guide.
Medicines: What Is Used and What to Avoid
Used and approved for induction, in hospital
- Dinoprostone tablet, gel or insert, and low-dose misoprostol, given with checks on your contractions and your baby's heart rate
- Oxytocin through a drip, after the waters are broken
- For pain, NICE lists simple painkillers, labour in water and an epidural; the NHS says paracetamol taken as the packet says is safe in labour
Avoid
- Misoprostol or any prostaglandin taken on your own. NICE says the uterus and the baby must be monitored while these drugs work, and their licences rule them out after a caesarean because of the risk of the womb tearing.
- Castor oil. NICE finds no evidence that it induces labour, and the German guideline says it should not be used outside hospital and only within research studies.
- Herbal supplements sold to bring on labour. The NHS says nobody knows if they are safe and they could harm you or your baby.
- Expecting acupuncture, homeopathy, hot baths, enemas or sex to start labour: NICE finds no evidence for any of them. Sex is harmless with your waters intact, but avoid it once they have broken.
What It Feels Like and How Long It Takes
No source gives a reliable average, because the time depends on where your cervix starts. The NHS says the hormones or the balloon usually take many hours to start working, and that a drip and breaking the waters may follow. NICE warns that your hospital stay may be longer than with a labour that starts by itself.
NICE asks staff to warn you about several things before you agree. You will have more vaginal examinations. Your choice of place of birth narrows, because you may be recommended a drip, continuous monitoring or an epidural that a home birth or midwife-led unit cannot provide, and the birth pool may be limited. Induced labour may be more painful than spontaneous labour. An assisted birth with forceps or ventouse is more likely, and with it the risk of a serious perineal tear.
Going home during the first stage
NICE suggests considering outpatient induction with a dinoprostone preparation or a balloon if you have no medical conditions or pregnancy complications and want to go home. You and the unit agree a plan before you leave, and you call them when contractions begin, if nothing has happened by the agreed time, if your waters break, if you bleed, if your baby moves less, if pain or contractions feel excessive, or if the pessary falls out.
Risks and Outcomes
Overstimulation of the womb
Hyperstimulation means contractions that come too often or last too long, which can change your baby's heart rate. NICE notes that both dinoprostone and misoprostol can cause it, that the risk varies by preparation and dose, and that mechanical methods carry less. If it happens, staff give no further medicine, remove any insert they can, check your baby and may give a drug to relax the womb.
An induction that does not start labour
The NHS is clear that induction does not always work. If labour has not started, NICE says the team should reassess you and your baby, then agree a plan with you: a rest period and another check, waiting, a further attempt at induction, or a caesarean birth.
Caesarean birth
The fear that induction leads to a caesarean does not match the trials. A 2020 Cochrane review of 34 trials with more than 21,000 women compared a policy of induction at or beyond 37 weeks with waiting. Induction probably meant fewer caesareans, little or no difference in forceps or ventouse births, fewer admissions to neonatal intensive care, and fewer perinatal deaths: 0.4 against 3 per 1,000. The ARRIVE trial found the same direction for caesareans at 39 weeks. The NHS still says an assisted birth is more likely once you are induced; the trials compare induction with waiting, which is the choice you face.
After a previous caesarean
NICE asks your team to discuss a higher chance of an emergency caesarean and a risk of the scar tearing (uterine rupture). Dinoprostone and misoprostol are not licensed for women with a uterine scar, so NICE suggests a balloon instead, or you may prefer a planned caesarean.
Your Choices
NICE is explicit that you can proceed with, delay, decline or stop an induction, and that staff must respect your decision and record it. You should get the reasons, the method, where and when it will happen, the pain relief on offer, and what happens if you say no, with time to talk it over with your partner before deciding.
Questions worth asking
- Why are you offering induction now, and what changes if I wait a few days?
- What is my Bishop score, and which method would you start with?
- Can I go home during the first part, and who do I call?
- Can I use the birth pool, and when can I have an epidural?
- If I decline, what monitoring do you offer?
Put your answers into your birth plan, including what you want if the induction is slow. Then pack with a long stay in mind: our hospital bag checklist covers the essentials, and phone chargers, snacks you are allowed and something to pass the hours earn their place.
When to Call Straight Away
Call your maternity unit straight away, at any hour, while you wait for or go through an induction, if: a contraction lasts longer than 2 minutes, you have 6 or more contractions in 10 minutes, or the pain is strong and does not ease between contractions; you have any vaginal bleeding; your baby is moving less than usual; your waters break, or the fluid is green, brown or smells; your temperature is above 37.5°C after your waters have broken; or the pessary falls out.
Call 999 in the UK or 911 in the US if the bleeding is heavy (soaking a pad soon after you put it on), you have severe tummy pain, you feel faint or dizzy, or you feel the baby coming with a strong urge to push.
At a Glance
Induction of labour starts labour on purpose. It is offered from 41 weeks, after waters break without labour, and for health reasons, and WHO recommends against routine induction before 41 weeks without one. The Bishop score decides the first step: a prostaglandin or a balloon for a closed cervix, breaking the waters and an oxytocin drip for an open one. It usually takes many hours and often hurts more, yet trials show fewer caesareans, not more, compared with waiting. You can accept, delay, decline or stop it.
Inside Baby Novum. The birth plan builder records your pain relief preferences, birth positions and wishes and exports a printable PDF (Premium), the hospital bag checklist has a reminder of its own, and the contraction timer logs every contraction once labour starts and alerts you when the 5-1-1 pattern has held for an hour.
Next: Signs of Labor → · Contraction Timer → · Week 40 →
Frequently Asked Questions
What is induction of labour?
Induction means starting labour artificially instead of waiting for it to begin on its own. Staff use hormones (a prostaglandin pessary, gel or tablet), a balloon catheter that opens the cervix, breaking the waters, or an oxytocin drip, often one after another. It takes place in a hospital maternity unit, although some units let you go home during the first stage.
When is induction of labour recommended?
The three common reasons are a pregnancy that reaches 41 weeks, waters that break at term without labour starting within about 24 hours, and a health problem such as high blood pressure, diabetes or a baby who is not growing well. WHO recommends induction once you are known with certainty to be 41 weeks or more, and recommends against routine induction before 41 weeks in an uncomplicated pregnancy.
How long does induction of labour take?
There is no single answer. The NHS says it usually takes many hours for the hormones or the balloon to start working, and some women then need their waters broken or a drip. If your cervix is already soft and open, breaking the waters may be enough and labour can follow quickly. Pack for a longer hospital stay than a labour that starts by itself.
Is induced labour more painful than natural labour?
The NHS says it usually is, and NICE tells women the same. Contractions can build faster, especially on an oxytocin drip. Being induced does not limit your pain relief: you should be offered everything your unit normally provides, including an epidural and, where your unit allows it, water. Write your preferences into your birth plan before the day.
Can I decline induction?
Yes. NICE says you can proceed with, delay, decline or stop an induction, and that staff must respect your decision even if they disagree. If you decline after 41 weeks, ask what monitoring your unit offers. NICE describes twice-weekly CTG heart-rate traces and an ultrasound check of the amniotic fluid from 42 weeks, while noting that monitoring cannot predict every problem.
What happens if the induction does not work?
If labour does not start, the team checks you and your baby, including a CTG trace, and talks the options through with you. NICE lists four: a rest period and reassessment, waiting, another attempt at induction, or a caesarean birth. A failed first attempt does not mean you need a caesarean straight away.
Is induction safe for the baby?
For low-risk pregnancies at or past term, the 2020 Cochrane review of 34 trials found fewer perinatal deaths, fewer stillbirths and fewer neonatal intensive care admissions with a policy of induction than with waiting. One risk to watch is contractions that come too often after prostaglandins, which is why the heartbeat is monitored and the medicine is stopped if that happens.
Does induction increase the chance of a caesarean?
The trials say no. The Cochrane review found probably fewer caesareans with a policy of induction at or beyond 37 weeks than with waiting. In the ARRIVE trial of first-time mothers, induction at 39 weeks led to caesareans in 18.6% against 22.2% with waiting. The comparison that matters is with waiting, not with a labour that starts on its own.
Sources
- NICE NG207 — Inducing labour: recommendations
- NICE NG207 — Appendix C: Risks of hyperstimulation with different pharmacological methods
- WHO — Recommendations on induction of labour, at or beyond term (2022)
- DGGG/OEGGG/SGGG — S2k guideline on induction of labour, AWMF 015-088 (2020)
- NHS — Inducing labour
- NHS — Signs that labour has begun
- NHS — Vaginal bleeding in pregnancy
- Middleton P et al. — Induction of labour at or beyond 37 weeks' gestation (Cochrane, 2020)
- Grobman WA et al. — Labor induction versus expectant management in low-risk nulliparous women (ARRIVE, NEJM 2018)