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To induce or not to induce - exploring the reasons you may be advised to have an induction.

When you reach the final weeks of pregnancy, the idea of induction might come up during your antenatal visits. You may wonder why your healthcare provider suggests starting labour artificially and whether it is truly necessary. Understanding the reasons that are sufficient or insufficient to induce labour can help you feel more confident in your birth plan and decisions. This post will guide you through common reasons for induction, what they mean for you and your baby, and when waiting for spontaneous labour might be the better choice.


Before we start, I am not against induction of labour as it can save lives when necessary. What I am against is women not being given all their options and being coerced into an unnecessary induction for whatever reason. Informed choice is so so important and you are not properly consenting to an intervention if you are not given all the information. More and more women are being induced so why are we not seeing an improvement in birth outcomes?


In 2023, around 173,074 women were induced in the NHS. This number shows that 33.9% of labours were induced in that year, which follows the trend from 2015/2016. Every review since this has shown an increase. Of those who were induced, one in three ended up having a caesarean section (NMPA, 2025). Induction is an intervention which can open a can of worms and lead to a whole cascade of other interventions. A rise in inductions wouldn't be bad if induction was always beneficial but there isn't enough strong evidence to show it is beneficial for everyone.


Don't get me wrong there are some amazing healthcare professionals out there that give women every option and have very in depth discussions on the pros and cons of inductions - you don't go into the job because you want to coerce women into making decisions. However, in the NHS there is rarely enough time to have a thorough conversation, staff are overworked and it is often virtually impossible. There is a lot of information out there about inductions and this can be used to tell one side of the story. This often causes women to make the decision to be induced thinking it is their best option when it might not be.


Why induction is sometimes recommended


Induction means using artificial methods to start labour before it begins naturally. It can involve synthetic hormones (using pessaries, tablets, gels or infusions) or physical methods such as a cervical balloon catheters, cervical dilating rods and artificial rupture of membranes. Your provider should help you balance the benefits and risks carefully and discuss which timing is best for you and your baby.


Here are some common reasons induction may be advised:


  • Being 'overdue'

    This is when pregnancy lasts beyond 41 or 42 weeks. When you get to 41 weeks, induction may be brought up to prevent you reaching 42 weeks of pregnancy. However around 99 in 100 women do go into spontaneous labour before 42 weeks when they wait for it to start by itself. Certain conditions can cause you to get to 42 weeks (please note this doesn't mean if you are 42 weeks you or your baby has a health condition). The reason you will be advised to avoid getting to 42 weeks is because there is a 30 out of 10,000 risk of having a stillbirth compared to 3 in 10,000 from giving birth prior to 42 weeks. However, 30 in 10,000 is still extremely low and it is unclear whether these 30 babies had other conditions which may have caused them to go past 42 weeks in the first place. If you have gone past 40 weeks in a previous pregnancy or you have a family history of prolonged pregnancies, it is probably safe for you to continue your pregnancy to 42 weeks.

    The reason I put overdue in inverted commas is because the calculation for a due date is very controversial. Even with an accurate date of your last period, only 5% of babies arrive on their estimated due date. This is because gestation length varies from woman to woman (remember I said that women with longer previous pregnancies go on to have more long pregnancies?). This variation between length of pregnancy may be as much as 37 days. Therefore it is completely normal that some women go into labour at 37 weeks and some go into labour at 42 - we are not robots, we are humans and all our bodies work differently. Unless you have another health condition, it isn't necessary to be induced just because you are past your 'due date'.


  • Water breaking after 37 weeks without contractions

    If your water breaks but labour does not start within 24 hours, induction will be discussed with you to lower the risk of infection for you and your baby.


  • Waters breaking under 37 weeks

    This is known as preterm prelabour rupture of membranes (PPROM). You will have the choice of waiting till 37 weeks or being induced straight away. If you wait you will avoid your baby being premature but depending on how many weeks you are and after assessing your individual risk of waiting, you may opt into being induced.


  • You or your baby having a health condition

    Conditions like pre-eclampsia can threaten your health and your baby’s well-being. Induction may be necessary to deliver the baby safely once the condition develops. However certain conditions may not benefit from induction.


Mum's medical reasons for induction

Pre-eclampsia

You will usually be offered an induction or c-section once you are 37 weeks. However, if you have severe pre-eclampsia and you cannot wait past 37 weeks you may be given the option to deliver earlier.


High blood pressure

Whether you have pre-existing high blood pressure or it began during pregnancy, you may be offered an induction or a caesarean after 37 weeks.


Diabetes

You will be offered an induction or c-section after 37 weeks if you have type 1 or type 2 diabetes. If you have complications such as high glucose levels, high blood pressure or a large baby (tread carefully here because growth scans are not always as accurate as you would think). It is also advised by the NHS to avoid going past 41 weeks of pregnancy and you will be recommended to give birth before you reach this milestone.


Intrahepatic cholestasis of pregnancy (ICP) AKA obstetric cholestasis

This is a condition that affects the how the liver functions in some pregnant women. Although a rare condition, your risks of stillbirth increase slightly compared to women without ICP when you get to 38-39 weeks so you will be offered an induction or c-section around this time. If you have severe ICP the risk of stillbirth is 3 in 100 pregnancies so you will be offered an induction at 35-36 weeks.


Chorioamnionitis

This is a condition that is associated with the membranes surrounding baby being inflamed and sometimes infected. It can happen antenatally, during labour and postnatally and affects around 4 in 100 babies born after 37 weeks. In premature babies it is a lot more common and may be as high as 70 in 100. Chorioamnionitis is treated with antibiotics but you might be advised to get an induction.


Placental abruption

This is when the placenta begins to separate from your womb before the delivery of your baby. Placental abruption can cause stillbirth so if it is diagnosed you will be advised to either have an induction or a c-section.


Rhesus disease

This is a condition where the antibodies within your blood destroy your baby's blood cells. If necessary, it may be advised for babies to be born via induction or c-section after 34 weeks of pregnancy to treat baby as soon as possible, as severe anaemia caused by rhesus disease can lead to stillbirth.


Baby's reasons for induction

If your baby is unwell and will either not improve or worsen by you remaining pregnant, you will be advised to have an induction.


Fetal growth restriction (FGR)

if your baby's growth has slowed down dramatically or stopped altogether based on their growth chart, along with a doppler showing reduced blood flow. This may suggest that the placenta isn't working as well as it should be. These babies benefit from induction as it significantly reduces the risk of stillbirth. If a baby isn't strong enough to go through labour, doctors will discuss having a c-section instead. However if the baby is just a little on the small side with normal dopplers and their growth is following the pattern of their growth chart, an induction probably isn't necessary.


Oligohydramnios - low levels of amniotic fluid

There is no evidence that isolated oligohydramnious (low levels of amniotic fluid) is a risk factor for poor outcomes, despite previous beliefs. However, induction for this reason has been shown to lead to a higher rate of caesarean sections. Poor outcomes that are seen in babies with oligohydramnios are usually associated with other conditions, for example pre-eclampsia and birth defects.


The main risk of low amniotic fluid is induction and caesarean section as a result of induction. Therefore, oligohydramnios alone is not a good reason for induction. 


Big baby

If you have a scan at 36 weeks or after and you are told you are having a baby, you may be advised to have an induction. It is important to note that scans can be very inaccurate and you may be told you have a large baby when they are not. When it comes to having a large baby, there are pros and cons to induce and not to induce. The main risk when giving birth to a large baby is developing shoulder dystocia which is where one of your baby's shoulders gets stuck. The statistics are as follows:

  • 4 in 100 of large babies of those who were induced may have shoulder dystocia.

  • 7 in 100 of large babies of those who went into labour naturally may have shoulder dystocia.

So there is a slightly decreased risk of shoulder dystocia in babies born after an induction.

A risk of inducing labour with a large baby is sustaining a third or fourth degree tear.

What happens is based on what you decide is preferable for you.


What induction means for your birth experience


Induction can change how labour unfolds. It may lead to a shorter or longer labour depending on your body’s readiness. Some women experience more intense contractions or need additional pain relief. There is also a higher chance of needing a caesarean birth and instrumental birth if induction does not progress well. You and your baby will be closely monitored during induction to ensure you are both coping with the intervention. For around 15% of women, induction simply does not work. On the other hand, 5% of women experience hyperstimulation where the womb contracts too much and will likely cause changes in baby's heart rate. Certain interventions done for induction can also increase your chance of getting an infection, such as having your waters being artificially broken and additional vaginal examinations.


In what circumstances will induction not be recommended?


  • Your baby is in a breech position

  • You have placenta praevia (your placenta is covering your cervix)

  • Your baby is not strong enough to undergo a vaginal birth


When waiting for labour is a good choice


If your pregnancy is healthy and you have no medical concerns, waiting for labour to start naturally is often the best option. Your body knows when it is ready to give birth, and spontaneous labour usually leads to fewer interventions and better outcomes.


It can be tempting to opt for induction when you reach your 'due date' as you feel like you have been pregnant for ages, your back hurts, you're exhausted and you just don't want to wait any longer to meet your little one! However, going down the route of induction when not medically necessary can lead to further interventions and poorer outcomes - why mess with the body's natural processes when nothing needs fixing? Our bodies have been giving birth for thousands of years - you CAN trust it!


You can prepare for labour by staying active, practising relaxation techniques, and discussing your birth preferences. If induction becomes necessary later, you will be informed when this happens and your options should be discussed with you.


Making the decision that’s right for you


Every pregnancy and birth is unique. The decision to induce labour should be based on clear medical reasons and your personal situation. Ask questions, seek second opinions if needed, and trust your instincts. Take your birth into your own hands and do research (from reliable resources). Why not hire a doula to help advocate for you and your family? If you check out my Instagram (Megan_the_doula), I share lots of useful, unbiased information on all things pregnancy, birth, postpartum and newborns!


Remember that induction is a tool to help when there are risks in waiting for labour to begin naturally. It is not a routine step for all pregnancies. Your healthcare provider’s goal is to keep you and your baby safe while respecting your wishes.


Useful resources:

Sara Wickham - Ten things I wish every woman knew about induction of labour: https://www.sarawickham.com/articles-2/induction-of-labour/


 
 
 

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