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This page provides information about induction of labour to pregnant women and their families, to help make informed choices. It is based on a national, evidence-based clinical guideline about induction of labour.

The list of risks included below are not all-inclusive.

Induction of labour is the process of artificially starting labour.

For most pregnancies, labour naturally starts between 37 and 42 weeks, and results in the birth of your baby. 

Your midwife or doctor may recommend induction of labour to you, if it is felt that you or your baby’s health will benefit from your baby being born sooner than waiting for natural labour to occur. On average, one in every three labours are induced.

The most common reason for induction is that your pregnancy is 7 to 14 days over your expected due date. We offer induction of labour at this time, as the risks for you and your baby start to rise at that stage. Other reasons for induction include gestational diabetes, concerns about the growth of your baby, if your baby is not moving as much, or if your blood pressure is raised. We will offer you an induction of labour if your waters break but labour does not start itself by a certain time.

Occasionally, we may delay the start of your induction if the activity on the maternity unit is high. If this occurs, you will be called on the morning of your planned induction and we will discuss with you the reason for delay. We understand that this can be disappointing, we will only delay your induction if it is necessary and will keep you updated about when we can start your induction, which for most cases is later in the same day.

On rare occasions, high activity on the Labour Ward can cause a delay in transferring you from the Antenatal Ward to the Labour Ward, and we have to prioritise which people are transferred to Labour Ward. This decision is based on clinical need, and if there is a delay in your transfer, your midwife will tell you why there is a delay and support you.

There are several different ways that can induce your labour. You may be offered one or more methods of induction described below, depending on your pregnancy.

The midwife or doctor will let you know where to go and what time your induction of labour is booked for. You will get confirmation of this on the My Frimley Health App. Many women will start their induction on the Antenatal Ward, unless you have been instructed to go to the Labour Ward.

On the Antenatal Ward you can have one supporting birth partner remain with you between 06:00 and 23:00, all other visiting is 14:00 to 20:00 with no more than two visitors to a bed space. There are no sleeping facilities for birth partners/visitors overnight so they will need to return home to rest prior to labour starting and caring for a newborn; unless there will be an imminent transfer to Labour Ward or you are in pain or contracting regularly and need support.

If you have special circumstances around our visiting times, please discuss this at your antenatal appointments, so arrangements can be put in place and agreed in advance with the midwife in charge.
We ask you to respect all other patients on the ward who are all in different circumstances. We ask that visitors do not use the patient toilets on the ward, but instead use the visitor toilets located outside the ward entrance

When transferred to Labour Ward, you can have two birth partners to support you.

Membrane sweeping involves your midwife or doctor placing a finger just inside your cervix and making a circular, sweeping movement to separate the membranes from the cervix. It can be carried out at home, at an outpatient appointment or in hospital. This has been shown to increase the chances of labour starting naturally within the next 48 hours and can reduce the need for other methods of induction of labour. Your midwife will discuss a membrane sweep with you from 39 weeks or before your scheduled induction.

If you have agreed to induction of labour and you fit the criteria above, you will be offered membrane sweeping. The procedure may cause some discomfort and/or slight bleeding but will not cause any harm to your baby and will not increase the chance of you or your baby getting an infection. You may be offered more than one membrane sweep. Membrane sweeping is not recommended if your membranes have ruptured (water broken).

Midwifery-led post-dates clinics are available within Wexham Park and Frimley Park maternity services. If you have a low risk pregnancy and are overdue, your community midwife can signpost you to the available services. This appointment will include an antenatal check, a stretch and sweep and complimentary therapies.

Prostaglandins are drugs that help to induce labour by encouraging the cervix to soften, shorten and move forward (ripen). This allows the cervix to open and contractions to start. 
Prostaglandins can be given vaginally or orally. This is done in hospital, usually on the Antenatal Ward. 

Propess

The pessary will be inserted into your vagina behind your cervix and will be taken out when you are in labour, or after 24 hours. If you are not in labour after 24 hours you will be examined to see if it is possible to break your waters.
If you are being induced for:

  • Post maturity (41-42 weeks) without any risk factors
  • Maternal request at 39-41 weeks without any other risk factors
  • Pelvic girdle pain/discomfort at 39-41 weeks without any other risk factors
  • IVF pregnancy with no other risk factors

You may be able to go home following the insertion of the pessary and monitoring of the fetal heart rate. You will be asked to return within 24 hours if labour has not started. We do not recommend going home if you live in an area not covered by Frimley Health community midwives. If your labour starts before 24 hours, please refer to the ‘going home following insertion of Propess’ leaflet provided.

If your waters cannot be broken after the Propess pessary, or you come in and your cervix is already favourable, you are likely to be advised to have a balloon catheter.

Before giving prostaglandins, your midwife will check your baby’s heartbeat. This is done using an electronic fetal heart rate monitor (also known as a CTG) and usually takes around 20 minutes. After being given prostaglandins, the baby’s heartbeat will be monitored for approximately 30 minutes to one hour with the CTG.

While you are an inpatient, monitoring will be repeated every six to eight hours following the insertion of the prostaglandin.

If you require pain relief, or your contractions become regular, your midwife will monitor your baby’s heartbeat using a CTG. The CTG will be discontinued if there are no problems, and you will be able to move around. If continuous CTG monitoring is advised due to concerns with you or your baby, we would arrange transfer to Labour Ward.

Occasionally, prostaglandins can cause the uterus to contract too much. If you have a Propess® pessary in, we may need to remove it to slow your contractions down. There is also medication we can give to help relax the uterus, and this would be discussed with you if needed. Contracting too much can also sometimes affect the pattern of your baby’s heartbeat. If this occurs, you may also be advised to change position and lay on your side, a doctor would be asked to review you, and you may be transferred to Labour Ward for continuous CTG monitoring.

Oral Misoprostol Tablets

Oral misoprostol is a medicine used to help start labour. It works by softening the cervix and helping contractions begin. The medicine is given as a tablet to swallow every 2 hours, up to a maximum of 8 doses.

Before your first dose, your baby’s heartbeat will be checked. During the induction, your baby will be monitored regularly to make sure they are coping well.

You will also be offered a vaginal examination at the start of the induction and again later if needed. This helps your midwife or doctor assess whether your cervix is changing and whether labour is starting.

While taking misoprostol, you can usually eat, drink, shower, bathe and walk around.

Some women notice period-like cramps after taking the tablets. These cramps may become stronger as labour begins.

Some women will go into labour after taking misoprostol. Others may need additional methods to continue the induction, such as:

  • Breaking your waters
  • An oxytocin drip to begin or strengthen contractions

If your waters cannot be broken after 8 doses, your care team will discuss the next steps with you. This may include another method of induction or a caesarean birth. This happens in around 8% of cases.

Misoprostol may not be suitable if:

  • You have had previous surgery on your uterus, including a previous caesarean birth
  • Your baby is not coping well before induction starts
  • Your waters contain meconium (your baby’s first poo)
  • You are bleeding from your vagina
  • Your baby is not head-down
  • You have kidney failure
  • You have a low-lying placenta or accreta
  • You have an allergy to misoprostol
  • You are already in labour
  • Your doctor or midwife will discuss whether misoprostol is suitable for you.
Side Effects & Risks Benefits

May occasionally lead to nausea and vomiting but it is uncommon.  If this happens, we can provide medication to reduce these side effects.

May work more quickly compared to other methods of induction

Has a high chance of vaginal birth

It may cause contractions that are too strong or frequent (Hyperstimulation). If this happens, we can provide medication to reduce these side effects.

May be preferred by women who want fewer vaginal examinations

Is less likely to cause very strong or very frequent contractions compared to Propess
  Has the highest patient satisfaction rate

Using an intracervical catheter

A balloon catheter can be used to soften and open your cervix so your membranes can be broken. This has shown to be a very safe method of induction of labour with very minimal risk to you and your baby. 
 
The procedure involves a catheter (a soft silicone tube) being inserted into your cervix with a balloon at the tip that sits inside. The balloon is filled with saline (sterile salt water) and rubs against and stretched the cervix, causing it to produce a hormone called prostaglandin. This balloon puts pressure on your cervix, just enough to start labour or trigger your waters to break naturally or allow a midwife to be able to break the waters around your baby.

Once the catheter is in place it will remain in for 24 hours, you will need to stay in hospital but you will be able to move around normally. Your baby’s heart rate will be monitored intermittently during this time. You will be examined 24 hours after the catheter has been inserted or if the catheter falls out. A plan will be made for the next stage of your induction, and this varies from woman to woman.

The balloon is made from a soft clear plastic called silicone. It will not cause any harm to your baby. Risks from its use are infrequent, overall, less than one in 1000. Your membranes may be accidentally broken whilst the balloon is being inserted. This will not stop the balloon from working, but your doctor may recommend that a Oxytocin drip is now a better option.

Risks Benefits
When the balloon is being filled you may feel faint. The procedure can be done more slowly once it is better tolerated. This usually settles when the procedure is complete.  If the procedure is successful, you may be able to go into labour or have your waters broken which is the next stage of the induction process.
There is a small risk of infection with a balloon catheter. If an infection is suspected in your womb, your baby will need to be delivered by the quickest possible method and this will not necessarily be by caesarean section (CS).  Successful induction of labour gives you a chance to have a normal birth, with further benefits of avoiding the risks of a caesarean section and may enable you to leave the hospital earlier.
The balloon may not achieve its purpose; your cervix may not open or dilate. In this case, further discussion with an obstetrician is required.  

Criteria for Prostaglandin and Intracervical balloon methods of induction

Propess® should only be used if you fulfil the criteria below and if you prefer this over the misoprostol (Angusta®) method of induction. All the following criteria need to be met:

  • Term pregnancy, 37- 42 weeks. (Propess® is not licensed for use at less than 37 weeks but can be used if you have had a consultation with an obstetrician and this is written in your electronic notes).
  • Your baby is cephalic presentation (Head down)
  • Your membranes are intact
  • You have no previous uterine scar
  • You have had no more than 3 full term vaginal births

Intracervical balloon method of induction can be chosen if you fulfil the following criteria:

  • You had a previous Caesarean Section
  • Fetal growth restriction
  • You are a Grand-multip (You have had 4 or more babies)
  • You have had a previous precipitate labour
  • You have had a previous myomectomy with no breach of the uterine cavity
  • If you have had a reaction to prostaglandins before
  • Maternal choice

When your cervix has opened enough to break your waters and your waters have not broken on their own, a procedure called an ‘amniotomy’ would be recommended to continue your induction. This procedure is performed on Labour Ward, so when Labour Ward can accept you, you will be transferred to your birthing room. Please be aware that we aim to transfer you as soon as possible, however when we have high unit activity, we aim for this to be within 24 hours.

With an ARM, your midwife or doctor makes a hole in your membranes to release (break) the waters and stimulate contractions. It is done through your vagina and cervix, using a small plastic instrument. The vaginal examination needed to do this procedure may be uncomfortable for you but your midwife can support you. After your waters are broken, your baby’s heartbeat will be monitored to ensure all is well.

Following this, you will be encouraged to move around or go for a walk around the hospital. If your contractions haven’t started after two to four hours, your midwife or doctor will suggest using oxytocin.

Oxytocin is a drug that stimulates contractions. It is given through an infusion (drip) into a vein in your arm. Once the contractions have begun, the rate of the drip is adjusted so that your contractions come every 2-3 minutes until your baby is born. Oxytocin is given in hospital in the delivery room on the Labour Ward.

Oxytocin is only given after your waters have broken. Being attached to the oxytocin infusion will limit your ability to move around. Whilst it may be possible to stand up, kneel or sit down, you will not be able to have a bath or move from room to room.

While you are having oxytocin, your baby’s heartbeat will be checked continuously using a monitor on your tummy (CTG). This helps the midwife make sure your womb is not tightening too often or too strongly, and that your baby is getting enough oxygen and coping well. Very occasionally, oxytocin can make the womb contract too much, which can make it harder for your baby to get the oxygen they need.

If the midwife or doctor sees this on the monitor, they may ask you to lie on your left side, and they may turn the drip down or stop it so the contractions become gentler and your baby can recover.

Prostaglandins can cause pre-labour pains, making you feel more tired and this can make labour seem more painful. This is similar to the latent (early labour) phase that many women experience when they go into spontaneous labour.

There are a range of choices for pain relief which can help. For further information on pain relief, please refer to ‘options for pain relief’ information on your My Frimley Health App.

It is very difficult to judge how long any labour will take, and induction of labour is no different. It can take up to three days for your cervix to open enough for us to be able to break your waters or for labour to become established.

Everyone responds differently to the methods used and will come in for induction with different findings on their examination.

We would recommend preparing to be with us for a few days and you will be updated with your progress as the process goes on.
Induction usually takes longer if it occurs earlier in the pregnancy and if it is your first baby.

 

During the initial stages of induction and early labour, there are no restrictions on your mobility. We encourage mobilisation to bring on contractions and encourage baby to move down. You can mobilise off the ward, around your bedspace or use the Poppy Room (At Frimley Park Hospital) or Bubble Room (at Wexham Park Hospital) which is set up with dim lighting and bean bags.

If we have concerns with your baby’s heartbeat or if you have an oxytocin infusion, we advise having your baby’s heartbeat continuously CTG monitored. This makes mobility more difficult, although you are still able to sit on a chair or a birthing ball rather than on the bed. We do also have telemetry on Labour Ward which is wireless CTG monitoring, to enable mobilisation. Additionally, you can stand, kneel, or rest on your hands and knees, and our Labour Ward beds can be adjusted into a seat/throne position.

Induction may cause strong contractions that stress the baby. Monitoring of your contractions and the baby’s heartbeat during induction is an important part of the procedure. If your contractions are strong or very close together, you may be given medication to reduce them again. If this is left untreated, it can cause distress in your baby or uterine rupture.

The aim is to enable you to have a normal birth, but there is an increased risk of an assisted birth (forceps or ventouse) or a caesarean section in labours that are induced.

Induction can fail to start labour for some women. If this happens, your doctors and midwives will discuss your options depending on your circumstances. These include waiting longer for spontaneous labour, trying to induce a second time, try an alternative method of induction, or having a caesarean section. 

If your midwife or doctor recommends induction of labour, but you do not wish to have your labour induced, you will be offered an appointment with a senior obstetrician. This appointment will be to discuss in more detail the risks and benefits of induction of labour for you and your baby. If you decide not to have your labour induced, you will be offered more frequent opportunities to monitor you and your baby’s health using an ultrasound and CTG.

It is important to understand that even extra monitoring cannot always predict or prevent serious problems for you and your baby.

The choice of whether or not to have your labour induced is ultimately yours. The midwives and doctors are here to help you make an informed choice. We hope this leaflet will help answer your questions.

Alternatively, you can contact the hospital midwives on:

  • 0300 613 4231 if you are having your baby at Frimley Park Hospital
  • 0300 615 4516 if you are having your baby at Wexham Park Hospital

Contact us

If you have any queries relating to this information, please contact the Maternity service.

About this information

Service:
Maternity

Reference:
M/029

Approval date:
1 June 2026

Review date:
1 June 2029

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This page provides general information only. It is developed by clinical staff and is reviewed regularly every 3 years for accuracy. For personal advice about your health, or if you have any concerns, please speak to your doctor.