Labour induction is a medical procedure where healthcare providers use medications or other methods to start contractions and begin the delivery process before labour starts naturally, helping to protect the health of the pregnant person and the baby.
Understanding Labour Induction Worldwide
Labour induction has become an increasingly common part of pregnancy care across the globe. The rates of induced labour have changed dramatically over recent decades, with the number of women undergoing this procedure nearly doubling since 1990. Today, in countries with advanced healthcare systems, roughly one in four babies is born following labour induction. This means that approximately 25 percent of births involve some form of medical intervention to start the labour process artificially, rather than waiting for labour to begin on its own.[5][13]
The frequency of labour induction varies considerably from country to country and even between different hospitals within the same region. In the United States, induced births make up about 23.4 percent of all deliveries. The variation in induction rates around the world reflects differences in medical guidelines, available resources, and clinical practices. Generally, high-income countries perform inductions more frequently than low- and middle-income countries, where access to the necessary medications, equipment, and trained healthcare professionals may be more limited.[7][13]
Why Labour Induction Is Performed
The primary reason healthcare providers recommend labour induction is when continuing the pregnancy presents greater risks to the pregnant person or the baby than the risks associated with starting labour artificially. Doctors and midwives carefully evaluate many factors before suggesting induction, including the overall health of the pregnant person, the baby’s condition, how far along the pregnancy is, the estimated weight and size of the baby, and the position of the baby in the uterus.[1]
One of the most common medical reasons for inducing labour is when pregnancy continues beyond the expected delivery date. If labour has not started naturally by 41 weeks of pregnancy, healthcare providers often recommend induction because waiting longer increases the risk of stillbirth and other complications for the baby. At 42 weeks from the last menstrual period, the pregnancy is considered postterm, meaning it has lasted longer than the normal duration. During this extended time, the placenta, which is the organ that provides oxygen and nutrients to the baby, may not function as effectively as it should.[1][2]
Health conditions affecting the pregnant person frequently lead to recommendations for induced labour. Diabetes, whether it developed during pregnancy (called gestational diabetes) or existed before pregnancy began, is a significant indication for induction. For people using medication to manage their diabetes, delivery is typically suggested by 39 weeks, and sometimes earlier if blood sugar levels are poorly controlled. High blood pressure is another important medical reason for induction, as it can lead to serious complications for both the pregnant person and the baby.[1][9]
Problems with the baby’s development and growth also prompt healthcare providers to consider induction. When the baby is not growing as expected, a condition called fetal growth restriction, it may be safer to deliver the baby than to continue the pregnancy. Similarly, if there is too little fluid surrounding the baby, known as oligohydramnios, induction may be necessary. Issues with the placenta, such as when it starts to separate from the wall of the uterus (called placental abruption), create urgent situations requiring delivery.[2][9]
Sometimes the amniotic sac surrounding the baby breaks (commonly called “water breaking” or premature rupture of membranes) but contractions do not begin. When this happens, there is an increased risk of infection for both the pregnant person and the baby. If the water breaks more than 24 hours before labour starts, healthcare providers typically recommend induction. The timing of this decision depends on how far along the pregnancy is and other individual circumstances.[3][10]
Infections in the uterus, particularly a condition called chorioamnionitis, require prompt delivery to protect both the pregnant person and the baby. Other medical conditions affecting the pregnant person, such as kidney disease, heart disease, or obesity, may also make induced delivery the safer choice before complications develop further.[1][2]
Elective Induction Without Medical Reasons
Not all inductions are performed for medical reasons. Sometimes a pregnant person and their healthcare provider may choose to induce labour even when there are no medical complications. This is called elective induction. Common reasons for elective induction include living far from the hospital, having a history of very fast deliveries that might make it difficult to reach the hospital in time, or personal preferences regarding timing.[6][11]
Recent studies have provided new information about elective induction at 39 weeks of pregnancy. Research suggests that for healthy women pregnant with their first baby, choosing induction at 39 weeks can be just as safe as waiting for labour to start naturally. In some cases, it may even reduce the likelihood of needing a cesarean section and lower the risk of developing high blood pressure problems during pregnancy. However, not all hospitals have the staff and resources to offer elective induction at 39 weeks, and this option is most appropriate for women who are healthy and carrying a single baby.[4][17]
Healthcare professionals emphasize that when both the pregnant person and the baby are healthy, induction should not be performed before 39 weeks of pregnancy. Babies born at or after 39 weeks have the best chance for healthy outcomes compared to babies born earlier. The baby’s brain and other organs continue important development during the final weeks of pregnancy, making this time critical for the baby’s health after birth.[4][17]
Medical Situations Where Induction Should Not Be Done
There are certain circumstances when labour induction is not safe and cannot be performed. These contraindications exist to protect the health and safety of both the pregnant person and the baby. One important situation is placenta previa, where the placenta covers the opening of the uterus. In this case, a vaginal delivery would be dangerous, and a cesarean section is necessary instead.[11]
The position of the baby in the uterus also matters. If the baby is lying sideways in the uterus or is in a breech presentation (bottom or feet first instead of head first), induction for vaginal delivery may not be safe. Another serious concern is a prolapsed umbilical cord, where the cord drops down into the vagina ahead of the baby, cutting off the baby’s oxygen supply.[11]
Active genital herpes infection at the time of delivery is another reason to avoid induced vaginal delivery, as the virus could be transmitted to the baby during passage through the birth canal. Additionally, certain types of previous uterine surgery, including some types of cesarean deliveries or surgeries to remove fibroids from the uterus, may make the uterine wall weaker. Using certain medications for induction in these situations could increase the risk of the uterus rupturing, which is a life-threatening emergency.[11]
How Labour Induction Is Performed
The process of inducing labour involves multiple steps and can be accomplished through several different methods. Before beginning induction, healthcare providers examine the cervix, which is the opening of the uterus at the top of the vagina. The cervix needs to be soft, thin, and beginning to open for labour to progress successfully. Healthcare providers often use a scoring system called the Bishop score to evaluate whether the cervix is ready for labour. This scoring system assigns points based on several factors including how open (dilated), how thin (effaced), how soft, and how positioned the cervix is, as well as the baby’s position in the pelvis. A Bishop score of less than 6 suggests that the cervix is not yet ready and needs preparation before labour can begin.[4][11]
When the cervix is not ready, the first step in induction is called cervical ripening. This process helps the cervix soften and thin out in preparation for delivery. Several methods can ripen the cervix. Medications containing hormones called prostaglandins can be inserted into the vagina as a tablet, gel, or suppository, or sometimes taken by mouth. These medications work to soften and prepare the cervix for labour. The specific medication called misoprostol is commonly used for this purpose and can be placed in the vagina or taken as a pill.[2][8]
Mechanical methods can also ripen the cervix. A small tube called a balloon catheter can be inserted into the cervix, and when the balloon is inflated, it gently stretches the cervix open. This device is typically left in place until the cervix has opened to about 3 centimeters, at which point the balloon usually falls out on its own. Some women may be able to go home while the balloon catheter is working, though this depends on individual circumstances and hospital policies.[2][8]
Another technique called membrane sweeping (also known as stripping the membranes) involves the healthcare provider using a gloved finger to separate the amniotic sac from the wall of the uterus during an internal examination. This action releases natural prostaglandins that may trigger contractions and help labour begin. Membrane sweeping can sometimes cause cramping and light bleeding. While it doesn’t always lead to labour starting, research shows it can increase the likelihood of spontaneous labour beginning within 48 hours.[3][12]
Once the cervix is adequately ripened, or if it was already favorable from the start, healthcare providers may use additional methods to start or strengthen contractions. The medication oxytocin is commonly given through an intravenous line (IV) to stimulate the uterus to contract. Oxytocin is a synthetic version of a hormone that the body naturally produces during labour. The amount given can be adjusted to create regular, effective contractions.[2][8]
Breaking the amniotic sac, called artificial rupture of membranes or amniotomy, is another method used during induction. The healthcare provider uses a small plastic hook to make a small opening in the amniotic sac during a vaginal examination. This releases the fluid surrounding the baby and often helps labour progress. This procedure should only be done after the cervix has started to open and the baby’s head is firmly settled into the pelvis.[8][11]
Duration and Timeline of Induced Labour
The length of time it takes for labour to begin and progress after induction varies significantly from person to person. There is no standard timeline that applies to everyone, as individual bodies respond differently to induction methods. With medications used to ripen the cervix and start contractions, active labour can begin quickly for some people, but for others it may take many hours or even days before active labour establishes.[7]
Healthcare providers typically advise people undergoing induction to expect at least 24 hours for the process. The cervical ripening phase alone can take many hours before contractions begin. Throughout the induction process, women usually remain in the hospital maternity unit where they can be monitored closely. In some situations, depending on the method used and individual circumstances, it may be possible to go home during the early stages of induction and return when labour becomes more active.[3][7]
During labour induction, healthcare providers continuously monitor both the pregnant person and the baby to ensure both are tolerating the process well. The baby’s heart rate is tracked to make sure the baby is responding normally to contractions. If concerns arise about either the pregnant person or the baby’s wellbeing during induction, the medical team adjusts the plan accordingly.[2]
Differences Between Induced and Natural Labour
Labour that is induced typically feels different from labour that starts on its own. One significant difference is that induced labour is usually more painful than spontaneous labour. The contractions brought on by medications tend to be stronger and may become intense more quickly than in natural labour. This increased intensity means that people undergoing induction may need stronger pain relief options earlier in the labour process.[3][12]
Being induced does not limit the pain relief options available during labour. All the usual methods of pain management remain accessible, including epidural anesthesia, which provides pain relief by numbing the lower body, and water births where available. Healthcare providers work with each person to ensure adequate pain relief throughout the labour process.[3][12]
Women who have induced labour may be more likely to need an assisted delivery, where instruments such as forceps or a ventouse (vacuum suction device) are used to help guide the baby out during the pushing stage. The exact reasons for this increased likelihood are not fully understood but may relate to the strength and pattern of contractions or how the baby responds to the induction process.[3][12]
Induction may affect where labour and delivery can take place. Because of the need for continuous monitoring and the possibility of complications requiring quick intervention, women undergoing induction typically need to remain in the hospital throughout labour. Some birth location options that might be available for spontaneous labour, such as freestanding birth centers or home births, are not appropriate for induced labour.[3][12]
When Labour Induction Does Not Work
Sometimes, despite all efforts, labour induction does not successfully lead to progressive labour and vaginal delivery. This situation is sometimes referred to as failed induction. If the induction process does not result in active labour within 24 hours or more, or if labour begins but then stops progressing, the healthcare team must reassess the situation.[7]
When induction is not successful and both the pregnant person and baby remain stable and healthy, several options exist. The healthcare provider may suggest sending the person home with plans to try induction again at a later date. If labour has started even slightly, instructions will be given to return to the hospital when contractions strengthen. However, if either the pregnant person or the baby shows signs of distress or complications during the failed induction attempt, a cesarean section may become necessary to ensure safe delivery.[4][12]
The likelihood of a successful vaginal delivery after induction depends on many factors, including whether this is a first pregnancy, the condition of the cervix at the start of induction, the reason for induction, and the specific methods used. Research shows considerable variation in success rates between different hospitals and medical centers, with cesarean rates following induction ranging widely. This variation reflects differences in patient populations, induction protocols, and clinical practices.[23]
Possible Risks and Complications
Like any medical procedure, labour induction carries certain risks. Understanding these potential complications helps people make informed decisions about whether induction is the right choice for their situation. One risk is that the medications used to cause contractions may lead to excessive stimulation of the uterus, causing contractions that are too frequent or too strong. This can potentially reduce the oxygen supply to the baby during contractions and may require intervention, including stopping the medications or performing an emergency cesarean section.[2]
Infection is another possible complication, particularly if the amniotic sac has been ruptured for an extended period or if instruments have been inserted into the cervix. Healthcare providers take precautions to minimize infection risk, but it remains a concern during prolonged induction attempts.[2]
Breaking the amniotic sac carries specific risks, including the possibility of the umbilical cord slipping down ahead of the baby (cord prolapse), which is an emergency situation. There is also a small risk of introducing infection or causing the baby’s heart rate to drop. For these reasons, amniotomy is only performed when appropriate and under controlled conditions.[11]
For people who have had previous uterine surgery, including certain types of cesarean sections, there is an increased risk of uterine rupture when using prostaglandins for cervical ripening or labour induction. Uterine rupture is a rare but serious complication where the wall of the uterus tears, which can be life-threatening for both the pregnant person and the baby. For this reason, prostaglandins should be avoided in people with specific types of uterine scars.[1]
Natural Methods Considered for Starting Labour
Many pregnant people wonder about natural ways to encourage labour to begin, especially as they approach or pass their due date. While various methods are discussed and tried, scientific evidence supporting most natural approaches is limited. It’s important to talk with a healthcare provider before attempting any method to start labour, even if it seems natural or harmless, because some approaches can cause problems.[16]
One of the few natural methods with some research support is eating dates. Studies have shown that women who ate six dates daily starting at 36 weeks of pregnancy were more likely to go into labour on their own and experienced shorter early labour phases. This simple dietary addition appears safe and may offer some benefit, though it doesn’t guarantee labour will begin.[22]
Walking and staying physically active during late pregnancy is generally safe and healthy. While walking itself hasn’t been proven to directly start labour, being upright may help the baby move into a better position for birth. Some people try curb walking, where one foot walks on the curb and the other on the ground, believing it might help shift the baby into position, though evidence for this specific technique is limited.[16][22]
Sexual intercourse is sometimes suggested as a natural way to encourage labour. The theory is that semen contains prostaglandins that might help soften the cervix, and orgasm can cause the uterus to contract. While sex is usually safe in late pregnancy if healthcare providers haven’t advised against it, there’s no strong evidence that it reliably starts labour. Sex should be avoided once the amniotic sac has ruptured because of increased infection risk.[16][22]
Nipple stimulation can trigger the release of oxytocin, potentially causing contractions. However, this method should only be attempted with healthcare provider guidance because it can cause very strong or frequent contractions that might not be safe without proper monitoring.[16][22]
Some methods promoted as natural are not recommended because they can be unsafe or ineffective. Castor oil, a strong laxative, is sometimes suggested to start labour, but it primarily causes uncomfortable digestive symptoms and dehydration without reliably bringing on labour. Other approaches like eating spicy foods, taking certain herbal supplements, or trying acupuncture have limited or mixed evidence regarding their effectiveness and safety.[22]
Augmentation of Labour Already in Progress
A concept related to induction is augmentation, which refers to helping labour progress when it has already started naturally but has slowed down or stopped. This situation is different from induction, where labour hasn’t begun at all. When active labour has started on its own but contractions become weak, irregular, or stop entirely, steps may be taken to strengthen the labour process and help it continue toward delivery.[8]
Augmentation might involve rupturing the amniotic sac if it hasn’t broken on its own, which often helps labour progress more effectively. If this alone doesn’t restart or strengthen labour, oxytocin may be given through an IV to stimulate stronger, more regular contractions. The goal of augmentation is to avoid a prolonged labour that could become exhausting or lead to complications for the pregnant person or baby.[8]
