How long is induction of labor
Induced labour | Pregnancy Birth and Baby
What is an induced labour?
Labour normally starts naturally any time between 37 and 42 weeks of pregnancy. The cervix softens and starts to open, you will get contractions, and your waters break.
In an induced labour, or induction, these labour processes are started artificially. It might involve mechanically opening your cervix, breaking your waters, or using medicine to start off your contractions — or a combination of these methods.
In Australia, about 1 in 3 women has an induced labour.
What are the differences between an induced and a natural labour?
An induced labour can be more painful than a natural labour. In natural labour, the contractions build up slowly, but in induced labour they can start more quickly and be stronger. Because the labour can be more painful, you are more likely to want some type of pain relief.
If your labour is induced, you are also more likely to need other interventions, such as the use of forceps or ventouse (vacuum) to assist with the birth of your baby. You will not be able to move around as much because the baby will be monitored more closely than during a natural labour.
You will only be offered induced labour if there is a risk to you or your baby's health. Your doctor might recommend induced labour if:
- you are overdue (more than 41 weeks pregnant)
- there is a concern the placenta is not working as it should
- you have a health condition, such as diabetes, kidney problems, high blood pressure or pre-eclampsia
- the baby is making fewer movements, showing changes in its heart rate, or not growing well
- your waters have broken, but the contractions have not started naturally
- you are giving birth to more than one baby (twins or multiple birth)
Not everyone can have an induced labour. It is not usually an option if you have had a caesarean section or major abdominal surgery before, if you have placenta praevia, or if your baby is breech or lying sideways.
Can I decide whether to have an induced labour?
If you are overdue, you might decide to wait and see if labour will start naturally.
However, if there is a chance you or your baby are at risk of complications, you might need to consider induced labour before your due date.
When making your decision, discuss the risks and benefits with your doctor. Do not be afraid to ask lots of questions, such as:
- Why do I need an induction?
- How will it affect me and my baby?
- What will happen if I do not have the induction?
- What procedures are involved and how will you care for me and my baby?
You might need to consider several other health concerns. For example, there is a higher risk of stillbirth or other problems if your baby is not born before 42 weeks, and an increased risk of infection if your waters break more than 24 hours before labour starts.
What can I expect with an induced labour?
During the late stages of your pregnancy, your healthcare team will carry out regular checks on your health and your baby's heath. These checks help them decide whether it is better to induce labour or to keep the baby inside.
Always tell your doctor or midwife if you notice your baby is moving less than normal.
If they decide it is medically necessary to induce labour, first your doctor or midwife will do an internal examination by feeling inside your vagina. They will feel your cervix to see if it is ready for labour. This examination will also help them decide on the best method for you.
It can take from a few hours to as long as 2 to 3 days to induce labour. It depends how your body responds to the treatment. It is likely to take longer if this is your first pregnancy or you are less than 37 weeks pregnant.
What options are there to induce labour?
There are different ways to induce labour. Your doctor or midwife will recommend the best method for you when they examine your cervix. You may need a combination of different strategies. You will need to provide written consent for the procedure.
Sweeping the membranes
During a vaginal examination, the midwife or doctor makes circular movements around your cervix with their finger.
This action should release a hormone called prostaglandins. You do not need to be admitted to hospital for this procedure and it is often done in the doctor's room. This can be enough to get labour started, meaning you will not need any other methods.
Risks: This is a simple and easy procedure; however, it does not always work. It can be a bit uncomfortable, but it does not hurt.
Oxytocin
A synthetic version of the hormone oxytocin is given to you via a drip in your arm to start your contractions. When the contractions start, the amount of oxytocin is adjusted so you keep on having regular contractions until the baby is born. This whole process can take several hours.
Risks: Oxytocin can make contractions stronger, more frequent and more painful than in natural labour, so you are more likely to need pain relief. You will not be able to move around much because of the drip in your arm and you will also have a fetal monitor around your abdomen to monitor your baby.
Sometimes the contractions can come too quickly, which can affect the baby's heart rate. This can be controlled by slowing down the drip or giving you another medicine.
Artificial rupture of membranes ('breaking your waters')
Artificial rupture of membranes (ARM) is used when your waters do not break naturally. Your doctor or midwife inserts a small hook-like instrument through your vagina to make a hole in the membrane sac that is holding the amniotic fluid. This will increase the pressure of your baby's head on your cervix, which may be enough to get labour started. Many women will also need oxytocin to start their contractions.
Risks: ARM can be a bit uncomfortable but not painful. There is a small increased risk of a prolapsed umbilical cord, bleeding or infection.
Prostaglandins
A synthetic version of the hormone prostaglandins is inserted into your vagina to soften your cervix and prepare your body for labour. It can be in the form of a gel, which may be given in several doses (usually every 6 to 8 hours), or a pessary and tape (similar to a tampon), which slowly releases the hormone over 12 to 24 hours.
You will need to lie down and stay in hospital after the prostaglandins is inserted. You may also then need ARM if your waters have not broken, or oxytocin to bring on the contractions.
Prostaglandins gel is often the preferred method of inducing labour since it is the closest to natural labour. Tell your midwife or doctor straight away if you start to experience painful, regular contractions 5 minutes apart for your first baby, or 10 minutes apart for subsequent babies, or if your waters break, because these are both signs that your labour is beginning.
Risks: Some women find their vagina is sore after the prostaglandin gel, or they might experience nausea, vomiting or diarrhoea. These side effects are rare and there is no evidence that induction using prostaglandin is any more painful than a natural labour.
Very rarely, the contractions can come too strongly, which can affect the baby's heart rate. This can be controlled by giving you another medicine or removing the pessary.
You need to let your doctor or midwife know immediately if you start bleeding, or if your baby is moving less, because this could be a sign that something is wrong.
Cervical ripening balloon catheter
A cervical ripening balloon catheter is a small tube attached to a balloon that is inserted into your cervix. The balloon is inflated with saline, which usually puts enough pressure on your cervix for it to open. It stays in place for up to 15 hours, and then you will be examined again.
Tell your midwife or doctor straight away if you start to experience painful, regular contractions 5 minutes apart for your first baby, or 10 minutes apart for subsequent babies, or if your waters break, because these are both signs that your labour is beginning.
You may also need ARM or oxytocin if you are using a cervical ripening balloon catheter.
Risks: Inserting the catheter can be a bit uncomfortable but not painful.
You also need to let your doctor or midwife know immediately if you start bleeding, or your baby is moving less, because this could be a sign that something is wrong.
Can I have pain relief during induced labour?
Induced labour is usually more painful than natural labour. Depending on the type of induction you are having, this could range from discomfort with the procedure or more intense and longer lasting contractions as a result of the medication you have been given. Women who have induced labour are more likely to ask for an epidural for relief.
Because inductions are almost always done in hospital, the full range of pain relief should be available to you. There is usually no restriction on the type of pain relief you can have if your labour is induced.
Are there any risks with inducing labour?
There are some increased risks if you have an induced labour. These include that:
- it will not work — in about 1 of 4 cases, women go on to have a caesarean
- your baby will not get enough oxygen and their heart rate is affected
- you or your baby get an infection
- your uterus tears
- you bleed a lot after the birth
What happens if the induction does not work?
Not all induction methods will work for everyone.
Your doctor may try another method, or you might need to have a caesarean. Your doctor will discuss all of these options with you.
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How Long Does an Induction of Labor Take? ~ From a labor pro!
Induction of labor is definitely a process. How long will it take? What should you expect? Pregnant women often wonder how long will it take until they give birth?
But first, why would you listen to me?
Hi, I’m Hilary — The Pregnancy Nurse 👩⚕️. I have been a nurse since 1997 and I have 20 years of OB nursing experience, I am also the curly head behind Pulling Curls and The Online Prenatal Class for Couples. 🩺 I have started thousands of inductions (and even had one of my own) so I really am a pro in this area. While no one can tell you exactly how long your induction will take — there are a lot of factors that can help us give a guess.
In this Article:
- What is Dilation
- What is an Unfavorable Cervix?
- Things They Can Do to Speed-Up Labor
- Things You Can Do to Speed-Up Labor
- Reasons for Induction (elective vs Medically-Necessary
- Textbook Labor Plan
While this article is top notch, if you really want to understand inductions from making the choice clear to when your baby is born — I really recommend my class Inductions Made Easy.
In less than 20 minutes you’ll be fully informed in:
- How to make the choice for an induction
- What normally happens at an induction
- Common induction outcomes.
How long will my induction take?
Things that affect labor timing
There are a few things that can affect how long it will likely take for your cervix to open.
We qualify these as something called the “bishop’s score”. It measures how prepared your cervix is to open. It’s on a scale of 0 to 13. You don’t need to know your bishop score, but some hospitals won’t do an elective induction if your cervix isn’t open/soft enough.
What/Where is your Cervix?
Your Cervix is at the end of your vagina, it’s at the opening of your uterus.
Cervical Dilation
This means how OPEN your cervix is. I have a whole post that explains vaginal dilation on my sister site, but what you need to know is that as the baby progresses into your pelvis, the cervix opens.
Kind of like when you push your head through a tight sweater neck.
The numbers go from 0 (or closed) to 10 (ten is actually when your cervix disappears behind the baby’s head).
The more open your cervix is, it normally means your induction will be shorter. Which make sense, as you don’t start to push the baby out til’ 10 centimeters (cm).
Cervical Thinning
If you keep the “head through a sweater” analogy, you’ll know that the sweater thins at the neck as you pull your head through. The same thing happens with your cervix.
Medical providers measure this as a percentage. Anything more than 50% normally just called “thick” (frankly, it’s impossible for us to know how thick your cervix is in the beginning).
We CAN measure the length of your cervix but that is done by ulrasound, rather than our hand.
That all being said, if your cervix is thick, it normally takes longer until the baby comes out.
Baby’s Station
It’s an odd way to say it, but this measures how above or below your ischial spines (your butt bones) the baby is.
I think it’s easier to envision how high or low in your pelvis the baby is.
If the baby is high it will take longer for it to descend.
NORMALLY, the lower your baby is, the more it will start to open your cervix (again, as you push your head further into the sweater it opens more).
Consistancy of your Cervix
This means how firm or soft it is.
Early in pregnancy your cervix is hard and firm like rubber, then it softens up as you progress. If your cervix is hard we know that it will take a bit of labor in order for it to soften.
If it’s your first baby, you will normally have a firmer cervix than subsequent babies.
Baby’s Position
This means the baby’s position in the womb. Is it looking at your belly button, or your spine.
If the baby is positioned looking up — it sometimes takes longer. However, babies can spin at any time.
Honestly, that’s the good news on all of these things. Babies drop or move or change and can advance your labor quickly at any time (or they can stay the same… such is mother nature, right)?
NOTE: If Baby isn’t head down that is called breech positioning and normally requires a cesarean section.
Now, most often (but not always) — as you get closer to your due date, you are more likely to be “favorable’ in these areas. So, a woman who is at 41 weeks of pregnancy most often has a more favorable cervix (and will have a quicker induction) than someone who is 37 weeks (where labor may take a long time). However, if you’re being induced early (especially for medical reasons) it may not be favorable — and that is OK too, we work with that frequently in the hospital.
As a note, most often first-time mothers take less time also, so all of those things will be considered before an induction of labor by your health care provider.
And finally, remember that ALL these things are just guesses based on statistics — who knows what will happen for you and your birth!
Ok, have we gotten your confused yet? If you’re having an induction and you have just a few dollars and a few minutes of time — can I recommend you take this class. It takes less than 20 minutes, but it’s handy video and printable will totally get you prepared for your induction.
Check it out!
Problems With an Unfavorable Cervix
When doctors schedule an induction, they consider how “favorable” your cervix is.
That is an over-generalization of the items I mentioned (that are also in your bishop’s score).
If your cervix isn’t favorable (or if your bishop’s score is low) it means that it will likely take longer for your induction.
And, the longer an induction takes, the more medication we have to use, the higher risk you become as you labor longer and longer.
So, obviously we would prefer that you have a favorable cervix coming in.
However, if your induction is medically necessary (see below) it doesn’t matter how favorable it is, as we NEED to have the baby out!
Things Your Providers Can Do to Speed-Up Labor
There are things we can do to speed up your labor. They are done to hopefully create a vaginal delivery.
Make sure you get informed consent before any of these procedures, as each do have potential risks (and benefits).
Membrane Sweep
Your provider will do this in the office after a cervical exam.
It is basically them just using their finger to go between your cervix and your bag of waters.
It is non-invasive and personally I find that it might bump you if you were already close to being in labor. If you weren’t going into labor, it doesn’t do much.
It is mildly painful, but worth a try if you’re 39 weeks and would love to go into labor.
If a membrane sweet is going to work — labor usually starts within 24 hours.
Foley bulb Insertion
This is where our doctor inserts a tube up the birth canal into your cervix.
We then fill a balloon at the end of the tube with water, which slowly stretches open your cervix.
This can be done in your doctor’s office or at the hospital. Fairly non-invasive, and if it doesn’t work it’s not something you can’t walk back from.
It is annoying to have put in, but after that you will likely feel some cramping or contractions with your cervix (hopefully) starting to open.
Your cervix must be somewhat open in order for this to work (otherwise they can’t get the tube into your cervix.
Amniotomy
This is when your healthcare provider breaks your amniotic sac (the nurse can’t do it at the hospital, a doctor or a midwife has to do it).
This should be done at the hospital and is an official beginning to labor because once your water breaks we should get the baby out soon (the next day or so) There is always a risk off infection once your water is broken and the baby isn’t protected by that anymore.
Your water can also break at home.
Breaking your water is often something that doctors do once ou are are already in labor to speed things along.
Induction Agents
These are medications we give that should start uterine contractions.. When your provider schedules you as an induction, he/she will likely use one of these methods. They are used very carefully, because at too high of doses they can cause a uterine rupture.
They start labor contractions similar to natural labor (vs spontaneous labor).
Cervidil / Cytotec / Prepidil
These are called cervical ripening agents. Some can be given orally, but some are placed using a gloved finger near your cervix.
These are usually given to soften your cervix, and then you move to…
Pitocin
Is given via IV. It is the same compound your body makes that puts you into labor on its own — the hormone oxytocin (it is just the synthetic version).
What if These Induction Agents Don’t Work?
In that event (and it does happen) — we have to ask ourselves:
- Does the baby medically need to come out (in which case you’d need a cesarean delivery)
- Could we wait a bit longer and try again (in which case you might go home).
DIY Induction Methods
Many women take castor oil, or try other things to start their labor. Studies show that things like this (particularly castor oil) can be very problematic, and don’t often work — so be mindful before you try an induction of your own.
Things you can do to speed up labor:
There are things you can do to help speed up labor….
Delay Epidural
It seems smart to just come in and get your epidural the minute you get your induction so that you won’t have to feel any pain.
I feel like there is a benefit to your body feeling some pain before you get the epidural.
This allows you to move more and possibly walk or sit on a labor ball to help baby find the best position.
Movement & Position Changes
As I said above, movement and position changes can help the baby find its best spot for delivery.
Some patients are unwilling to change positions. Sometimes some nurses don’t change your position once you have an epidural. I like to move my patients every hour (once they have an epidural).
So, just try to change your position and use movement to your benefit when you have it (even if you’re on pitocin you can often stand by the monitor and move in sexy hip circles or use a stool or a yoga ball).
And yes — I do talk a lot about movement, and I even have labor movement cards with images you can use to help find a comfortable position in labor in The Online Prenatal Class for Couples.
Elective vs Medically Necessary Inductions
An elective induction is something you are choosing to do. Reasons can be:
- You have childcare for a specific day
- Your husband can come on a specific day
- Your doctor is available on a specific day
- Your doctor just thinks you should have the baby
- You are tired or miserable being pregnant with no specific medical issues.
Medically Necessary Inductions
Often medically necessary inductions happen before you are due. I have a whole post on 37 week inductions.
These are done because providers feel baby’s health will be better outside your womb, than inside.
A medically necessary induction can happen for a variety of reasons — I go into the vast majority of reasons in My Online Course, but the top few are:
Diabetes
Both gestational diabetes and type 1 or 2 diabetes can be a reason to be induced early as baby might be bigger, and you have an increased risk with pregnancy.
Baby Size
The baby’s size can always be a indicator to be induced.
Large Baby
If the baby is getting too large, it might not come out of your pelvis.
Small Baby
If the baby isn’t growing as it should, it is likely that we can help it grow better outside.
Too Much / Too Little Fluid
Oligohydramnios
This means that you have too little amniotic fluid. This can be problematic because baby needs to be surrounded by fluid to both protect it and the cord (and cushion it so it doesn’t get squished).
Polyhydramnios
This means you have too much amniotic fluid. This can be a problem to over-stretch your uterus, or too much room for baby.
Preeclampisa
This is a disorder of your smooth muscle caused by something in the baby/placental development. It is often characterized by high blood pressure or lab work changes with our urine and blood.
That means the only way to stop it is to get the baby out.
Which, is why you might need to be induced.
Other Reasons
Like I said, there are a lot of reasons why a doctor will induce you — these are just the most common.
Alright, so hopefully you understand that all of these come together to show how long your induction will likely be.
Textbook Labor Plan
If your baby read the textbook — it would know that average labor progresses about 1 cm per hour and then pushing begins.
However, most babies don’t read that book and labor can be tricky.
I find that the first 5 centimeters go longer than the last 5.
I also find that none of this starts until you’re actually IN LABOR (called active labor), and sometimes it takes a while to get there (often based on how thick or firm your cervix is).
Active labor is defined as the point when your cervix is dilating at least 1 cm’ish/hour.
With all that being said, if you’re induced early, an induction can sometimes even take 2-3 days, but if you’re induced after 40 weeks and have a very favorable cervix your baby could be out in just a few hours.
Which, I realize isn’t helpful at all. There is no shame in asking your doctor how long they think it will take (believe me, they have an educated guess), or asking your nurse once you’re in labor (it’s hard to tell until you’re in active labor and actually changing your cervix).
AND, finally — I am a big fan of letting mother nature take the lead and going into labor on your own. If you can avoid an induction I would recommend that if at all possible. But, sometimes it isn’t, so hopefully this article gave you some good info as well!
I know this all seems very complicated, but it really isn’t. Let me simplify it for you in Inductions Made Easy!
Or, if you’re not quite ready for that — grab my free birth prep kit:
- About the Author
- Latest Posts
Hilary Erickson, BSN RN
A nurse since 1997, she has worked in various fields including pediatrics, geriatrics & hospice.
She has 20 years of labor and delivery experience in the San Jose, CA and Phoenix, AZ areas.
She is also the curly head behind the website Pulling Curls and is the creator of The Online Prenatal Class for Couples — the #1 hospital-based prenatal class on the internet.
Induction of labor or induction of labor
The purpose of this informational material is to familiarize the patient with the induction of labor procedure and to provide information on how and why it is performed.
In most cases, labor begins between the 37th and 42nd weeks of pregnancy. Such births are called spontaneous. If drugs or medical devices are used before the onset of spontaneous labor, then the terms "stimulated" or "induced" labor are used in this case.
Labor should be induced when further pregnancy is for some reason unsafe for the mother or baby and it is not possible to wait for spontaneous labor to begin.
The purpose of stimulation is to start labor by stimulating uterine contractions.
When inducing labor, the patient must be in the hospital so that both mother and baby can be closely monitored.
Labor induction methods
The choice of labor induction method depends on the maturity of the cervix of the patient, which is assessed using the Bishop scale (when viewed through the vagina, the position of the cervix, the degree of its dilatation, consistency, length, and the position of the presenting part of the fetus in the pelvic area are assessed). Also important is the medical history (medical history) of the patient, for example, a past caesarean section or operations on the uterus.
The following methods are used to induce (stimulate) labor:
- Oral misoprostol is a drug that is a synthetic analogue of prostaglandins found in the body. It prepares the body for childbirth, under its action the cervix becomes softer and begins to open.
- Balloon Catheter - A small tube is placed in the cervix and the balloon attached to the end is filled with fluid to apply mechanical pressure to the cervix. When using this method, the cervix becomes softer and begins to open.
The balloon catheter is kept inside until it spontaneously exits or until the next gynecological examination. - Amniotomy or opening of the fetal bladder - in this case, during a gynecological examination, when the cervix has already dilated sufficiently, the fetal bladder is artificially opened. When the amniotic fluid breaks, spontaneous uterine contractions will begin, or intravenous medication may be used to stimulate them.
- Intravenously injected synthetic oxytocin - acts similarly to the hormone of the same name produced in the body. The drug is given by intravenous infusion when the cervix has already dilated (to support uterine contractions). The dose of the drug can be increased as needed to achieve regular uterine contractions.
When is it necessary to induce labor?
Labor induction is recommended when the benefits outweigh the risks.
Induction of labor may be indicated in the following cases:
- The patient has a comorbid condition complicating pregnancy (eg, high blood pressure, diabetes mellitus, preeclampsia, or some other condition).
- The duration of pregnancy is already exceeding the norm - the probability of intrauterine death of the fetus increases after the 42nd week of pregnancy.
- Fetal problems, eg, problems with fetal development, abnormal amount of amniotic fluid, changes in fetal condition, various fetal disorders.
- If the amniotic fluid has broken and uterine contractions have not started within the next 24 hours, there is an increased risk of inflammation in both the mother and the fetus. This indication does not apply in case of preterm labor, when preparation of the baby's lungs with a special medicine is necessary before delivery.
- Intrauterine fetal death.
What are the risks associated with labor induction?
Labor induction is not usually associated with significant complications.
Occasionally, after receiving misoprostol, a patient may develop fever, chills, vomiting, diarrhea, and too frequent uterine contractions (tachysystole).
In case of too frequent contractions to relax the uterus, the patient is injected intravenously relaxing muscles uterus medicine. It is not safe to use misoprostol if you have had a previous caesarean section as there is a risk of rupture of the uterine scar.
The use of a balloon catheter increases the risk of inflammation inside the uterus.
When using oxytocin, the patient may rarely experience a decrease in blood pressure, tachycardia (rapid heartbeat), hyponatremia (lack of sodium in the blood), which may result in headache, loss of appetite, nausea, vomiting, abdominal pain, depression strength and sleepiness.
Induction of labor, compared with spontaneous labor, increases the risk of prolonged labor, the need for instrumentation
(use of vacuum or forceps), postpartum hemorrhage, uterine rupture, the onset of too frequent uterine contractions and the associated deterioration of the fetus, prolapse umbilical cord, as well as premature detachment of the placenta.
If induction of labor is not successful
The time frame for induction of labor varies from patient to patient, on average labor begins within 24-72 hours. Sometimes more than one method is required.
The methods used do not always work equally quickly and in the same way on different patients. If the cervix does not dilate as a result of induction of labor, your doctor will tell you about your next options (which may include inducing labor later, using a different method, or delivering by caesarean section).
ITK833
This informational material was approved by the Women's Clinic on 01/01/2022.
Induction of labor in women with a normal pregnancy of 37 weeks or more
Does an induction policy at 37 weeks' gestation or more reduce the risks for infants and their mothers compared with a policy of waiting until later gestational age or until there is an indication for induction of labor?
This review was originally published in 2006 and subsequently updated in 2012 and 2018.
What is the problem?
The average pregnancy lasts 40 weeks from the start of a woman's last menstrual period. Pregnancies lasting more than 42 weeks are described as "post-term" and therefore the woman and her doctor may decide to give birth by induction. Factors associated with postnatal pregnancy and delayed delivery include obesity, first birth, and maternal age over 30 years.
Why is this important?
Protracted (term) pregnancy may increase risks for infants, including greater risk of death (before or shortly after birth). However, induction (stimulation or induction) of labor can also pose risks to mothers and their babies, especially if the woman's cervix is not ready for delivery. Current diagnostic methods cannot predict risks to babies or their mothers per se, and many hospitals have specific policies regarding how long a pregnancy can last.
What evidence did we find?
We searched for evidence (July 17, 2019) and identified 34 randomized controlled trials in 16 different countries involving more than 21,500 women (mostly at low risk of complications).
The trials compared a policy of induction of labor after 41 completed weeks of gestation (>287 days) with a policy of waiting (expectant management).
Labor induction policies were associated with fewer perinatal deaths (22 trials, 18 795 babies). Four perinatal deaths occurred in the induction policy group compared with 25 perinatal deaths in the expectant management group. Fewer stillbirths occurred in the induction group (22 trials, 18,795 infants): two in the induction group and 16 in the expectant management group.
Women in the induction of labor groups in the included studies were probably less likely to deliver by caesarean section than in the expectant management groups (31 studies, 21,030 women), and there was probably little or no difference when compared with assisted vaginal delivery (22 studies, 18,584 women).
Fewer infants were admitted to the neonatal intensive care unit (NICU) in the induction policy group (17 trials, 17,826 infants; high-certainty evidence).
A simple test of the baby's health status (Apgar score) at five minutes after birth was likely to be more favorable in the induction groups than expectant management (20 trials, 18,345 infants).
An induction policy may make little or no difference for women who have had a perineal injury, and likely has little or no effect on the number of women with postpartum hemorrhage or breastfeeding at hospital discharge. We are uncertain about the effect of induction or expectant management on length of stay in the maternity hospital due to the very low certainty of the evidence.
Among newborns, the number of children with trauma or encephalopathy was similar in both groups (moderate and low-certainty evidence, respectively). None of the studies reported the development of neurodevelopmental problems during follow-up of children and postpartum depression in women. Only three trials reported some measure of maternal satisfaction.
What does this mean?
An induction policy compared to expectant management is associated with fewer infant deaths and probably fewer caesarean sections; and probably has little or no effect on assisted vaginal delivery.
