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What is Induction of Labour?
Dr Jane Maher
Obstetrician
Induction of labour is a process that is used to start your labour and it can be recommended for a variety of indications and it can require a couple of different methods.
Indications: Reasons that a type of care or treatment might be recommended.
The most common indication for induction in labour is post-dates or post-term or overdue pregnancy.
We usually consider a term pregnancy being between about 37 and 42 weeks and post-dates pregnancy is usually an induction of labour recommended any time from 41 weeks.
In Australia about 10% of women go overdue or post-dates in their pregnancy.
There are a number of different methods we use for an induction of labour and these depend on your clinical circumstances and also an internal examination of the cervix which is the neck of the womb to see what the cervix needs to help facilitate labour and that may be medication or a mechanical device called a balloon (Balloon catheter diagram on screen) to help to dilate the cervix or it may require breaking of the waters or rupturing (Rupturing the membrane diagram on screen) the membranes around baby and starting a hormone medication through a drip.
All these processes are used to start labour and may be dialed back or altered throughout the course of your labour depending on how your body responds.
Alison Rule
Registered Midwife
Sometimes there are things that change during the pregnancy which don’t necessarily present a huge emergency risk but they might suggest that it would be safer to bring on your labour at a certain point in pregnancy instead of waiting for labour to naturally start.
Women may choose even if everything is normal to have an induction of labour and this is something you need to discuss with your caregivers based on your individual circumstances.
Elly Franks
Previously had inductions of labour within Queensland Health
You know I’ve had every type of induction. Five babies, four of them were born via induction. The first one I wasn’t really, I hadn’t self-educated myself. I probably didn’t ask enough questions. I’d been to my regular appointments but there was a lot of unknown. Asking questions I think is really important. There is no such thing as a silly question throughout your appointments. For my second to fifth baby I had always had a pen and paper handy in the kitchen so when I thought of something, I’ve got an appointment in two weeks. I’m going to write that down.
Why might Induction of Labour be recommended?
Odette Teerink
Registered Midwife
When change needs to occur, it follows the same pathway that a midwife would have in any labour. It’s talking through decision making, benefits and risks. There are a lot of situations where they need to be pre-informed so that they can quickly make decisions going through their birth journey.
Risks and benefits for induction all depend on the indication for the induction, the method of induction that we use and your individual clinical circumstances. It’s best that you talk about these specific risks and benefits with your midwife, doctor and treating team.
Just knowing that you’ve, with an induction it’s planned, I don’t think there’s any such thing as a 100% birth plan sticking to it ever. I really just enjoyed, okay, so this is what I’m doing, let’s just take a moment to pause and think about getting into that mindset of getting to meet the baby.
Other considerations for induction of labour include pre-eclampsia or high blood pressure problems in pregnancy, any problems of growth for baby and this may be overgrowth or undergrowth and other things we measure for are baby’s wellbeing and that’s things like looking at the level of fluid around baby or the blood flow measures on ultrasound. Other conditions that women may have heard of or have experienced including itch in pregnancy, something we call cholestasis, is when itch may affect baby’s wellbeing. This also can be an indication for an induction.
What other things do I need to think about if I have an induction of labour?
A woman needs to prepare for induction of labour the same way that she would if she was going into spontaneous labour. You do have a little bit more of an insight as to timing. You just need to bring the same things that you would normally bring that make your environment feel safe, more homely and how you would like things.
Kirstie Johnston-Wise
Previously had an induction of labour within Queensland Health
I probably thought, like, how’s my body and the baby going to react to the synthosin drip? It’s a drip that releases oxytocin, which is the labour hormone, so it helps your contractions get started and then the midwife can make it stronger the longer that your labour is going.
With that artificial hormone that’s released through your body, it can bring your contractions on a lot faster and a lot more intense as well. So there is a need to have had a previous discussion with your midwife about induction of labour that also covers the plan that you have for pain management as well. As midwives, we like to have that conversation pre-birth just to make sure that you have got a really good understanding of what your analgesia (pain relief) options are and making sure that you understand the risks and benefit for each of those pain management options as well.
An induction of labour can be a time of worry for women. They’re worried about themselves, they’re worried about their babies, and that’s because this matters. It’s not common that things go wrong, but some things that women may worry about are whether they may need a caesarean birth, whether they may need an instrumental birth, or any sort of intervention throughout the labour that comes with an induction process.
Throughout the day, the midwife becomes your best friend really. I mean your partner or your birthing person is there, which great, but just having that open communication with the midwife and just trying to take every moment as it comes really.
For some women, the recommendation of an induction of labour may be quite unexpected and not what they were planning for their birth. It’s important to remember that the team caring for you are only recommending an induction of labour when the risks to remaining pregnant outweigh the risks of an induction. The team caring for you are coming to work hoping for a good outcome for you and your baby. So when induction is recommended, that is the time you can use to voice your concerns and come up with a birth plan for induction that works for both you and your baby.
The most important part of the induction of labour is that you are feeling comfortable, that you understand the process, that you’ve had opportunities to ask questions and really make informed choices.
For further information about Induction of Labour, please talk with your midwife and wider care team. Other resources are the Queensland Health Timing of Birth Decision Aid, Induction of Labour Decision Aid, Induction of Labour Consent form and patient information leaflet, and your local health and hospital service website.
Special thanks to Office of the Chief Midwife Officer, Clinical Excellence Queensland. Developed with funding from Clinical Excellence Queensland
Queensland Government logo.
When you are nearing the end of your pregnancy, it can feel like there are a lot of unknowns and things to know. This information will help you understand what an induction of labour (IOL) might mean for you and your baby. Remember, your treating team can also help to answer any questions you may have.
In most pregnancies, labour will start by itself between 37 and 42 weeks. Sometimes it may be recommended by your treating team to ‘induce’ or use different techniques to start your labour. In Australia, about one in three women choose, or are recommended, to start or induce labour for several reasons. There are different ways an induction can be done depending on your situation, and it may differ from one pregnancy to another.
IOL is a clinical process that may include vaginal examinations; medications or balloons inserted into your vagina to assist in the labour process; insertion of an intravenous (IV) line or 'drip' to allow medications and fluids to be given; monitoring ('observations') of your wellbeing; and continuous monitoring of your baby's wellbeing using heart rate sensors.
There are different ways of inducing labour, and your treating team will talk to you about the best options for your circumstances.
Choosing to have an IOL
Induction of labour is recommended by your treating team when giving birth to your baby is considered safer than staying pregnant. Some common reasons for induction of labour are:
- Your pregnancy has gone longer than 41 weeks (a week or more over your ‘due date’). When your pregnancy has gone beyond your 40-week estimated due date (EDD) by 10 days, this is called “post-dates”.
- You may see or hear this referred to as 40+10 (40 weeks and 10 days) or 41+3 (41 weeks and 3 days). Your baby is not growing as expected (your baby could be bigger or smaller) or is not well.
- You have a health condition (for example high blood pressure).
Benefits of IOL
IOL for health reasons
An induction of labour might be recommended for clinical or health reasons to reduce the risk of harm to you or your baby. Your treating team will talk with you about your circumstances and induction of labour options.
IOL for post-dates
The risk of stillbirth at the end of pregnancy (term) is very low but increases the longer your pregnancy goes past term, so an IOL is recommended because compared to waiting for labour to start on its own, you are:
- less likely to have a stillborn baby
- less likely to need a caesarean birth
- less likely to have a baby that needs care in a neonatal unit.
Risks of IOL
The risks depend on why you are being induced, the method of induction, and your circumstances. These will be discussed with you by your treating team. Some risks include:
Contractions too frequent or too long
Medications can help resolve this if it happens. Sometimes it might mean you or your baby will require to undergo an emergency caesarean section or an instrumental delivery (forceps or vacuum).
Cord prolapse
This is when your baby’s umbilical cord comes out before your baby is born. Although a rare complication, this will require an emergency caesarean.
Labour doesn’t start despite medication
Options for this depend on your individual circumstances. Your treating team will talk with you about your options, including the possibility of waiting and trying the induction again, or planning a caesarean section.
Declining recommended maternity care (including IOL)
- You are central to discussions about your care; ask questions to fully understand risks and benefits.
- You have the right to refuse care and the responsibility to ask questions to understand your options.
- Healthcare providers must ensure you understand the risks and benefits of both accepting and declining care and will ask you to sign some paperwork to show this.
- You should ensure you have looked at the information around declining recommended maternity care.
If you are considering declining your recommended IOL, your treating team will discuss conservative management (watch and wait) with you:
- No medical or physical treatment is given.
- Enables discussion of further recommendations based on ongoing assessments.
- Increased monitoring and checks to ensure the health of you and baby.
- Allows more time for labour to begin naturally.
- Helps assess if continuing this approach is safe.
- Can give a more accurate picture of the health of you and baby during active monitoring and cannot predict ongoing safety.
Resources
Your treating team can answer your questions and give your more information. You can also find links to more information below, to help you understand the risks and benefits of IOL.
- Induction of Labour Decision aid – Guide [PDF 496.91 KB]
- Induction of Labour Decision aid – Tool [PDF 197.98 KB]