ACOG guidance for induction of labour

Induction means starting labour with medicines or procedures before labour begins on its own. The obstetric team considers the reason for delivery, gestational stage, cervical readiness, the baby's position and wellbeing, membrane status, previous births and any uterine surgery. Guidance informs the discussion, but it does not replace an assessment of the individual pregnancy.

Reasons for recommending delivery can include maternal illness, concern about the baby, ruptured membranes without labour, or a pregnancy continuing beyond the advised time. Pre-eclampsia is one condition in which the balance between ongoing pregnancy and delivery may change. The proposed timing depends on the full clinical picture rather than the diagnosis name alone.

Your clinician may examine the cervix to decide whether cervical ripening is needed. Options can include a balloon device or a medicine such as misoprostol, depending on your history and the hospital protocol. Once the cervix is suitable, breaking the waters or giving oxytocin may be considered. A membrane sweep is different from formal induction and may be offered beforehand in some situations.

Discuss why induction is being proposed now, the alternatives to it, what monitoring is planned and what happens if the first method does not establish labour. Induction can involve several stages and the response varies. If labour does not progress or concerns develop, the team may reassess the plan, including whether caesarean birth is appropriate.

Before a scheduled induction, contact your maternity unit urgently for reduced or changed fetal movement, vaginal bleeding, waters breaking, regular painful contractions, severe constant abdominal pain, breathing difficulty, a severe headache, vision changes, pain beneath the ribs, sudden swelling or feeling acutely unwell. Do not wait for the booked admission time when a warning sign occurs.

During induction, tell staff promptly about constant pain between contractions, heavy bleeding, breathing problems, faintness or any sudden change that worries you. Monitoring and the next step are adjusted to your symptoms, contraction pattern and the baby's response.

Ask what makes induction advisable in your case, what could happen if you wait, and whether there is time to consider your options. Clarify which method is likely to be offered first, how you and the baby will be monitored, whether pain relief remains available, and what circumstances would lead to pausing the process or recommending caesarean birth.