What is an induction of labour? Your Maternity Service

An induction of labour involves trying to start labour (contractions). It can be done with or without the use of drugs. Induction of labour is common, with 1 in 3 women and birthing people having an induction of labour (University Hospitals of Leicester, 2024). The induction of labour journey is different for everybody. Your labour can be induced in many different ways. It can often take a few days until your baby is born.

Read on to find the answers to some of the most commonly asked questions about an induction of labour, or click on one of the links below to be taken to a specific question:

Why might I be offered an induction of labour?

There are lots of reasons why you might be offered an induction of labour. A personal plan will be made with you about the timing and reason for induction of labour.

Some of the most common reasons for induction of labour are:

If your pregnancy has continued more than 41 weeks
If your waters break and your labour does not start
If there are any concerns about your baby’s movements, growth or health
If you have any health conditions in pregnancy (diabetes, high blood pressure)

Induction of labour aims to reduce or remove some of the risks to you or your baby.

How will my labour be induced?

When you come to the hospital for your induction of labour:

the midwife will do a full antenatal check like the ones you have when you visit your community midwife
Your baby’s heartbeat will be monitored using a cardiotograph (CTG) machine. This gives a paper recording of your baby’s heartbeat
You might also have a scan to check your baby’s position
Before the start of your induction of labour, your midwife or doctor will do an internal (vaginal) examination to assess the neck of your womb (cervix). This will tell them which is the best method to start your induction of labour
During induction of labour, you may need more vaginal examinations compared to if you were not having an induction

There are 3 parts to induction of labour:

Part 1 – preparing the neck of your womb (cervix) to break your waters

Part 2 – breaking your waters

Part 3 – using a hormone drip to establish labour

For the midwives and doctors to start your labour, they need to be able to break your waters (part 2)
For them to be able to break your waters, your cervix needs to be open enough for them to be able to do this (part 1)
If your contractions do not start after they break your waters, they would advise you start the hormone drip (part 3).

Some people may be ready to have their waters broken at the start of their induction without the need for part 1.

Part 1 – preparing the neck of your womb (cervix) to break your waters

Two different methods can be used during this stage. They are:

Mechanical method (using a cervical balloon catheter). This is also known as Foley balloon catheter
Hormone method (using a Propess pessary)

1. Cervical balloon catheter (mechanical method)

The catheter is a soft silicone tube. It is inserted into your cervix with or without the use of a smooth plastic tube (speculum)
It has a balloon near the tip. When it is in place the balloon is filled with a sterile salt water (saline) fluid
The catheter stays in place for 24 hours. The balloon puts gentle pressure on your cervix
The bottom of the catheter tubing is taped to your leg
The pressure should soften and open your cervix enough to be able to break the waters around your baby or it may start labour

It is important to know that this does not happen for everyone. You may need to move on to other methods. You may have period type cramps and the mucus plug (show) might start to come away.

Image courtesy of Hull University Teaching Hospitals NHS Trust

You can do things as you would normally, for example, showering, having a bath, going to the toilet as normal or walking. However, please avoid having sex.

After going to the toilet, please wash your hands
Make sure the catheter is clean
Change your underwear regularly

You need to be aware that although catheters are widely used all around the world to induce labour, the company has not sought a license for its use for induction of labour. There have been many research trials that have shown that this is a safe, effective method of induction. If you would prefer not to have this treatment, you may have the option of using a prostaglandin pessary instead.

Removing the balloon

The balloon might fall out on its own. Please tell a midwife if this happens.

If, after 24 hours, the balloon has not fallen out, a midwife or doctor will gently take out the catheter by removing the water in the balloon. This should not be painful.

A vaginal examination will then be performed to see if your waters can be broken.

2. Hormone method – Propess pessary

The hormone method uses prostaglandins. These are natural hormones that occur in labour. Man-made (artificial) prostaglandins can be used to induce labour.

Propess is a small, flat soft plastic tablet on a string that can be taken out (pessary). It is placed inside your vagina behind your cervix.

The Propess^® pessary:

Slowly releases the prostaglandin hormone for 24 hours
Is a small piece of soft plastic on a long piece of string. This allows for easy removal when needed
If it falls out then wrap it in some tissue and show it to a midwife
It may be possible for you to go home with the Propess^®pessary in. Speak to your midwife if this is something you would like to do
You may have period-type cramps and the mucus plug (show) might start to come away
You will only be given 1 Propess^®pessary

Your medical team will take the Propess pessary out after 24 hours. After it is taken out, they will do a vaginal examination to see if they can break your waters.

You can do things as you would normally, for example, showering, having a bath, going to the toilet as normal or walking. However, please avoid having sex.

What will happen if you cannot break my waters after I have had the balloon or propess pessary?

A doctor will review you. They will make a plan with you based on your personal situation. They may offer you a different method of induction. This might include using a vaginal prostaglandin called Prostin.

Prostin (a dissolvable tablet):

Is placed next to the cervix and dissolve
You may notice a creamy discharge after a short time, but this is normal
Prostaglandins often cause the womb (uterus) to contract without obvious changes to the cervix
You may have period-type cramps, the mucus plug (show) might start to come away
You can have up to two prostin tablets 6 hours apart
If you have prostin, you will stay on the delivery suite

Each method has advantages and disadvantage. In some cases, you may need both methods for your waters to break.

Things to consider

Mechanical method (Balloon catheter)

When the catheter is inserted, there is a small chance your waters might break
There is a small chance of infection and bleeding
It can be uncomfortable

Hormone method (Propess pessary)

It might make your womb contract too. This can cause distress to your baby
You are less likely to be able to go home during your induction of labour

Induction of labour increases the chance that you may need more interventions. Some studies suggest that you may be more likely to need help with your birth where instruments are used (ventouse or forceps). It might mean you are more likely to need a caesarean section.

If you have previously had a caesarean section or surgeries on your womb, you will be advised not to use propess for your induction of labour. This is because it increases the chances of the scar on your womb coming apart. Your doctor will make a plan with you for your induction of labour.

Part 2 – Artificial rupture of membranes (ARM)

This is also known as ‘breaking the waters’
You will need a vaginal examination to have your waters broken
Having your waters broken should be no more uncomfortable than having a vaginal examination
It involves making a small hole in the membranes using a plastic tool with a small hook on the end. This lets the fluid that surrounds you baby in the womb (amniotic) to drain
The fluid will then continue to drain until the baby is born
This may be enough to start labour, but often the oxytocin hormone drip is also needed

When your cervix is open enough, your waters will be broken when it is safe to do so. You will need a midwife to look after you and be in a private birthing room. Often, there are delays in breaking your waters. This delay can sometimes be a few days. Staff will keep you updated and make sure you and your baby are safe.

Although breaking your waters is usually straightforward, it can increase the risk of cord prolapse, bleeding and infection. Your doctor or midwife will take care to avoid this. They are trained to manage any emergencies which might happen. Your baby’s heartbeat will be monitored before and after breaking your waters.

After your waters have been broken, your midwife and doctor will talk to you about the timing of starting the oxytocin hormone drip.

Part 3 – Oxytocin (hormone drip)

Oxytocin is produced naturally by your body during labour. It helps to make your womb contract and helps your cervix to open. Your midwife and doctor may advise you to start the artificial oxytocin drip. The timing of starting the oxytocin drip will be a joint choice made by yourself, midwife and doctor.

Oxytocin is only given after your waters have been broken
Oxytocin is used to try and start and/or make strong regular contractions of the womb (every 2 to 3 minutes)
It is given through a drip that is inserted into a vein in your hand/arm
The drip starts slowly and builds up over time
The flow of Oxytocin through the drip is altered by your midwife or doctor. This depends on how your labour is going
It is more common to use an epidural for pain relief when the Oxytocin drip is being used during labour
Your baby’s heartbeat will be checked all the time whilst you are having the Oxytocin drip
The time you will be on the Oxytocin hormone drip is different for everyone. Doctors and midwives will check you regularly. You will have vaginal exams to check on how your labour is going

What if my induction of labour does not work?

If you do not go into labour after an induction, your midwife and doctor will discuss the next steps with you and make sure that both you and your baby are safe. There may be a few options but this will depend upon your circumstances. If your waters have not broken it may be possible:

To stop the induction process and allow a period of rest then repeat the induction process
A caesarean section may be recommended

What will happen if my induction of labour is delayed?

Your induction of labour journey might take a few days, but sometimes it can happen very quickly. Unfortunately, doctors and midwives are unable to predict this.

Delays can be either before the induction has started or during your induction of labour journey. Delays often happen due to:

Delivery suite being very busy
Midwives are involved with caring for other women in labour

During the later stages of your induction of labour, you will need a midwife who is caring only for you. Please be assured that as soon as it is safe to continue your induction of labour, they will do so. Your doctor and midwife will not delay your induction of labour if there are any immediate concerns with you or your baby’s health. They will make a plan with you to check you and your baby if there are any delays.

Women and birthing people having induction of labour are reviewed on a regular basis throughout the day by the specialist doctors and senior midwives working on labour ward. They use a standardised prioritisation tool to help decision making based on personal situations. If you have any concerns at any time, you can ask to speak to any member of the team.

When there are delays, you may be offered to continue your induction of labour at a different hospital. The medical team will talk to you about this.

What will happen on the day I am booked to be induced?

The doctors and midwives will start your induction of labour at the hospital
It can be started at any time of the day
The midwife will phone you from the hospital before 2pm on the day of your induction of labour. They will give you a time to attend the hospital for your first assessment. If you are not contacted by 2pm, please call Labour Ward on 0116 258 6111
When you arrive at the hospital, the midwife will take your maternity notes
They will complete an antenatal check
Once you have had your induction of labour assessment, you may be able to spend some time at home until the next part of the induction, but it may be better for you to stay in hospital on the antenatal ward. The team will talk to you about this.
If you have other children, it is important that you organise child care for a few days in case you are in hospital for a while

Can I go home during my induction of labour?

You may be able to go home if you have been given a balloon or propess. This will depend on why you are being induced and your circumstances.

If you go home, the doctors and midwives will ask you to return to the hospital after 24 hours from the balloon or propess being inserted, or if you:

Have bleeding from the vagina
Have contractions
Have concerns about the baby’s movements
Are feeling unwell
Feel your waters break
Experience issues with the balloon catheter or propess falls out
Have any other concerns or wish to return to the hospital

Where will my baby be born if I have an induction of labour?

Most women are advised to have their baby at the hospital if they are having an induction of labour. In some circumstances, you may be able to give birth at home or in a birth centre but this depends on your situation (what methods of induction you need and why you are being induced). If you have any questions, please discuss this with your midwife or doctor.

If I am induced can I still choose to use a birthing pool in labour?

Using the birthing pool in labour is not suitable for every woman whose labour is induced. Each case is looked at individually. Your midwife will be able to discuss this with you.

The use of a birthing pool is not advised if:

More than one method is needed to induce your labour
You need the Oxytocin hormone drip

What if I am unsure whether to have an induction of labour?

Midwives and doctors are there to support you to make decisions.

They will advise an induction of labour when there is evidence to suggest that it will benefit either you or your baby/babies from an earlier delivery, rather than waiting for labour to start naturally.

You will be fully involved in any decisions made about inducing your labour. The doctor or midwife will explain the induction of labour journey. This will include any benefits and any risks. You can ask questions at any time about induction of labour. You can choose to accept or refuse an induction of labour, it is your choice.

Whilst making your decision about induction of labour, you may find it helpful to use the BRAIN tool below to help you talk to your midwife or doctor.

What happens if I decide I do not want to be induced?

You may decide you do not want an induction of labour. Your wishes will be respected. Your midwife and doctor will discuss your concerns with you and make sure you have all the information to help you make an informed decision.

You may be offered a personal plan to check you and your baby/babies. It is important to know that monitoring and using scans do not help predict or avoid problems that might happen suddenly. Neither of these tests can accurately predict whether your baby is more or less likely to have a stillbirth in the future, but can help to tell you how your baby is at the time of the scan or test.

You may be offered the opportunity to meet with a specialist midwife or consultant obstetrician to discuss your options.

Other choices to an induction of labour include:

Delaying your induction until a chosen date/gestation
Having a membrane sweep and allowing more time
Deciding to have an elective caesarean section rather than an induction of labour if this is your choice

What is a membrane sweep?

Towards the end of your pregnancy or if you have an induction of labour planned, you will be offered a membrane sweep. This can be done at home, in a community clinic/birth centre or in the hospital.

A membrane sweep is a drug free method that can help start labour within the next 48 hours
It involves an examination inside the vagina
The midwife inserts a finger into the neck of the womb (cervix) to separate the membranes from the cervix in a circular movement. A membrane sweep cannot be done if your cervix is closed. This can be uncomfortable
A membrane sweep is usually offered at 39 to 40 weeks of pregnancy
Sometimes a membrane sweep is not recommended, for example, if your waters have already broken or your baby’s head is not fixed in the pelvis.
Membrane sweeping may start labour without the need for other methods of induction. A study in 2005 found that 1 in 7 women may go into labour after a membrane sweep (Finucane et al 2020)
Pain, discomfort and vaginal bleeding are possible after the membrane sweep. A membrane sweep will not cause any harm to your baby. It does not increase the chance of you or your baby getting an infection
More membrane sweeps can be offered if labour does not start after the first sweep (3 sweeps in total)

If you have not been offered a membrane sweep and would like one, please call the Community Midwifery office on 0116 258 6111 and press option 5.

Who can be with me during my induction of labour?

You are able to have 2 birth partners with you while your induction is being started.

Once you have chosen your birth partners, they are not able to swap with anyone else.

If you go into labour overnight and your birth partners are not present, the midwife can phone them for you.

Depending on which method is used to induce you and the reason for being induced, you may be transferred to the antenatal/postnatal ward. The visiting times on the antenatal ward are:

You are able to have your 2 chosen birth partners with you between 9am and midnight
You can also have your own children visit you during this time. Your children must be looked after by an adult visitor at all times.

Other Visitors: Between the hours of 2pm to 4pm and 6pm to 8pm you can have 2 visitors. Visitors can swap during this time, keeping to 2 in total. Other people on the ward must have their privacy during this time. We ask that swapping of visitors be reduced to lower any infection risks.

Please note: University Hospitals of Leicester are actively working with the Leicester, Leicestershire and Rutland Maternity and Neonatal Voices Partnership to extend visiting times for birthing partners.

As your induction of labour may take a few days, your partner may want to think about not starting their paternity leave until you are in active labour.

What should I bring with me for my induction of labour?

Your handheld maternity notes
Your ‘My Maternity Journey’ booklet and birth plan
Your hospital bag
Any regular medication you are taking
Your blood glucose monitor (if you have diabetes)
Anything that will make you more comfortable: pillow, blanket, iPad, headphones, ear plugs, card games etc

What pain relief can I have during my induction of labour?

During the early stages of your induction of labour journey, you will have a choice of pain relief options including:

Paracetamol or dihydrocodine tablets
Pethidine injection
TENS machine (the hospital does not supply these)
Water (having a bath)
You will be able to use a birthing ball during your induction of labour
You will be able to use gas and air and epidural once your waters have been broken or you are in established labour

Click here to find out more about the pain relief options available when in labour.