Induction of Labour: What It Really Means, When It’s Needed, and How to Prepare

Sep 25

The word induction can often bring up fear or resistance, but it doesn’t have to. While induction may be seen as unnatural, the result of obstetric pressure, or inevitably negative, that isn’t always the case. The key, as always, is informed consent. When you are given all of the information, you can make the decision that feels right for you and your baby and go into it feeling calm, knowing you are in control of the choices you are making.

While your OB, family doctor, or midwife should provide you with all the information you need to make true informed consent, unfortunately that doesn’t always happen. Many women also fear that asking too many questions will make them seem annoying, distrustful, or even “stupid.” My goal for this post is to break down what induction really is, why it’s offered, the actual statistics behind it, and to share questions you can ask and guidance on how to move forward feeling confident in your decision.

What Is Induction of Labour?

Induction is the medical process of starting labour artificially before it begins on its own. In other words, your baby is not fully “done cooking” and your body has not yet been signaled to begin labour, so certain interventions are used to nudge things along.

Common methods include:

Membrane sweep (non-pharmacological)
Cervical ripening agents (prostaglandins, Foley balloon)
Amniotomy or Artificial Rupture of Membranes (breaking the waters)
Oxytocin (Pitocin/Syntocinon) infusion

Induction vs. Augmentation

A common question is: “If I received oxytocin in the hospital but I went in with contractions, does that mean I was induced?”

Not exactly. While it’s similar, this is called augmentation of labour. The difference is that induction starts labour from ‘zero’, while augmentation speeds up a labour that has already begun.

Why speed things up? Natural, physiological labour can be slow. It’s normal for first labours to last days, with irregular contractions gradually dilating the cervix. For many women this feels exhausting, especially when contractions intensify overnight and slow down during the day, making sleep difficult. By the time they arrive at the hospital, they may be three to four centimeters dilated but progressing slowly.

With an induction, the first step is usually cervical ripening. This can be done with prostaglandins (such as misoprostol/Cytotec®) in gel, pill, or suppository form, or by mechanical methods such as a Foley balloon. The balloon is inserted into the cervix and filled with sterile saline. The pressure against the cervix can promote dilation and it will usually fall out once the cervix reaches at least three centimeters.

After the cervix has softened and dilation has started, the next common intervention is an amniotomy (breaking the waters). This can help things move along but doesn’t always. It also creates certain time constraints that we’ll talk about later.

To keep labour progressing, Pitocin is commonly given (either before or after breaking the waters, depending on hospital policy). Pitocin is a synthetic version of oxytocin, the natural hormone that stimulates uterine contractions during childbirth and lactation. Pitocin is administered through a continuous IV, which means you’ll be attached to an IV pole and continuous fetal monitoring. This limits mobility options and can reduce access to natural pain relief measures like showering or using a tub. You’ll essentially be attached to multiple wires or cords (like a “leash”) and can only move so far from your bed, unless your hospital has wireless monitoring available.

For some women, rupturing the membranes (breaking the waters) is enough to get things going, and that alone can intensify contractions to the point where an epidural feels necessary. For others, not much happens until Pitocin is started. Once contractions intensify, things can pick up quickly; whether in cervical dilation or in the perception of pain, which can lead to requesting an epidural. With an epidural, mobility is extremely limited in most cases, leaving you bound to your bed. Without movement and gravity, progress can sometimes slow down.

Pitocin vs. Natural Oxytocin

Natural oxytocin crosses into the brain and helps create emotional bonding, feelings of calm, and the release of endorphins, which are the body’s natural pain relievers. These endorphins help you cope with the intensity of contractions and support you in moving through labour. Pitocin does not cross the blood-brain barrier, so it doesn’t trigger the same hormonal or bonding effects. Contractions from Pitocin are often more intense and closer together, which can overwhelm your body’s ability to produce enough endorphins, making the pain feel harder to manage and increasing the likelihood of requesting an epidural.

Why Induction Is Offered

Common medical reasons for induction include:

Post-dates pregnancy (41+ weeks)
Concerns about maternal health (preeclampsia, diabetes, high blood pressure)
Concerns about baby’s well-being (low fluid, growth restriction, decreased movement)
Premature rupture of membranes (waters breaking) with no contractions

Elective reasons may include:

Convenience or scheduling
Partner availability
Maternal anxiety
Personal request
Ensuring your medical provider is on call

What Does the Evidence Say?

A Cochrane review of 30 randomized controlled trials with over 12,000 women compared induction with expectant management (waiting) in term and post-term pregnancies. Induction was associated with a decreased risk of perinatal death and fewer cesarean deliveries. Based on this and other data, induction is recommended after 42 weeks and can be considered at or after 41 weeks.

For example, in a large California study (1997–2006):

At 42 weeks, the mortality risk of waiting was 17.6 per 10,000 pregnancies
At 42 weeks, the mortality risk with delivery was 10.8 per 10,000 pregnancies

Scaled down:

Waiting → about 1.8 deaths per 1,000
Delivering → about 1.1 deaths per 1,000

So while the risk almost doubles, it’s important to highlight that the actual difference is less than one additional death per 1,000 pregnancies.

Why Are Inductions So Common?

In Canada, induction rates rose from 12.9% in (1991-1992) to 21.8% in (2004-2005), holding steady until climbing again to 32.5% during the pandemic (2019–2020) and around 34% in recent years.

One reason is the ARRIVE trial (2018), which found that for low-risk, first-time mothers at 39 weeks, elective induction lowered the rate of cesarean births compared to waiting. This shifted practice patterns. However, the study did not consider maternal experiences of highly medicalized labours or the long-term impacts on postpartum well-being.

In fact, an Italian study following 161 women found that those with spontaneous labours reported lower levels of anxiety and depression three months postpartum compared to women who were induced.

Birth is not just about a single day. It marks the beginning of a transformation that continues into the postpartum period, with profound effects on a woman’s mental health and her relationship with her baby. Focusing only on short-term safety while ignoring these longer-term factors is concerning, especially for women with a history of mental health challenges.

Benefits of Induction

Reduces certain risks such as stillbirth in prolonged pregnancies and complications from high blood pressure. High blood pressure can progress to preeclampsia or HELLP syndrome, placing both mother and baby at risk. While medications may help temporarily, they do not always control the condition. Because the placenta drives these complications, the only way to truly stop the progression is to deliver the baby. In these situations, induction is often the safest choice.
Sometimes safer for the baby than waiting longer. For example, with low amniotic fluid, growth restriction, or decreased movement. Induction is sometimes suggested when doctors think the amniotic fluid is either too high or too low. The tricky part is that we don’t fully understand how amniotic fluid is regulated, or even what the true “normal” range should be. There also isn’t a perfectly accurate way to measure it, and experts don’t all agree on what counts as “too much” or “too little.”
- The reliability of IUGR (intrauterine growth restriction) assessment is also challenged by the difficulty of distinguishing constitutionally small babies from those with actual growth restriction, and by the need for accurate gestational dating.
- Another important point: when you are told the estimated weight of your baby in utero, it’s just that—an estimate. Ultrasound estimated fetal weight (EFW) typically has a margin of error of about 15%. This means an ultrasound predicting a 7-pound (about 3.2 kg) baby could mean the actual birth weight is anywhere from 6 to 8 pounds (about 2.7 to 3.6 kg).
Inductions provides reassurance when there are genuine concerns.

Risks and Considerations

Stronger, more intense contractions can increase epidural use
Induction can trigger a cascade of interventions (continuous monitoring, limited mobility, assisted birth with vacuum or forceps)
Sometimes inductions do not work, leading to cesarean
Emotional impacts, such as feeling rushed or losing the natural rhythm of labour

Once your waters are broken, the risk of infection increases over time. Long Pitocin infusions can stress the baby’s heart, and sometimes no matter what is done, your body is simply not ready to progress at the hospital’s pace. This is when labour may be labeled “failure to progress,” or more accurately, labour dystocia, often leading to a cesarean.

Every hospital has its own policy, and policies can vary greatly from country to country or even hospital to hospital. You can always ask your doctor or midwife ahead of time what the policy is at the hospital where you’ll be delivering.

How to Approach the Conversation

Questions to ask your provider:

Why are you recommending induction?
What happens if we wait 24–48 hours?
What are the risks and benefits of each method?
Can we try one method first before moving to another?
How long do you wait after my waters are broken to declare “prolonged rupture of membranes,” and what are my options at that point?

Remember, you have the right to pause, reflect, and decide. You don’t have to agree to something you don’t understand or feel comfortable with. Ask as many questions as you need, and if you want more time, say so.

Making Induction More Gentle and Physiological

If induction becomes part of your story, you can still make it gentle and positive:

Use movement, upright positions, and gravity to help labour progress
Delay the epidural if possible; if you choose one, request a “walking epidural” and use pillows or a peanut ball to keep the pelvis open. (Note: a “walking epidural” usually means you can still move your legs, but most hospitals will not allow you to actually walk regardless of the type of epidural)
Request intermittent or wireless monitoring if safe
Create a calming environment with dim lights, music, affirmations, or candles
Surround yourself with supportive people such as a partner or doula
Use comfort measures like breathing, water therapy, massage, or hypnobirthing when possible

Conclusion

Induction is not “good” or “bad.” It is a tool. Used appropriately, it can keep mother and baby safe. Sometimes, however, it is suggested for convenience. The choice, as always, is yours. While induction has clear benefits, it also comes with considerations, just like any medical intervention. It’s important to weigh these carefully and consider how induction may affect not only your birth experience but also your postpartum journey.

With knowledge, preparation, and the right support, you can approach induction from a place of empowerment instead of fear. And if it becomes part of your birth story, it can still be meaningful, supported, and powerful.