Induction of labour

The clinic is running late and the last woman is 41 weeks, well, and asking whether she should "just be induced". You have five minutes, and whatever you say next will shape her birth. Induction is the most common obstetric intervention you will ever recommend and the one most often recommended badly.^[3][5]

Examiners know this. They will not ask you to list methods — they will ask you to justify the decision, name the dose, and say what you do when the uterus contracts too often.^[6][19]

Overview and definition

Three words get confused constantly, and the confusion costs marks. ^[2][19]

• Induction of labour — starting labour artificially before it begins spontaneously.
• Cervical ripening — softening, shortening and opening an unfavourable cervix so that induction can succeed. It is a step within induction, not a synonym for it.
• Augmentation — stimulating a uterus that is already in spontaneous labour. Same drug, different clinical question, different consent conversation.^[2][19]

A membrane sweep sits outside all three. It is an attempt to provoke spontaneous labour, offered at an antenatal visit, and it is not an induction.^[11]

References20ShowHide

1. [1]BISHOP EH PELVIC SCORING FOR ELECTIVE INDUCTION Obstet Gynecol, 1964.PMID 14199536
2. [2]Wheeler V, Hoffman A, Bybel M Cervical Ripening and Induction of Labor Am Fam Physician, 2022.PMID 35166491
3. [3]Grobman WA, Rice MM, Reddy UM, et al. Labor Induction versus Expectant Management in Low-Risk Nulliparous Women N Engl J Med, 2018.PMID 30089070
4. [4]Wennerholm UB, Saltvedt S, Wessberg A, et al. Induction of labour at 41 weeks versus expectant management and induction of labour at 42 weeks (SWEdish Post-term Induction Study, SWEPIS): multicentre, open label, randomised, superiority trial BMJ, 2019.PMID 31748223
5. [5]Alkmark M, Keulen JKJ, Kortekaas JC, et al. Induction of labour at 41 weeks or expectant management until 42 weeks: A systematic review and an individual participant data meta-analysis of randomised trials PLoS Med, 2020.PMID 33290410
6. [6]Rattanakanokchai S, Gallos ID, Kietpeerakool C, et al. Methods of induction of labour: a network meta-analysis Cochrane Database Syst Rev, 2026.PMID 41587762
7. [7]Alfirevic Z, Keeney E, Dowswell T, et al. Labour induction with prostaglandins: a systematic review and network meta-analysis BMJ, 2015.PMID 25656228
8. [8]de Vaan MD, Ten Eikelder ML, Jozwiak M, et al. Mechanical methods for induction of labour Cochrane Database Syst Rev, 2023.PMID 36996264
9. [9]Jozwiak M, Oude Rengerink K, Benthem M, et al. Foley catheter versus vaginal prostaglandin E2 gel for induction of labour at term (PROBAAT trial): an open-label, randomised controlled trial Lancet, 2011.PMID 22030144
10. [10]Ten Eikelder ML, Oude Rengerink K, Jozwiak M, et al. Induction of labour at term with oral misoprostol versus a Foley catheter (PROBAAT-II): a multicentre randomised controlled non-inferiority trial Lancet, 2016.PMID 26850983
11. [11]Finucane EM, Murphy DJ, Biesty LM, et al. Membrane sweeping for induction of labour Cochrane Database Syst Rev, 2020.PMID 32103497
12. [12]Kelly AJ, Alfirevic Z, Ghosh A Outpatient versus inpatient induction of labour for improving birth outcomes Cochrane Database Syst Rev, 2013.PMID 24222365
13. [13]Wise MR, Marriott J, Battin M, et al. Outpatient balloon catheter vs inpatient prostaglandin for induction of labour (OBLIGE): a randomised controlled trial Trials, 2020.PMID 32066505
14. [14]Budden A, Chen LJ, Henry A High-dose versus low-dose oxytocin infusion regimens for induction of labour at term Cochrane Database Syst Rev, 2014.PMID 25300173
15. [15]Rouse DJ, Weiner SJ, Bloom SL, et al. Failed labor induction: toward an objective diagnosis Obstet Gynecol, 2011.PMID 21252738
16. [16]Grobman WA, Bailit J, Lai Y, et al. Defining failed induction of labor Am J Obstet Gynecol, 2018.PMID 29138035
17. [17]Lydon-Rochelle M, Holt VL, Easterling TR, et al. Risk of uterine rupture during labor among women with a prior cesarean delivery N Engl J Med, 2001.PMID 11439945
18. [18]Landon MB, Spong CY, Thom E, et al. Risk of uterine rupture with a trial of labor in women with multiple and single prior cesarean delivery Obstet Gynecol, 2006.PMID 16816050
19. [19]American College of Obstetricians and Gynecologists ACOG Practice Bulletin No. 107: Induction of labor Obstet Gynecol, 2009.PMID 19623003
20. [20]Leathersich SJ, Vogel JP, Tran TS, et al. Acute tocolysis for uterine tachysystole or suspected fetal distress Cochrane Database Syst Rev, 2018.PMID 29971813