Induction of Labour Part 1: Who, Why, and When, and the Importance of Consent

Who is offered induction of labour, and why? What do the guidelines say? What are your rights? What are the risks?

By Sam The Doula (Blooming Miracle)Published 3 years ago • Updated 2 years ago • 4 min read

Induction of Labour Part 1: Who, Why, and When, and the Importance of Consent

How many women have their labour induced?

At the time I did my antenatal teacher training (a decade almost to the day, as of writing this post), the statistic was 1 in 5 birthing women here in the UK would be induced. (I believe my local area had a higher rate.)

Early on in my teaching career, I made sure to talk about induction at least once during each course because I knew some people in the room were definitely going to need that information.

That rate has risen plenty over the last few decades. It was 1 in 10 back in the mid 90's, and up to 1 in 4 in 2018. (Source) As of March 2021, it was up to 1 in 3. (Source.)

(An aside: I wonder, when our daughters and granddaughters have children, what miniscule proportion of them will begin labour spontaneously? What effect might this have on women and babies collectively? What does this say about the pathologisation of female bodies? A post for another day, maybe.)

Here and now: it's important to arm yourself with facts antenatally, because you're statistically likely to be offered induction. You need to know the pros and cons so you can make an informed decision. If you accept induction, there are several ways that can go, and you need information to help you navigate that. If you decline, you're likely to need information and support with that, as well.

Who is offered induction? Why is labour induced?

A woman might be offered induction if:

she's gone past her estimated date of birth
her baby is not growing as expected (IUGR)
her baby is predicted to be very large
her waters have released
she's considered "old" (might be expressed as something like "advanced maternal age" - charming!)
she has a health condition that means she needs to give birth soon (eg. pre-eclampsia
her baby has a health concern that means s/he needs to be born soon
she has diabetes
she's carrying multiples (twins or triplets)

(In 2021, proposed guidance suggested induction at 39 weeks for women belonging to an ethnic minority. I believe this has been changed, following criticism, to offering those women additional support. Please do correct me if I'm wrong!)

It's worth noting that many of those things on that list would not be a reason for induction, for me. I'd decline. Some of those things, I would accept induction. Some I consider logical contraindications for induction. In those cases, I might request caesarean birth instead.

Your own circumstances and comfort level are sure to differ from mine. I recommend doing your own reading, discussing with your midwife and weighing the options.

I must reiterate: I'm not a medical professional and cannot advise you, nor diagnose you or your baby. I am here only to share information, as plainly as I can, to support women in making the choices that are right for them.

Am I allowed to decline induction?

The most important thing I want you to be aware of is that most of the time, whether to be induced is a personal choice. You have the right to decline.

What are the risks?

First, please be reassured that in many cases, the risk of something terrible happening to you or your baby is miniscule either way - whether you choose to be induced or wait out your pregnancy. For example if you are being induced because you've gone past your estimated date of birth (a very common reason for induction). (Source.)

If you are induced, there is a higher chance of further intervention. You are likely to be monitored more closely, depending on which type of induction is chosen. You are more likely to request pain relief. Some kinds of pain relief (like pethidine or epidural) are risk factors in themselves, and might also trigger more monitoring. All these factors mean it is trickier to use techniques to help your baby be born more easily. For example, it's more tricky to stay mobile, and this alone affects how your labour unfolds, and how smoothly your baby is able to move down through your body. You might be more likely to need more help as labour progresses - needing forceps or ventouse, for example. Or the induction might not work well and you need a caesarean.

Some women don't mind any of this, but others prefer less intervention if possible. Many induced labours often (not always, but often) involve more intervention. Each of those interventions also carries risk. The tough truth: there's no completely risk-free option.

The importance of your choice

It's important that you are happy with the care you're given as you bring your child into the world. It's a momentous occasion, and a rite of passage. You absolutely have a say in how that happens.

In Conclusion

As with anything, there are pros and cons to induction of labour. Like all medical offerings, it carries some risk. It is a valuable tool, but probably wildly overused.

Each woman's vision for the birth of her baby is a significant factor, and her needs and wishes remain important. Education is key. Knowledge is power.

Here are my suggestions for activities to try at the end of your pregnancy:

Happy Birthing!

S x

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Coming up in Part 2: The different types of induction including a brief overview of what is involved, and the pros and cons.

Thank you for reading. I'd love to hear your experience!