Induction of Labour (IOL)

Your LMC has directed you here to prepare yourself for a possible induction of labour (IOL).
Induction of labour is a process used to gently encourage pēpi and the body to begin labour when continuing the pregnancy is no longer the safest option. It can involve methods that soften and open the cervix or stimulate contractions and is planned together with you after careful kōrero about your health, your baby, and your preferences.

 

Frequently asked questions

What is an induction?

Induction of labour is when labour is started artificially, rather than beginning naturally on its own. This may involve medication, breaking the waters, or both.

Why might induction be recommended?

Your LMC or obstetric team may recommend induction if:

  • You are overdue (usually 41+ weeks)

  • Your waters have broken but labour hasn’t started

  • There are concerns about pēpi’s growth or wellbeing

  • You have medical conditions such as pre-eclampsia, diabetes, or high blood pressure

  • There are concerns about reduced movements

The goal is always the safety of both you and your baby.

How long does an induction take?

It varies. For some, labour establishes within hours.
For others (especially first babies), it can take 1–3 days depending on how ready the cervix is.

Induction is often a process, not a quick event.

Is induction more painful?

Induced contractions can feel stronger and closer together, particularly with oxytocin. Many wāhine choose additional pain relief, but this is entirely your choice and support is always available.

Can I use the birth pool if I’m induced?

Unfortunately, it is not recommended. CWH is limited in terms of birthing pools. It is also recommended to have continuous CTG monitoring. CTG equipment is not able to be used in the water, which means the birth pool is generally not an option during an induced labour. 

We know the pool can be a comfort measure, so we’ll always support other ways to help you feel calm, involve water, and feel well supported throughout your labour.

What should I bring/how should I prepare?

We encourage you to take: 

  • Water bottle (and keep really well hydrated)
  • Snacks
  • Chargers
  • Comfortable clothing
  • Entertainment (devices etc) 
  • Hospital bags

Can I move around during induction?

Yes, during most parts of your induction you are free to move around, and you are not confined to your room.

Once labour is established, you are moved to a birthing room. Continuous CTG monitoring is recommended to keep an eye on baby’s heartbeat and your contractions. This can limit larger movements, but you can still change positions, sit upright, stand, or use a birth ball with support.

What are the risks of induction?

Like any intervention, induction has benefits and risks. These may include:

  • Strong or frequent contractions

  • Baby becoming distressed

  • Increased chance of assisted birth (forceps or vacuum)

  • Increased likelihood of caesarean (especially if induction doesn’t progress)

Your obstetric team will discuss your individual situation so you can make an informed decision.

What is the process?

Once you have your IOL date, you will arrive to level 3 CWH (birthing suite). Once you are there you will be admitted to the assessment part of the ward where you will be looked after by a hospital team of midwives. They will explain and start the process of an IOL.

Once you are in established labour, the hospital midwives will contact your LMC, and she will come in then. This is also when you will be moved to a birthing room (if you have not already been). 

Can I have support people with me?

The assessment space is small, so you may want to limit visitors during the early stages of induction. You are welcome to have one support person with you overnight.

Once labour is established and you are moved into a birthing room, you are welcome to have whoever you would like with you for support.

What happens if i decline an IOL?

Choosing to decline is your right. If you decide to wait, we will usually recommend increased monitoring such as CTG, scans, blood pressure checks or blood tests, depending on the reason induction was suggested.

The original concern does not disappear, so ongoing kōrero and review of the plan is important. We will continue to support you and revisit decisions together. 

Methods of IOL

MISOPROSTOL

This medication is a liquid made from a small tablet dissolved in water and is taken every two hours, up to eight times in one day. It works gently to soften and prepare the cervix, but it can take many hours, or sometimes a couple of days, for labour to begin. Before each dose, a CTG is recommended to check on pēpi and how they are responding. Some people feel mild period‑like cramps or tightening as the medication starts to work, while others may not feel much at all at first. Once labour becomes established, the hope is that your body continues to progress naturally, with ongoing support and monitoring to keep you and your baby safe.

BALLOON CATHETER

A balloon catheter is a small tube that is gently placed through the cervix and positioned so it sits between the cervix and the baby’s head. Once in place, the balloon is filled with sterile water so it presses on the cervix, encouraging the release of natural hormones that help the cervix soften and open. It can stay in for up to 24 hours, or it may fall out on its own once the cervix has opened enough. Some people feel pressure or period‑like cramps while it’s in place, while others feel very little. If this method doesn’t bring on labour or open the cervix enough, your midwife or doctor will talk with you about the next steps in your induction plan.

ARTIFICAL RUPTURE OF MEMBRANES

A small instrument, shaped a bit like a long thin hook, is gently passed into the vagina so the membranes (the “bag of waters”) can be broken. Releasing the waters can help bring baby’s head down onto the cervix and may speed up the start or progress of labour. Some people notice an increase in pressure or stronger tightenings soon after the waters break, while others may take longer to establish a regular pattern. If contractions don’t become steady within an expected timeframe, your midwife or doctor may talk with you about starting a syntocinon (synthetic oxytocin) drip to help labour progress in a safe, supported way.

OXYTOCIN

Oxytocin (often called syntocinon) is a hormone given through an IV drip to start or strengthen contractions. It is usually used after your waters have been broken, or if contractions have started but are not strong or regular enough.

The medication is given slowly at first and increased gradually until regular contractions are established. Because oxytocin can make contractions stronger and closer together, continuous CTG monitoring is recommended to keep a close eye on the heartbeat of your pēpi and your contractions.

You will have:

  • An IV line in your arm/hand

  • CTG belts around your abdomen

  • Regular observations from your midwife

Declining an IOL for Post Dates (>41w)

Women who choose to decline an induction of labour (IOL) should have their decision fully respected.

Research shows that at 41 weeks or later, some women prefer to wait for labour to begin naturally, while others would choose an induction next time. From 42 weeks, extra monitoring can be offered to check on pēpi and the amniotic fluid around them, although this monitoring has not been shown to reduce the risk of stillbirth. This usually includes:

  • twice‑weekly CTG
  • ultrasound checks of fluid levels
  • umbilical artery Doppler assessments

 

CDHB Maternity guidelines - Induction of Labour

Exact timing of IOL depends on the women’s preferences and local circumstances.