Labour on a Schedule: What to Expect with Induction

Childbirth is a deeply personal and unique journey for every parent. While many labours begin organically (without any medical intervention), many are often recommended to be given a ‘nudge’ in getting the body started.

More and more evidence show that babies have a clever way of letting the world know they’re ready to make their grand entrance. They send out chemical signals—essentially shouting, “Hey, my lungs are good to go!”—which triggers the mother’s body to produce ‘prostaglandins’, the hormones that get labour rolling.

Inducing labour, on the other hand, is like giving Mother Nature a little nudge (or sometimes a big shove). While it’s often associated with medical interventions, even DIY approaches or complementary therapies count as induction. The goal of all these methods is the same: to jump-start or mimic the body’s natural labour process. But messing with nature’s timeline can sometimes have ripple effects.
In the UK, about 1 in 3 births now involve induction, and the process is managed and monitored by healthcare professionals (midwives and doctors) to supposedly control the risks associated with this intervention. If you’ve been told induction might be ‘necessary’ or you’re curious about what to expect, this little guide is for you.

Why Induce?

An induction can be suggested in a variety of situations, and the timing often hinges on the specific reason for recommending it. It might be due to concerns about the wellbeing of you or your baby. Depending on how far along your pregnancy is, deciding when to proceed with induction can sometimes feel like a balancing act—considering the risks of giving birth too early against the risks of continuing the pregnancy.
More commonly, induction is offered as a precaution, based on worries that complications might arise or that certain risks (like stillbirth), could increase if the pregnancy goes past a certain point. But here’s the tricky part: the evidence behind these recommendations isn’t always clear-cut. In some cases, research shows that induction can lower the chance of harm to you or your baby. In others, the evidence is patchy, contradictory, or virtually non-existent. And even when risks are cited, they’re usually quite low regardless of whether labour starts naturally or is induced.

Given these uncertainties, the decision often comes down to personal perspective. Do you lean toward “Induction might help, so why not try it just in case?” or “If there’s no solid evidence it works, why intervene unnecessarily?” It’s a question of what feels right for you.

Here’s a quick overview of some common reasons induction might be offered. While there are many more, diving into all the evidence for induction in every possible situation would take us far beyond the scope of this blog. See AIMS Guide to Induction of Labour for further information.

Pregnancy lasting beyond 41 weeks (post-term/post-dates pregnancy)

The NICE guidelines recommend that you are informed of “some risks associated with pregnancy continuing beyond 41 weeks may increase over time” and that inducing labour at this stage “may reduce these risks.” However, they also highlight that you should consider how induction might affect your birth experience when deciding.

The listed risks include a higher likelihood of caesarean birth, your baby being admitted to a neonatal unit, and stillbirth or neonatal death. That said, the guidelines admit that the evidence for induction reducing these risks isn’t “definitive,” and the overall risks remain low whether or not labour is induced after 41 weeks. In fact, studies on this topic often contradict one another.

Concerns about the baby’s growth or wellbeing (large/small for gestational age)

Big baby (LGA): If your baby is predicted to be on the larger side (and you don’t have diabetes), the NICE guideline points out that there’s no clear answer about whether induction is better than waiting for labour to start organically. Because of this, they don’t recommend offering induction before 41 weeks in this situation.

Baby growing slowly (SGA): If your baby seems to be growing slower than expected, the Saving Babies’ Lives Care Bundle (a set of initiatives aimed at reducing the national stillbirth rate) recommends inducing labour between 37 and 38 weeks for the smallest 3% of babies (below the 3rd centile) and at 39 weeks for those between the 3rd and 10th centiles. That said, most small babies are born healthy, and an early delivery has its own risks. Right now, there isn’t enough solid evidence to say whether it’s always better to induce labour when a baby is small or to wait and keep a close eye on how they’re doing.

Premature rupture of membranes (waters breaking without any further signs of labours – like contractions/surges starting)

If your waters break after 37 weeks of pregnancy, the NICE guideline suggests offering you the option to be induced either immediately or within 24 hours. This approach helps reduce the risk of infection for both you and your baby. However, if you’d prefer, you can choose to wait a little longer, as most labours tend to start organically within 24 hours after your waters break. Remember it should be about giving you the flexibility to make the choice that feels right for you!

The mother’s/birthing person’s health conditions, such as high blood pressure or diabetes

Guidelines recommend offering induction or a planned caesarean before 41 weeks if you have any of the above risk factors. Be sure to checkout the guideline relevant to each of these and consider in depth discussion with your obstetrician!

How is Labour Induced?

Induction of labour is the process of using interventions (medical or otherwise) to start labour artificially.

Natural Methods

When it comes to natural ways to encourage labour, research is unfortunately limited, and most of the studies that have been conducted are on the smaller side. However, there is some evidence suggesting that methods like nipple stimulation, acupuncture or acupressure, and even eating dates in the final weeks of pregnancy could help bring on labour.

On the other hand, there’s not much clinical proof that other popular self-help techniques—like eating curry or pineapple, having sex, or using complementary therapies such as hypnotherapy, homeopathy, reflexology, or aromatherapy—are effective. Despite the lack of solid evidence, many people report finding these methods helpful, and simply trying them could help you feel more in control and relaxed, which may increase the chances of your labour starting naturally without the need for medical intervention.

Medical Methods

The method used will depend on the state of your cervix at the time and the specific circumstances of your pregnancy. However, common methods include:

Membrane Sweep

This procedure involves a midwife or doctor performing an internal vaginal examination while inserting one of two fingers into your cervix and moving it around (sweeping) to help loosen the membranes.

Prostaglandins

Prostaglandin is a hormone-like substance that helps soften and open the cervix. It’s usually administered in the form of a gel, pessary, or tablet inserted into the vagina. You may need more than one dose over several hours, and it may take some time for surges to begin.

Breaking the Waters (Amniotomy)

If your cervix has already started to dilate, your midwife or doctor may recommend breaking your waters artificially. This is a quick procedure where a small instrument is used to make a hole in the amniotic sac. Once the waters are broken, contractions often follow naturally.

Oxytocin Drip

If your labour still doesn’t progress after the above methods, you may be given a synthetic version of the hormone oxytocin through a drip in your arm. This stimulates contractions and is closely monitored to ensure they are effective but not overly intense.

Mechanical Methods

What to Expect During Induction

Induction can be a longer and more structured process than spontaneous labour. Here’s what you might experience:

• Patience is key: Induction doesn’t always work immediately. It can take hours or even days, particularly if your body isn’t yet ready for labour.

• Monitoring: Your baby’s heart rate and your contractions will be closely monitored, especially if oxytocin or other interventions are used.

• Pain relief options: Induced labour can sometimes be more intense than natural labour, so it’s worth discussing pain relief options with your midwife. These include gas and air, epidurals, or other medications.

• Unexpected changes: While most inductions lead to vaginal births, some may result in assisted/instrumental delivery (e.g., using forceps or a suction cup) or a caesarean section if complications arise or progress is slow.

Whether your induction is planned or becomes '“necessary” due to medical reasons, staying informed and trusting your care team can make the experience smoother and more empowering. Remember, every birth journey is unique, and the most important outcome is a healthy baby and happy parents.