If labour has to be induced

Labour is a natural process that usually starts on its own. Sometimes it needs to be started artificially: this is called ‘induced labour’.

About a third of women in the UK have their labour induced. This is often because they are overdue, or their waters have broken but labour has not started.

Inducing labour can be the best option if there are health risks to the mother or baby of continuing the pregnancy. But it may affect other choices women have made, like where they give birth and their options during the birth, so it is important that all women can choose for themselves whether to have an induction.

Making informed decisions

Decisions about treatment and care are best made when all the choices available, and all the possible outcomes, have been discussed. Your care team should give you clear information, talk with you about your options and listen carefully to your views and concerns. This includes explaining how your labour will be induced if you choose this (this can be done either by giving medicines that can help start labour, or by using medical equipment), and telling you why some options may not be right for you (for example, some medicines shouldn’t be used if you’ve previously had a caesarean birth).

To help you make decisions, think about:

What are you most worried about – are there risks or downsides to having your labour induced that worry you more than others?
How will induction of labour affect you and your baby?
What happens if you decide not to have your labour induced?

If you need more support to understand the information you are given, ask your care team.

Read more about induction of labour on the NHS website.

Appendix A: Risks associated with different induction of labour timing strategies

This information is based on national recommendations, however, we will always aim to provide a personal plan of care which considers your individual circumstances and preferences. If you have any questions please contact your midwife or obstetrician.

Methods of induction of labour

There are several ways to soften and open your cervix that can be used, the first method that is offered is a cervical ripening balloon.

Cervical ripening balloon (balloon catheter method)

Vaginal Dinoprostone controlled release pessary (Propess)

Dinoprostone (Prostin)

Artificial Rupture of Membranes (ARM)

Oxytocin (Syntocinon)

Frequently asked questions

What is induction of labour (IOL)?

Induction of labour (IOL) is the process of starting labour artificially. Almost 1 in 5 pregnant women in the UK are induced. A common reason is if your pregnancy has gone past your expected due date, but there are many other reasons which your midwife/ obstetrician will discuss with you if these may affect you or your baby.

What if I choose not to be induced?

If you choose not to be induced at this stage then you will be offered an appointment to be seen by an Obstetrician who will agree a personalised plan of care with you.

When is induction of labour recommended?

Here in Barnsley, we will offer you an induction of labour from 41+0. This is a national recommendation from the National Institute for Health and Care Excellence (NICE) based on evidence which shows that some risks associated with a pregnancy continuing beyond 41+0 weeks may increase over time and these include:

Increased likelihood of caesarean birth
Increased likelihood of the baby needing admission to a neonatal intensive care unit
Increased likelihood of stillbirth and neonatal death (2021)

NICE guidance suggests a discussion must take place with your midwife/obstetrician to explain that an induction of labour from 41+0 weeks may reduce these risks, but that you will also need to consider the impact of induction on your birth experience.

For more information relating to this, please visit these links:

NICE: Rationale and impact- Induction of labour for pregnancy lasting longer than 41 weeks.

Increased likelihood of caesarean birth
Increased likelihood of the baby needing admission to a neonatal intensive care unit
Increased likelihood of stillbirth and neonatal death (2021)

For more information relating to this, please see the NICE website:

There may be other reasons why your obstetrician or midwife may recommend an induction of labour earlier than this; if yourself and obstetrician/midwife decide together that it would benefit your health and the health of the baby.

The offer to induce labour is usually made when there are thought to be fewer risks to mother or baby with induction, than if the pregnancy is left to continue.

Where will my induction of labour take place?

Induction of labour is performed in the hospital and takes a minimum of 24 hours (often longer); however, some women may be able to go home for part of the process. This is called an outpatient induction of labour.

IOL as an outpatient will only be offered to you if it is felt appropriate to do so. Having an outpatient induction will involve an initial assessment and beginning the process in hospital and then returning home to a comfortable and familiar environment. There is some research to suggest that women who are more relaxed tend to go into labour when they are at home in their own surroundings.

What are the benefits of having induction of labour as an outpatient?

An outpatient induction of labour will:

reduce the amount of time you will need to spend in hospital before your labour begins
allows you to stay at home in a familiar, comfortable environment and wait for labour to star
reduces the number of internal examinations you will be offered which reduces the risk of infection

Who can have induction of labour as an outpatient?

You may be offered an outpatient induction if:

your pregnancy has been uncomplicated
following a discussion with an obstetrician you are suitable for this
you have a relative/birth partner who will be at home with you throughout the process and have immediate access to the hospital if required
you live 30 minutes or less away from the hospital
you have access to a telephone and transport
you have good understanding of English

What happens when I reach my expected due date?

At your antenatal appointments the midwife will offer to assess the position of your baby. If it is your first baby and the midwife feels that the baby’s head is not engaged when you reach full term, she will refer you to the antenatal clinic to discuss a suitable plan of care for induction of labour.

If your baby’s head is engaged, your midwife will offer a membrane sweep at antenatal appointments from 39+0 weeks. If labour does not start spontaneously following the first sweep, your midwife will offer you an additional membrane sweep at your next antenatal appointment.

What is a membrane sweep?

This involves your midwife or doctor placing a finger just inside your cervix (neck of womb) and making a circular, sweeping movement to separate the cervix from the membranes around your baby’s head.

This procedure may cause some discomfort and slight bleeding (a show), but will not cause any harm to your baby and it will not increase the chance of you or your baby getting an infection. It can be carried out at home, at an outpatient appointment or in the hospital.

The membrane sweep has been shown to increase the chances of labour starting naturally within the next 48 hours.

Occasionally this may cause uterine tightening’s, contractions and there is a small risk of breaking your waters. You may also experience period type pain.

Following the membrane sweep your midwife will offer you an induction date.

How can labour be induced?

The aim of induction is to soften and open the cervix (the neck or opening to the womb) enough to enable the waters around the baby to be broken artificially by a midwife or doctor (called artificial rupture of the membranes - ARM). This will hopefully start the process of labour but can be followed by a drip in your arm containing a drug to make you have contractions if they do not start on their own.

What happens on the day of your induction?

Your midwife or doctor will arrange a date for you to attend the hospital for your induction of labour. You will be asked to attend at a specific time given to you by a midwife or doctor. Please bring with you an overnight bag just in case you need to stay in hospital.

How long should induction of labour last?

This is different for each pregnant woman and depends on how ready the neck of the womb is for labour initially and how sensitive your body is to the drug inside the pessary.

Generally speaking, if this is your first baby and the neck of the womb is long and closed on your first examination, then the process of getting the neck of the womb ready for labour can take 2-3 days.

Can I stop the IOL process once it has started?

Yes, this is your choice and a thorough discussion will take place between you and an obstetrician. This should include the risks and benefits of stopping the induction of labour based on your individual circumstances at this point, and what your next options are.

What happens if the process does not work?

If it is not possible to break your waters then a doctor will discuss further options with you, which will include using other methods to induce labour or to have a planned caesarean section.

Delays to induction

There can sometimes be delays whilst we await a bed and a midwife to be available on the Birthing Centre to provide one-to-one care for you in labour. This is because the unpredictable nature of childbirth can sometimes cause periods where there are increased numbers of women in labour or there are women who have associated illnesses who require a higher level of care, which can lead to some delays for women who require induction of labour.

In order to maintain a safe birthing environment for women, it may be necessary to postpone or delay your induction of labour until we can ensure it is safe to proceed. This can be a number of days. You may want to take this into account as such delays may have an impact on your family, for example when your partner is anticipating starting paternity leave. It may also be necessary to offer you transfer to another local hospital if delaying your induction is deemed unsafe for you or your baby. This will be assessed on an individual basis.

During this time, if suitable and you wish to you will be able to go home and return to the hospital when there is a midwife available. If you wish, or if clinically indicated you may remain in hospital during this period so that the midwives and the doctors can continue to assess you and your baby's wellbeing and should there be any concerns, appropriate action would be taken.

Similarly, if active labour starts whilst you are on the ward, you would take the same priority as other labouring women in being promptly assigned a midwife on the Birthing Centre.

Further information

Please call us if you have any questions before your induction. Get in touch with your community midwife or call the Antenatal Day Unit on 01226 432203 if your midwife is not available.

If you have any problems or concerns after your induction process has been started, please contact the Maternity Assessment Unit on: 01226 432249.

If you need to contact the Antenatal/Postnatal ward please contact: 01226 432242 or 01226 432241. These numbers are available 24 hours, 7 days a week.