What Is an Induction of Labour (IOL)?

Induction of labour (IOL) is when labour is started off artificially. It is recommended when it is considered safer for you or your baby for them to be born. It's important to know the research doesn't always support this.

Why Is the Induction of Labour Rate Rising in England?

In England, rates of induction have increased significantly over the past decade or so, the most current statistics show that 33% of women in England had an induction in 2021/22, compared to 22% in 2011/12. The most recent statistics shared by our local trust on their Facebook page, East Kent Hospitals Maternity, are from March 2024 and show an IOL rate of 32% of that 61% had a vaginal birth, 30% had an emergency caesarean section and 9% had an instrumental assisted birth (forceps or ventouse).

Having an IOL should always be your choice – you are 'allowed' to accept or decline. Unfortunately (but unsurprisingly) what we hear from women and birthing people is that they often feel a lot of pressure to agree to an IOL. Coercion is rife in the NHS maternity care, and it is not uncommon to hear of the ‘dead baby’ card being played, which is when women and birthing people are told their baby may die if they don’t have an IOL. Blanket recommendations for IOL based on population level risk factors fail to see women as individuals. Conversations about IOL lack nuance and often fail to acknowledge that there are risks involved to both women and babies when labour is started artificially. 

What Are the Reasons Induction of Labour Is Recommended?

• pre-eclampsia – high blood pressure, protein in the urine and/or abnormal blood test results
• pre-existing or gestational diabetes
• intrahepatic cholestasis of pregnancy (ICP) – also known as obstetric cholestasis – a condition that affects how the liver works in pregnancy
• small for gestational age (SGA) – when the baby is predicted to be small, with or without associated placental function issues
• reduced fetal movements at term – 37+ weeks of pregnancy
• post-dates – whilst this technically means 42+ weeks of pregnancy, induction for postdates is frequently offered from 41 weeks of pregnancy
• if you’re over 40 years old
• IVF pregnancy
• if your waters have broken before labour begins – the rationale is that there is a small increase in the likelihood of neonatal infection (0.5% to 1%) once the waters have been broken for over 24 hours
• if your waters break before labour and the baby has done a poo – called meconium-stained liquor
• expecting twins – depending on the type of twins and only if the first twin is head down

What Does the Research Say About Induction of Labour Outcomes?

Recently Dahlen et al. conducted a large retrospective study on interventions and outcomes following induction of labour in the Australian population. They looked at a 16-year period of data from 2000 – 2016. The findings of this study are relevant to women and birthing people with uncomplicated pregnancies, who had an induction of labour for a non-medical reason (i.e. they did not have diabetes, high blood pressure, concerns with a baby’s growth). 

Findings of the study

• More likely to have epidural or spinal anaesthesia
• More likely to have caesarean section
• More likely to have an instrumental birth (forceps or ventouse assisted birth)
• More likely to have an episiotomy (cut to the vagina)
• More likely to have a postpartum haemorrhage (bleeding >500ml after birth)

Risks for babies

• Higher odds of birth asphyxia (reduced oxygen supply)
• Higher odds of birth trauma
• Higher odds of needing major resuscitation at birth
• Higher odds of infection

Making an Informed Decision About Induction of Labour

We are not here to tell you that you should or shouldn’t have an IOL, but we also won’t be sugarcoating what having an IOL means. We don’t share the results of the Dahlen et al. study to freak people out. We share them because we know that too often this information isn’t being shared. We also know that we need more research the outcomes for women, birthing people and their babies who have an IOL for medical indicated reasons.

In the same way that having a risk factor for something doesn’t guarantee that that thing will happen, not everyone who has an IOL will experience the things mentioned above. In order to make an informed decision, you need to have as much information as possible. You have to be able to decide if the benefits of IOL outweigh the risks in your specific circumstance and no-one else can make that decision for you.

It is also vital that women and birthing people are aware that IOL is very different to spontaneous labour and takes you on a very different path, usually involving more interventions. Again, this doesn’t mean that no-one should ever have an IOL – but knowing that when you agree to an IOL you are agreeing to heading out on this path.

Stay tuned for the next blog, we will be looking at the different methods of IOL, including those that are used at our local East Kent NHS trust.