I need a birth induction - what are my options?
Being told you need an induction can feel overwhelming and leave you with many questions. The most important thing to know is that you still have choices. This blog will help you understand more about why induction is being recommended, what the research says, what induction involves, and how you can maintain control over your birth experience.
Understanding induction of labour
Induction of labour (IOL) may be recommended when your healthcare provider believes the risks of continuing the pregnancy are higher than the risks involved in the induction process itself. However, it's crucial to understand that the final decision always rests with you. You do not have to consent to an induction.
Your healthcare team's role is to provide you with comprehensive information, not to make decisions for you. When they recommend rather than simply inform, they take ownership of the outcome - and that's not their role, nor yours to give away.
Your right to informed consent
Every person has the legal right to determine what happens to their own body. For true informed consent, you should expect, and have the right to ask for:
A clear explanation of what the procedure involves
Why it's being suggested in your specific case
The risks and benefits of the proposed intervention
Alternative options, including doing nothing
What happens if the induction isn't successful
If these elements aren't discussed with you, technically, you haven't given proper consent.
When do guidelines recommend induction?
Understanding when induction is and isn't recommended can help you assess your own situation.
“It may be the case that your healthcare provider’s recommendation does not align with evidence-based research or global guidelines. ”
I suggest doing your own research to understand what those guidelines are so you can make a more informed decision.
Resources
Australian Pregnancy Care Guidelines (for Induction-specific go to the Prolonged pregnancy section.
World Health Organisation (WHO)
Conditions where induction is widely recommended
Pre-eclampsia: All major guidelines recommend induction due to serious risks to both mother and baby, including fitting and organ complications.
Gestational Diabetes with abnormal blood glucose level (BGL): All major guidelines recommend induction due to the risk of having a larger baby, which could result in a birth injury and low postnatal BGL for the baby. However, the research is inconclusive about beneficial outcomes, which means induction doesn’t necessarily reduce the risk of these things happening.
Pre-existing Diabetes: Guidelines recommend induction at 39 weeks, although research is inadequate to fully support this improving outcomes.
High Blood Pressure: Guidelines suggest a wait-and-see approach, rather than inducing labour just in case. However, for women with blood pressure lower than 160/110 mmHg, the timing of birth should be agreed between you and a senior obstetrician, taking into account your whole clinical picture.
Obstetric Cholestasis (ICP): Guidelines suggest induction based on a woman’s peak bile acids level. In women with mild levels and no other risk factors, stillbirth risk is similar to the baseline risk of normal pregnancies, and they should consider options of planned birth by 40 weeks.
For moderate levels with no other risk factors, the risk of stillbirth is similar to normal pregnancies until 38–39 weeks' gestation, and they should consider planned birth at 38–39 weeks' gestation.
For severe ICP, the risk of stillbirth is higher than in a normal pregnancy, and women should consider a planned birth at 35–36 weeks' gestation.
See RCOG’s guidelines for more information.
Growth-restricted babies (IGUR): The risk of stillbirth for unidentified IUGR is 1.9% chance which is reduced to 0.9% if identified. Diagnosis can only be made by umbilical doppler assessment, not by weight estimation. Guidelines recommend birth before placental function declines. C-sections are also recommended rather than induction because the baby may not be able to deal with the stress of labour.
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Conditions where guidelines vary
Gestational Diabetes with normal blood sugar: WHO doesn't recommend induction, while NICE suggests induction before 41 weeks, despite no increased risks when blood sugar is well-controlled.
Post-dates (After 42 weeks): Guidelines recommend induction, and research shows it can reduce perinatal death rates, though individual factors should be considered. The prospective risk of stillbirth increases with gestational age from 0.11 per 1,000 pregnancies at 37 weeks to 3.18 per 1,000 at 42 weeks.
See the research.
Advanced maternal age: Guidelines suggest offering induction after 39 weeks for women over 35, with stronger recommendations for women over 40; however, research in this area has been found to be problematic.
Reduced Fetal Movement: 40% of women will experience reduced fetal movement at some point in pregnancy. The risk lies in recurrent episodes, as this could indicate growth restriction (IGUR) and placental insufficiency. IGUR should be confirmed with an umbilical doppler and if placenta issues are diagnosed, induction will be recommended.
Prolonged pre-term Rupture of Membranes (PROM): If your waters break before 37 weeks, you are likely to go into labour within 24 hours. If you go beyond this, the risk of infection is increased. Guidelines vary with research indicating that induction has no impact on infection rates, but does increase respiratory problems for the baby.
Conditions where induction may NOT be recommended
Suspected big baby: Both NICE and WHO state that induction should not be recommended based solely on a suspected large baby, as we cannot accurately estimate baby size before birth.
Multiple pregnancies: WHO states there's insufficient evidence to recommend induction for uncomplicated twin pregnancies.
The induction process: What to expect
Induction typically involves three stages and is always most effective when your body is primed to go into labour naturally.
The purpose of the first stage is to prime your cervix to soften and start to open so that your waters can be broken.
1. Ripening the cervix
Membrane Sweep (Stretch and Sweep)
This is usually the first intervention offered and can be done during a regular appointment. Your healthcare provider inserts a finger through your cervix and makes a circular sweeping motion to separate the amniotic sac from the cervical wall. This releases natural prostaglandins that may trigger labour.
What to expect: The procedure itself takes just a few minutes, but can be uncomfortable or painful. You might experience cramping, spotting, or a bloody show afterwards. Some women go into labour within 24-48 hours, while others don't respond at all.
Effectiveness: Membrane sweeps can reduce the need for further induction interventions; however, studies often involved multiple sweeps (sometimes every 48 hours from 38 weeks), and the benefits weren't considered clinically significant when used solely to prevent other induction methods.
Side effects: Pain during the procedure, bleeding, and potentially prolonged early labour that can last for days, leaving you exhausted before active labour even begins. Rarely, it can accidentally rupture your membranes.
Synthetic Prostaglandins (Prostin gel/pessary, Cervidil)
These are artificial versions of the hormones your body naturally produces to soften and open the cervix. They're inserted into your vagina as either a gel or a pessary (tablet-like insert) that sits against your cervix.
What to expect: You'll need to lie down for 30-60 minutes after insertion, then you can usually move around. The medication works over 6-12 hours. You might start having contractions, or your cervix might simply soften without labour starting. If labour doesn't begin, the process might be repeated after 6-8 hours.
Effectiveness: Research shows this intervention significantly improves induction outcomes and is more likely to lead to successful labour than mechanical methods alone.
Side effects: Very common side effects include sharp pains and uterine cramping that can be quite intense. Less common but possible: nausea, vomiting, diarrhea, fever, and hyperstimulation (overly strong contractions that can stress your baby). If hyperstimulation occurs, the pessary can be removed, and the effects wear off relatively quickly.
Foley Balloon (Mechanical Ripening)
This involves inserting a thin catheter with a small balloon on the end through your cervix. Once in place, the balloon is inflated with sterile water, creating gentle, constant pressure that encourages your cervix to open. Sometimes two balloons are used (one on each side of the cervix).
What to expect: The insertion can be uncomfortable, similar to having a speculum exam. Once in place, you might feel pressure or cramping. You can usually move around normally with the balloon in place. It typically stays in for 12-24 hours or until it falls out naturally (which means your cervix has dilated to about 3cm).
Effectiveness: Studies show this method causes less discomfort than prostaglandins for many women, though comfort levels vary significantly between individuals. It's beneficial for women who can't have prostaglandins due to previous cesarean sections or other medical reasons.
Side effects: Common effects include discomfort and cramping. Uncommon but possible complications include accidental rupture of membranes, baby moving into an awkward position (malposition), cord prolapse (very rare), or the device becoming trapped and needing removal in theatre.
Important Notes:
Sometimes cervical ripening alone is enough to trigger natural labour
If ripening doesn't lead to labour, you'll need to understand and consent to the next steps
You can ask about comfort measures during any of these procedures
The effectiveness and comfort level of each method vary greatly between individuals
2. Breaking the waters (Artificial Rupture of Membranes - ARM)
This procedure involves your healthcare provider using a thin plastic hook (called an amniocentesis hook) to make a small tear in your amniotic sac during a vaginal examination. In spontaneous labour, your waters typically break near the end of labour, but in induction, this is done earlier to help labour progress.
What to expect: The procedure itself usually isn't painful - just like having a vaginal examination. You'll feel a gush or trickle of warm fluid, and contractions often become stronger and more regular afterwards. Your baby's head pressing directly on your cervix (without the cushioning amniotic fluid) helps encourage dilation.
Why it's done in induction:
Increases the pressure of your baby's head onto the cervix, encouraging it to open
Promotes more regular, effective contractions when combined with synthetic oxytocin
Reduces the very rare risk of amniotic fluid embolism (a serious complication where amniotic fluid enters your bloodstream)
What you lose: The amniotic fluid normally serves important protective functions - it cushions your baby during contractions, protects the umbilical cord from compression, and provides some protection against infection. Once your waters are broken, these protective benefits are gone.
Common side effects:
Bleeding (usually minimal)
Your baby may show signs of stress as contractions become more intense
Contractions typically become significantly more painful as they're no longer cushioned by fluid
Labour often progresses more quickly, which can feel overwhelming
Uncommon but serious risks:
Cord prolapse: The umbilical cord slips down ahead of your baby's head, requiring an emergency cesarean. This happens in about 1 in 556 to 1 in 909 births after ARM
Rupture of placental blood vessels (very rare)
Accidental injury to your baby or cervix during the procedure (scratches, usually minor)
Important consideration: If your cervix isn't ready and ARM doesn't lead to effective labour, you'll likely need synthetic oxytocin to get contractions going.
3. Synthetic Oxytocin (Syntocinon drip)
This involves receiving artificial oxytocin through an IV drip to create strong, regular contractions. While synthetic oxytocin has the same molecular structure as your body's natural oxytocin, the way it works in your body is quite different.
How it differs from natural oxytocin: Natural oxytocin is released in pulses from your brain, influenced by feedback between you, your baby, your uterus, your emotions, and your birth environment. It builds up slowly in early labour, crosses into your brain (providing natural pain relief), and crosses to your baby in small amounts.
Synthetic oxytocin is delivered as a constant stream into your bloodstream, unaffected by the natural feedback systems. It doesn't cross into your brain (so no natural pain relief), acts only on your uterus, and can cross to your baby's brain in very high volumes. This means you miss the gradual build-up and natural pain management that comes with spontaneous labour.
What to expect:
An IV cannula (drip) will be inserted, usually in your non-dominant hand
The medication starts at a low dose and is gradually increased every 30 minutes until you have 3-5 strong contractions every 10 minutes
Contractions typically become strong very quickly, cutting out the gradual early labour phase
Most women find these contractions significantly more intense and harder to cope with than natural contractions
You can ask for a "half dose" to start more gently
Why continuous monitoring becomes necessary:
The constant, strong contractions can stress your baby
Healthcare providers need to watch both your contractions and your baby's heart rate continuously
This usually means being connected to a CTG machine, which can limit your movement
Regular vaginal examinations are offered to check progress (though you can decline these)
Additional effects:
Water retention: Synthetic oxytocin makes your body retain fluids. Combined with IV fluids, both you and your baby may retain more water than normal. This can make your baby appear heavier at birth, then "lose" more weight in the early days, potentially affecting breastfeeding confidence
Faster labour: Many women report that induced labour progresses much more quickly once established
Positioning challenges: The constant contractions give your baby less "breathing space" between contractions and no longer has the amniotic fluid to move into optimal positions for birth
Potential complications:
Hyperstimulation: Overly intense or frequent contractions that can reduce oxygen to your baby
Increased cesarean risk: Especially for first-time mothers (26.5% vs 12.5% in some studies)
Malposition and shoulder dystocia: Less opportunity for your baby to find the best position
Perineal tearing: Particularly for women who've given birth before, due to the speed of descent
Postpartum hemorrhage: Your uterus may become less responsive to oxytocin after prolonged exposure, affecting its ability to contract after birth and control bleeding
Neonatal complications: Your baby may need additional support or resuscitation due to the stress of intense contractions
Breastfeeding considerations: Because synthetic oxytocin doesn't cross into your brain, it doesn't trigger the same bonding hormones as natural labour. While you will, of course overwhelmingly love your baby, some research suggests this may impact early breastfeeding establishment and bonding behaviours, though this varies greatly between individuals.
Your choices
Once you have agreed to Syntocinon, the monitoring and interventions that follow often come as a “package deal”, mainly because it is unsafe for the care provider to give you an induction without taking some or all of these measures. This is why it’s important to understand the effects and consequences of induction before you go ahead. You can discuss ahead of time pain relief options for induction so you have a plan and know what’s available.
Potential risks to consider
Like any intervention, induction carries risks:
Increased chance of cesarean section, especially for first-time mothers
More intensive contractions that may be harder to cope with
Higher risk of assisted delivery or perineal tearing
Possible complications with the baby's positioning
Potential impact on breastfeeding establishment
Additional interventions often become necessary (IV, continuous monitoring, etc.)
Your choices within induction
If you are proceeding with induction, you still have many choices.
During cervical ripening
Choose your preferred method after discussing options. Your hospital may have its own preferred way of doing things, but you are in control.
Decide on comfort measures and pain relief. For example, do you want a heat pack to help with any cramps? Find out if you’ll be able to walk around.
Determine how long to wait for ripening to work. Your hospital may have its own timings, but you can discuss this and decide if it’s acceptable for you.
Choose who you want to be present for support, keeping in mind that this process can take many hours.
For breaking waters
You can decide with your caregiver how long to wait and see if labour establishes before starting synthetic oxytocin.
Discuss what happens if meconium is present.
During synthetic oxytocin labour
Request your preferred environment. For example, do you want the door closed and minimal interruptions? Do you want a darkened room and soothing music?
Choose IV placement. Perhaps you’d prefer it on your non-dominant arm, or in your hand.
Understand pain management options so you can research ahead of time and decide what you prefer, should the need arise.
Request to be consulted before any monitoring or changes to medication dosage
Choose the frequency of vaginal examinations. Most hospitals have a policy to offer one every four hours, but you can request more or none.
Decide on how you’ll push your baby out. Do you want directed pushing? Which may be helpful if you’ve had an epidural, or do you want to follow your body’s urges and not be told when to push?
After birth
Plan for immediate skin-to-skin contact
Discuss cord clamping timing and request that your care provider wait for white.
Plan for placenta delivery. This is likely to be actively managed in an induction, but ask them about options for the type of synthetic oxytocin available and discuss what will happen if your uterus is oversaturated due to the induction.
Prepare for potential NICU transfer decisions.
Tips for your induction
Before your induction:
With the three induction steps in mind, create a birth preferences document outlining your choices for each stage.
Use the BRAIN framework for decision-making: Benefits, Risks, Alternatives, Intuition (How do I feel?, Nothing (What if we do nothing?)
Discuss all options thoroughly with your birth team
Ensure your support person understands your preferences so they can help advocate for you.
Enlist the support of a Doula who can support you with these steps before induction and on the day.
During your induction:
Remember, you can ask for a half-dose of Syntocinon to start
You can request breaks or changes if needed
Communicate regularly with your care team about your comfort
Don't hesitate to ask questions and inform your medical caregiver that you will need some time to discuss decisions with your support person.
For comfort:
Consider bringing comfort items from home, especially for the cervical ripening stage. Books or magazines, podcasts to listen to, music you like, and your favourite snacks. Anything that will help make you feel more at ease.
Plan positions and movement options that can encourage your baby to get into the optimal position for birth.
Discuss pain management options early
Relaxation techniques can still be beneficial
Remember, you're still in control.
“Research shows that women who feel they maintained control during their labour experience greater satisfaction, regardless of how the birth unfolds. An induction doesn’t mean giving up all your choices - it means making informed decisions within a different framework.”
Your birth, your baby
If induction has been suggested for you, take time to:
Understand the specific reasons in your case
Ask about the strength of evidence supporting induction for your situation.
Discuss all your options, including waiting
Consider your individual circumstances and preferences
Create a plan that reflects your values and comfort level
Remember, hospital policy is not the law!
While your healthcare team provides medical expertise, you provide the intimate knowledge of your own body, values, and circumstances. Together, you can make the best decision for your unique situation.
A doula will support whatever decision you make and help you navigate your choices with confidence and information. Your birth experience matters, and you deserve to feel informed, supported, and respected throughout your journey.
Learn more about my birth doula package.
This blog provides general information about induction and does not replace medical advice. It should form part of your research, but it is advised you undertake additional research as well. Always consult with a healthcare professional for personalised advice based on your individual circumstances and medical history.
Contact Kelly
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About Kelly Allen
My name is Kelly, and I’m an emerging birth and postpartum doula who is completing training at the Doula Training Academy. I service women and birthing people in the North Shore of Sydney, helping you enter and emerge from birth and the fourth trimester feeling physically and emotionally well.