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Are you unsure about how you would like to give birth ? This leaflet will give you lots of information to help you decide.

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A selection of videos promoting pelvic health, also in other languages

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Pelvic Health and Wellbeing during Pregnancy and After Birth Videos
To translate this page into another language then please use the recite me accessibility toolbar. The accessibility toolbar can be used to adjust elements for individual needs. This looks at aspects such as font style, size, colour, zoom functionality, keyboard navigation, screen readers and more.
The London Maternity Clinical Network has collaborated with Imperial College Healthcare Trust, North West London Local Maternity and Neonatal System (LMNS), South West London LMNS, South East London LMNS, LMNS service-user representatives, Maternity Voices Partnership, and other NHS professionals to create a series of videos about the changes the body undergoes before, during, and after birth. From pelvic floor health and bladder care, to posture and returning to exercise, these videos have been developed by NHS Physiotherapists and Healthcare professionals and will provide information and useful advice about supporting your body's journey through pregnancy and beyond.

These videos will enable women to:​

Understand and manage physiological changes that occur in pregnancy​

Optimise pelvic floor health​

Understand how to exercise safely in pregnancy and after birth ​

Be knowledgeable about self care in the postnatal period​

Know when to seek medical advice and referral​

Pelvic health and wellbeing during pregnancy and after birth
POGP are hosting these videos in support of the educational value and relevance of the content, this does not imply direct involvement in its development.

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Pelvic Health and Wellbeing during Pregnancy Videos

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To translate this page into another language then please use the recite me accessibility toolbar. The accessibility toolbar can be used to adjust elements for individual needs. This looks at aspects such as font style, size, colour, zoom functionality, keyboard navigation, screen readers and more.

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Slides from the Class (correct as of 1 May 2025)

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Getting baby into a better position for birth

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Some tips on helping baby into a good position for labour, which can sometimes even help to avoid induction

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Information on how and why we listen to your baby's heartbeat during labour

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These can be printed out and used in your room or looked at on a phone or tablet

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Columns are titled for ease of searching

Click on the website link/page/document to either view or download

Use the grey bar to the side of each column and at the bottom to scroll up and down or along

Please note that CW Trust is not responsible for information and links provided by outside organisations

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Tips to help your baby into a better position for labour

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Spinning Babies - Comfort in Pregnancy and Easier Birth

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Easier birth with fetal positioning. Use site & videos to improve fetal position (breech, transverse, posterior) and birth. Reduce the chance of cesarean.

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Induction of labour decision aid - postdates pregnancy FINAL

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What does it mean if I have a "small" baby?

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What does it mean if I have a "small" baby?

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Published: October 2014

Please note that this information will be reviewed every 3 years after publication.

This information is for you if you want to know more about pregnant with a small baby. You may find it helpful if you are pregnant and have been told that your baby may be small.

This information may also be helpful if you are a partner, relative or friend of someone who is in this situation.

The information here aims to help you better understand your health and your options for treatment and care. Your healthcare team is there to support you in making decisions that are right for you. They can help by discussing your situation with you and answering your questions.

This information covers:

possible reasons why your unborn baby may be small

how to reduce the risk of your baby not growing well

how the diagnosis of a small unborn baby can be made

what extra care to expect if you are thought to be having a small baby.

This information is not for women who are pregnant with more than one baby.

Within this information, we may use the terms 'woman' and 'women'. However, it is not only people who identify as women who may want to access this information. Your care should be personalised, inclusive and sensitive to your needs, whatever your gender identity.

A glossary of medical terms is available at A-Z of medical terms.

Sources and acknowledgements

This information has been developed by the RCOG Patient Information Committee. It is based on the RCOG Green-top Guideline No. 31, The Investigation and Management of the Small-for-Gestational-Age Fetus. The guideline contains a full list of the sources of evidence we have used.

This leaflet was reviewed before publication by women attending clinics in Belfast, Glasgow, Kirkcaldy, Newcastle and Birmingham.

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Having a small baby patient information leaflet

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Would you like to take part in our MOLI study?

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Frequently asked questions

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Join our weekly workshop to learn more about optimising your experience of induced birth

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Helping your baby into a better position for labour - although this article was written to assist midwives in their care of women in labour, it is still a really good read for parents-to-be.

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Further information about induction

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This page is intended to explain in outline the situations where induction of labour might be offered, what it might involve and what options you have. There is a lot more detail on all these topics in our book AIMS Guide to Induction of Labour(principal author Nadia Higson.)

What is induction of labour?

There is increasing evidence that babies send chemical signals when they are ready to be born, and in particular when their lungs are ready to start breathing. This causes the mother's body to produce chemicals called prostaglandins that start the physiological process of labour.

Inducing labour means taking action to bring forward the start of labour rather than waiting for this physiological process to begin. It is often understood to mean medical methods, but self-help methods or complementary therapies when used to start labour are also a form of induction. All these methods are trying to stimulate or mimic the physiological process of labour and this can have consequences.

Why might I be offered an induction?

According to NHS Maternity Statistics the proportion of labours in England that are induced has increased from 21% in the year to March 2010 to 34% in the year to March 2021.

There are many different situations in which induction is offered. The point in pregnancy at which it is suggested will depend on the reason for suggesting it. It might be because there is a cause for concern about the wellbeing of you and/or your baby. Depending how far advanced your pregnancy is, your decision on the timing of an induction may need to be a trade-off between the risk to your baby of being born too soon, and the risk of continuing your pregnancy.

More often induction is offered because of a concern that problems might develop or some risks to you or your baby (including stillbirth) might increase if the pregnancy were to continue beyond a certain number of weeks. The quality of the evidence about whether there really is an increased risk in these situations, and if so whether induction would reduce it, varies a lot. In some cases there is good evidence that induction can reduce the chance of harm to you and/or your baby, but often the evidence is limited, of poor quality and even contradictory, and sometimes it is virtually non-existent. It's also usually the case that the actual risks remain low, whether or not labour is induced.

Due to the limitations of the evidence, it's often a case of considering which view you feel more comfortable with: "Induction might help, so why not do it just in case?" or "There's no evidence that induction does any good, so why do it?"

Below is a brief discussion of some of the common reasons for induction to be offered, but there are many others, and a full discussion of the evidence about induction in various situations is beyond the scope of this article. For more details of situations in which you might be offered induction, a review of the evidence for each and a list of things that you may want to consider, see the AIMS Guide to Induction of Labour, or contact the AIMS Helpline for information and support.

Your waters broke before your labour started: The NICE guideline recommends offering a choice of induction either after 24 hours or straightaway if your waters break after 37 weeks of pregnancy (though it's up to you if you want to wait longer than this). This is to avoid an increased risk of infection for you or your baby. Most labours will start naturally within 24 hours of the waters breaking. The evidence review 'Planned early birth versus expectant management (waiting) for prelabour rupture of membranes at term (37 weeks or more)' suggests that induction may reduce your chance of developing an infection yourself, but there may be no difference in the chances that your baby will. None of the evidence is of high quality, and any additional risk appears to be small.

If your waters break earlier in pregnancy there is evidence that it may be better to wait for your labour to start at least until 37 weeks if there is no other cause for concern, to avoid the risks to your baby of being born prematurely.

Your pregnancy has lasted 41 weeks: The NICE guideline recommends that you should be told that "some risks associated with a pregnancy continuing beyond 41+0 weeks may increase over time" and induction from 41 weeks "may reduce these risks", but that you "will also need to consider the impact of induction on [your] birth experience when making [your] decision". The risks they list are: a higher chance of a caesarean birth; your baby being admitted to a neonatal unit; and stillbirth or neonatal death. However, they say that the evidence that induction reduces these risks is not "definitive" and "the absolute risk remains low" whether or not labour is induced after 41 weeks. In fact, the evidence from different types of study is contradictory. One recent review suggests that about 500 inductions of pregnancies that have lasted 41 weeks would be needed in order to avoid one baby dying.

There are guidelines that recommend offering induction or a planned caesarean earlier than 41 weeks if you have any of the following risk factors. Please see the relevant guideline or the AIMS Guide to Induction of Labour for details.

You have Type 1, Type 2 or Gestational Diabetes Mellitus[9] especially if your baby is also predicted to have a high birth weight

You have high blood pressure that can't be controlled with drugs, or develop

You develop severe Intrahepatic Cholestasis of Pregnancy[11]

You are expecting twins or triplets[12]

You might also be offered induction before 41 weeks for various other reasons (such as your age or the fact that you conceived through IVF), but you should be aware that there is no good evidence to support this.

Your baby is expected to have a high birth weight but you don't have diabetes: The NICE guideline says that in this situation "there is uncertainty about the benefits and risks of induction of labour compared to expectant management". For this reason they have not made a recommendation about offering induction earlier than 41 weeks.

Your baby seems to be growing slowly but is otherwise well: A package of measures designed to address the national stillbirth rate (the Saving Babies' Lives Care Bundle) recommends induction between 37 and 38 weeks for the smallest 3% of babies (below the 3rd centile), and at 39 weeks for babies between the 3rd and 10th centiles. However, the majority of these small babies are born in good health and being born early also carries some risks. At present, we do not have enough evidence to show whether it is always better to induce labour when a baby seems small, or to wait and monitor the baby's growth and well being.

Can I decline an induction?

It is your right to decide whether to accept the offer of induction and no-one should try to pressure or bully you into it. The new NICE guideline on inducing labour makes it very clear that your midwife or doctor should "recognise that women can decide to proceed with, delay, decline or stop an induction. Respect the woman's decision, even if healthcare professionals disagree with it, and do not allow personal views to influence the care they are given". For more about your rights to make decisions, and your care team's duty to give you information to help you decide, see our webpage Making decisions about your care and our book AIMS Guide to Your Rights in Pregnancy & Birth (principal author Emma Ashworth.)

Can I request an induction?

Although you have the right to decline an induction, you do not have the right to insist on one, but your doctor should at least be prepared to consider your request. The NICE guideline says, "Consider requests for induction of labour only after discussing the benefits and risks with the woman, taking into account the woman's circumstances and preferences". If you feel strongly that this is the right thing for you, or are worried about you or your baby's well being if they are not born soon, and feel that you are not being heard, you have the right to ask for a second opinion from another doctor.

When should I not be offered induction?

The NICE guideline says that induction "is not generally recommended" for babies in the breech position (bottom down) but could be considered if your baby needs to be born soon and you don't want a caesarean. It also says that labour should not be induced if a baby has very poor growth and is also showing signs of distress, but a planned caesarean should be offered. You should not be offered induction just because of a previous very fast labour.

What is involved in an induction?

Non-medical methods of induction

Unfortunately, very little research has been done on the effectiveness or safety of these methods and most of the studies that have been done were small.

There is some limited evidence that nipple stimulation, acupuncture or acupressure, and eating dates in the last few weeks of pregnancy can help to bring on labour. There is a lack of clinical evidence about whether other self-help methods (such as eating curry or pineapple, or having sex) or using complementary therapies (such as hypnotherapy, homeopathy, reflexology or aromatherapy) work. However, people do report finding them helpful, and trying them may make you feel more in control and able to relax. This could in itself make it more likely that your labour will begin without the need for medical induction.

Raspberry leaf (as tea or tablets) is often suggested but there is no evidence that this helps to start labour, and it may have potential adverse side-effects or interact with other medications such as insulin, so check with your midwife before taking it.

Methods of medical induction

This section gives a basic outline of the methods that you may be offered, but for details of the evidence on the effectiveness, benefits and risks of these please see the AIMS Guide to Induction of Labour.

The methods that you are offered will depend on how far your body has progressed in its preparation for labour (your Bishop's score). To assess your Bishop's score a midwife or doctor would need to perform a vaginal examination to feel how much your cervix has softened, thinned and started to dilate. A high Bishop's score makes it more likely that an induction will be successful, so before making decisions about induction you might want to ask what your Bishop's score is.

A membrane sweep involves a midwife or doctor carrying out an internal vaginal examination, and at the same time passing a finger inside your cervix and moving it around to loosen the membrane. The NICE guidelinerecommends you should be offered a sweep at an antenatal appointment after 39 weeks if you want it.

Evidence suggests that a sweep makes it about 20% more likely that you will go into labour without further interventions, but you are no more likely to avoid a caesarean or assisted birth. A sweep may be more painful than a regular vaginal examination and can cause bleeding.

If you have decided to proceed with an induction and your Bishop's score is still six or less, the NICE guidelinerecommends that you should be offered the choice of either artificial prostaglandins or a mechanical method to encourage your cervix to ripen further.

There is evidence that prostaglandins are effective at bringing on labour, but they can cause severe pain and nausea, and sometimes very strong, frequent contractions (hyperstimulation), which can be stressful for the baby.

The evidence about mechanical methods is more limited but they do not seem to carry the same risk of hyperstimulation and one type (called a balloon catheter) has been shown to be effective.

With both methods it could take 24 hours (sometimes much more) before you are in active labour.

Once your Bishop's score is above six, the NICE guidelinerecommends having your waters broken artificially (called amniotomy or ARM) and then being given a synthetic version of the hormone oxytocinthrough a drip to encourage strong labour contractions, either at the same time or a bit later.

There is no direct evidence for the effectiveness of either of these methods if labour has begun but is progressing slowly following induction with prostaglandins or a mechanical method. There is some evidence that synthetic oxytocin helps to shorten a labour that started naturally so it may have a similar effect in an induced labour. Both methods have potential risks which include more pain and increased stress on you and your baby.

How might having an induction affect my choices for the birth?

Agreeing to an induction could affect your other choices and your experience of birth.

You would be asked to agree to repeated vaginal examinations to assess your Bishop's score and check progress.

Your choice of birthplace is likely to be limited to a hospital labour ward as procedures like breaking your waters or giving a hormone drip would not be done at home or in a birth centre.

It may mean spending several days in hospital before getting into active labour.

You may not be able to have a partner or supporter present throughout the early stages of induction

You may have limited options for pain relief especially in the early stages, and may find it harder to get agreement to use a birth pool.

An induced labour may be more painful, especially if you have your waters broken or use a hormone drip.

Continuous monitoring is likely to be recommended for an initial period after the insertion of prostaglandins or a mechanical induction device. It may also be offered if you have your waters broken and is usually recommended if you use a hormone drip.

If the induction fails to work you may need to consider having an unplanned caesarean.

What can help me make decisions about induction?

The NICE guidelinerecommends that you should have a chance to discuss your options for the birth early in your pregnancy and again later on. You may find it helpful to have this conversation early so that you can start thinking about your preferences, especially if you know you are likely to need to consider an induction. Alternatively, you may prefer to focus on positive preparation for labour and not think about induction unless a reason arises. This could happen late in your pregnancy, and mean that you do not have very long to think about it.

Depending on your circumstances and how things develop, there are various decisions you might want to make including:

Whether you want to bring forward the time of your baby's birth or wait for labour to start naturally.

If you decide to bring your baby's birth forward, whether to have an induction or a planned caesarean and at which week of pregnancy to do this.

If you decide to have an induction, which methods you want to use to try to start your labour, including whether to have one or more membrane sweeps in late pregnancy, and whether you prefer prostaglandins or a mechanical method.

If you would like to go home in the early stages of induction if all is well.

If the ripening methods fail, whether to try again (e.g. have another dose of prostaglandin), try ARM and an oxytocin drip, wait a while, or request a caesarean instead.

What methods of pain relief you'd like to use (See our webpage Ways of managing your labour)

You may find it helpful to look at our webpage Making decisions about your care and the section in the AIMS Guide to Induction of Labour called 'Discussing induction with doctors and midwives'. This includes a list of questions that you might want to ask your carers. There are also sections on what may help an induction to work and things to consider if you are planning an induction.

References

[1] Higson N. (2020) AIMS Guide to Induction of Labour. shop.aims.org.uk/products/aims-guide-to-induction-of-labour

[2] Gao L. et al Steroid receptor coactivators 1 and 2 mediate fetal-to-maternal signaling that initiates parturition J Clin Invest 2015 Jul 1;125(7):2808-24. www.jci.org/articles/view/78544

[3] NHS Maternity Statistics, England - 2020-21 - NHS Digital, November 2021 digital.nhs.uk/data-and-information/publications/statistical/nhs-maternity-statistics/2020-21

[4] NICE Guideline 'Inducing Labour', November 2021 www.nice.org.uk/guidance/ng207

[5] Middleton P et al Cochrane review 'Planned early birth versus expectant management (waiting) for prelabour rupture of membranes at term (37 weeks or more)' January 2017 www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD005302.pub3/full

[6] RCOG 2019 "Care of Women Presenting with Suspected Preterm Prelabour Rupture of Membranes from 24+0 Weeks of Gestation (Green‐top Guideline No. 73 ) obgyn.onlinelibrary.wiley.com/doi/10.1111/1471-0528.15803

[7] Chippington Derrick D. & Higson N 'Labour Induction at Term - How great is the risk of refusing it?' AIMS Journal, 2019, 31:1 www.aims.org.uk/journal/item/induction-at-term

[8] Middleton P et al Cochrane review 'Induction of labour at or beyond 37 weeks' gestation' July 2020 www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004945.pub5/full

[9] NICE guideline 'Diabetes in pregnancy', December 2020 www.nice.org.uk/guidance/ng3

[10] NICE guideline 'Hypertension in pregnancy', June 2019 www.nice.org.uk/guidance/ng133

[11] ICP support 'Guideline for managing ICP', August 2019 www.icpsupport.org/protocol.shtml

[12] NICE guideline 'Twin and triplet pregnancy, September 2019 www.nice.org.uk/guidance/ng137

[13] Editor's note: The term 'expectant management' means waiting to see or waiting for labour to start.

[14] Saving Babies' Lives Care Bundle: www.england.nhs.uk/mat-transformation/saving-babies

[15]Making decisions about your care. AIMS 2020. www.aims.org.uk/information/item/making-decisions

[16] Ashworth E. (2020) AIMS Guide to Your Rights in Pregnancy & Birth. shop.aims.org.uk/products/aims-guide-to-your-rights-in-pregnancy-birth

[17] Raspberry leaf tea during pregnancy www.babycenter.com/pregnancy/diet-and-fitness/red-raspberry-leaf-tea_40007946

[18] Raspberry Leaf and Hypoglycemia in Gestational Diabetes Mellitus
pubmed.ncbi.nlm.nih.gov/27824754
[19] Finucane E.M. et al Cochrane review 'Membrane sweeping for induction of labour', February 2020 www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD000451.pub3/full

[20] Editor's note: ARM stands for Artificial Rupture of the Membranes. AIMS has a useful glossary of terms here: www.aims.org.uk/general/glossary

[21] Editor's note: Ripening refers to the measures taken to soften the cervix in preparation for the further stages of the induction process. Ripening happens naturally in the days before the spontaneous onset of labour.

[22] Ways of Managing Your Labour. AIMS 2018 www.aims.org.uk/information/item/managing-labour

Written by: Nadia Higson
Reviewed by: Debbie Chippington Derrick and Julie Milan
Reviewed on: 01/02/2022
Next review needed: 01/02/2024

AIMS supports all maternity service users to navigate the system as it exists, and campaigns for a system which truly meets the needs of all. AIMS does not give medical advice, but instead we focus on helping women to find the information that they need to make informed decisions about what is right for them, and support them to have their decisions respected by their health care providers. The AIMS Helpline volunteers will be happy to provide further information and support. Please email helpline@aims.org.uk or ring 0300 365 0663.

Published on 9th March 2022

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information for parents about induction of labour and the decisions that are theirs to make

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National Institute for Clinical Excellence (NICE)

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National Institute for Clinical Excellence (NICE)

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What does the research say ?

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Overview | Inducing labour | Guidance | NICE

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This guideline covers the circumstances for inducing labour, methods of induction, assessment, monitoring, pain relief and managing complications. It aims to improve advice and care for pregnant women who are thinking about or having induction of labour

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The Padlet that accompanies the Antenatal Education Course

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Welcome Birth stories can be really inspiring when you're preparing for your own induction. I remember searching for positive induction stories before my first birth and struggling to find th...

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Questions to ask

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What are the best questions to ask if you're offered induction of labour?

This is something I get asked a lot. So I have put together this guide to the five best questions that you can ask in order to get more information and make the decisions that are right for you.

I'm also going to tell you what you can learn from the answers you are given.

In case we've not met before, my name is Sara. I'm a midwife, speaker, researcher and the author of two books about induction of labour. They are In Your Own Time and Inducing Labour: making informed decisions. I've also written a book to help women and families make birth decisions. That's called What's Right For Me?

Here's the important thing. I'm not here to tell you whether to have your labour induced or not. That's not up to me. (Or your midwife, obstetrician, childbirth educator, doula or hypnobirthing teacher, but we'll come back to that.) Your decision won't affect me or any of those people. And, as I am very fond of saying, one size doesn't fit all. My work is about trying to help you to understand and navigate the evidence so you can make the decisions that are right for you.

Let's start with what I think is the first question anyone should ask if induction is mentioned.

Question 1: Why are you suggesting this? / What's the indication?

The first thing you need is a clear and specific explanation of why you're being offered induction of labour. So "why" is the first question to ask.

Midwifery and medical professionals call this "the indication." Asking "what's the indication?" will help you find out whether or not there is a clear, single indication. But you don't have to use the jargon. You could also ask, "Why are you suggesting this?" Or, "Can you tell me exactly why you're offering me induction?"

You might have to ask this - and the other questions - more than once. Don't be afraid to do that. It's your body and your baby, and the decisions you make can affect you and your baby's health and you family for a long time. So unless you're in one of those rare situations where it's really an emergency, it's really okay to take time to think about them.

And one tip is that, if it's truly an emergency, you're not likely to be offered an induction. Induced labour often takes three days to get going. If there's a genuine emergency, you'll be offered a caesarean, which is much faster. So if someone offers you an induction and says it's an emergency, you might want to ask some questions about that.

What can you learn from the answer?

There are three common answers to questions about why induction is being offered.

"You or your baby have a medical problem."

The answer you get may be very clear and specific and mention an actual medical problem.

For instance, you might be told, "because you have pre-eclampsia." Or, "because your baby has a heart condition and we need him to be born so we can do surgery."

In these situations, it's still your decision, of course. And yes, there's a difference between having symptoms of pre-eclampsia and being close to developing eclampsia. So you might want to explore what you're being told in a bit more depth. You'll still want to ask the remainder of the questions below, and you can then decide whether or not the benefits of induction outweigh the downsides for you and your family. But where there's a clear and specific reason that involves an actual medical condition, it's more likely that induction is genuinely warranted.

This is a useful thing to know. Because there's an important difference between being offered induction because you or your baby actually HAS a specific named medical condition, and being offered induction because you or your baby is thought to be "at risk" of something. It's important to determine which is the case for you.

You might be told that you're being offered induction because you or your baby are "at higher risk." When you ask what that means, you discover that it's because you are for example over a certain age, larger than average, or you conceived by IVF.

None of those things are an actual medical condition. So let's look next at what you might want to consider if you're told you're being offered induction because you have one or more risk factors.

"You have a risk factor."

The second possible answer is that you are told something like this:

"We offer induction to everyone who is 41 weeks pregnant."

"Your BMI is over 35."

"We offer induction to everyone who has a suspected big baby."

"Induction is best for women who conceived by IVF or ARTs."

That list isn't exhaustive; they are just a few examples.

What this kind of answer tells you is that the offer isn't tailored to your specific, individual situation. You're being offered induction because you fall into one or more categories. In many countries, induction is routinely offered on a population basis to anyone who ticks a box or has a 'risk factor.'

You might still want induction in these circumstances, but it's important to know that having a risk factor is different to having an actual medical condition. Having an actual, diagnosed medical condition right now is different from being in a group that might be at greater risk of developing a problem. Most of the time, only a small number of those in the group will develop a problem, whereas someone with a medical condition definitely has that condition.

Often, the actual chance of women who are told they are "at risk" having a poor outcome is very low. More on what to ask about the numbers below. In many cases, there's still a very high chance of everything being just fine. And remember that induction has downsides too and life doesn't come with a "no risk" option.

This is where you really need to look at the evidence and weigh things up. Sometimes, induction is offered to women with risk factors in the hope of saving a very small number of babies. But there's not always clear evidence that it does save babies. And hundreds or thousands of women and babies need to have induction in the hope of saving one. Some of them will end up with other problems as a result of the induction and associated interventions, and so it's a question of weighing up the pros and cons. Often, there isn't good evidence to support induction for risk factors alone. There are some articles on this on our induction information hub and loads more on the evidence in In Your Own Time. And there's more on how to ask about the actual numbers below.

"Mumble, waffle, jargon, jargon."

The third common answer to this question is a reply that is unclear, provides little information or is full of jargon. Someone may list several potential problems or risk factors in an unspecific way that leaves you wondering what they just said. Don't let that put you off asking more questions. A garbled, unclear, or 'stun you with science' response may mean that the person you're speaking with is not really keen on you making your own decision. It might mean that there isn't a clear indication. If someone has to add three risk factors together to justify their offer but can't provide you with robust evidence for any of them, be wary.

It might be that the person offering induction may be afraid of physiological labour, or of waiting for women to birth in their own time. (It's more common than you might think.) They may genuinely think this is 'for the best', or just prefer to control when labour happens.

If you are given a list of complications or risk factors, ask lots of questions about what these complications are. Ask the questions below as well. There's more about this in my blog post on induction for gestational diabetes. Look at the section in that blog post called "Risks and recommendations." Even if you've not been told you have gestational diabetes, the principles are the same.

Don't be impressed by jargon. If an intelligent person has a justifiable suggestion, they should be able to explain and discuss it with you in a reasonable manner. If that's not happening, be alert.

This brings me to my next tip.

Question 2: What's the evidence?

Once you've discovered exactly why induction is being recommended in your situation, ask what the evidence says. This is another of the key questions to ask if you're offered induction. Ask if there is evidence of benefit of induction. Often there is not. And, if someone tells you that there is evidence of benefit, ask them to provide you with the evidence or a reference, so that you can look at it for yourself.

One thing that's important to know is that not all induction studies are good studies. Some were poorly conducted and/or were biased in their approach. This is especially true of some of those which claim to show that induction reduces the chance of caesarean section. Some studies are now quite old. It's possible the participants weren't similar to you. For instance they might not have given birth in the setting/country that you're in. This kind of evidence may not necessarily apply to you.

This is a complex area and I can't give all the detail here (which is one reason I write books for those who want more in depth information). But some of the more controversial studies to listen out for include The Canadian Post-Term Trial, the ARRIVE Trial, and the SWEPIS study. The last one is sometimes described as a Swedish study which was stopped because some babies died. Yes, they did, which is very sad. But that doesn't mean they would have been saved by induction, or that a lack of induction was the problem. The media headlines and those who quote this study have been criticised by other researchers. That's because there were some issues with the trial. Data from a half-finished study isn't robust enough to let us draw conclusions and make recommendations. Again, if you'd like more detail, have a look at my other induction blog posts or grab one of my books.

What can you tell from someone's reply to this question?

Well, you're looking for a reply that is clear, honest and that acknowledges that no research study is perfect. If you feel that the person is trying to convince you that they are absolutely right and there's no room for debate, be alert. If they try to stun you with science and numbers, they may not really be wanting you to make your own decisions. Good practitioners will be happy to share the evidence with you and discuss the pros and cons in an open way that focuses on what's right for you.

Question 3: What's the absolute risk?

If you are told that there is a specific reason for induction, especially if that is a risk factor, ask for some numbers.

Some professionals will tell you the relative risk of something happening but not the absolute risk. So they might say, "your baby is twice as likely to die if you do X rather than Y." But what they don't tell you is that the risk of Y is one in 4000 and the risk of X is one in 2000. In other words, the unwanted outcome is very, very unlikely no matter what you do.

And, as we'll get to in the next tip, intervention carries downsides as well as advantages.

It's always a good idea to ask for the absolute risk of a problem occurring, no matter what health decision you're making. As with the last tip, you may also want to ask for the evidence or a reference so you can look at it yourself.

Also as with the last tip, you should be able to tell a lot from their response. All of the things I've mentioned about this above apply here as well. How open and honest are they in their response? Is there acknowledgement that there's not always one clear 'correct' way that's right for everyone?

Question 4: What are the downsides?

You should also ask about the downsides of induction.

I recommend asking this question even if you feel you already have this information. If you've been to my website before, you may already know that induction has downsides. ( If not, there's lots more info on that here. I recommend that families ask this question even if they already know what the downsides are.

That's because asking this question is an excellent way of finding out if the person you are speaking to is being open and transparent about the pros and cons of the different options. Anyone who is being respectful should honestly and openly tell you the things in this article. They should also mention the negative consequences of induction for you and your baby.

If they don't tell you these things, or they gloss over them, treat it as a red flag. You need the full picture. And you deserve caregivers who will give you that.

Question 5: How, when, where, what and who?

Find out about the process of induction, the pros and cons, the evidence for the most common reasons and the information you need to decide if it's right for you.

Don't be afraid to keep asking until you have enough information. If you want to be prepared before you have this conversation, there is also lots of info on the practical reality of induction in Inducing Labour: making informed decisions.

Many women are dissatisfied with their experience of induction. This is one of the key issues that comes up in the studies that ask women about their experience. One of the main reasons for this is that they had not been given adequate information about what would happen. They were not told, for instance, that induction can sometimes take three or four days to get going. They were not told that the early contractions can be quite painful, even though they may not be doing much. Women aren't always told that their partner, family, friends or doula can't be with them except during visiting times. These hours are quite restricted in some places. In others, they aren't. The induction experience varies a lot; it's a postcode lottery.

So ask as many questions as you need to in order to get a sense of what it would be like in your area. Then, you will be much better placed to weigh this up with all the other information you've gathered and decide whether induction is right for you and your baby.

So those are my five best questions to ask if you're offered induction. I hope that these questions will help you consider and explore your options. There's lots more induction information on this website. Make a cup of tea and have a look around!

If you'd like more in-depth information or to learn more about the evidence, you might enjoy In Your Own Time and/or Inducing Labour: making informed decisions. My book What's Right For Me? also contains lots of information about birth-related decision making.

Books to help you become informed and make the decisions that are right for you...

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Five questions to ask if you're offered induction of labour - Dr Sara Wickham

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What are the best questions to ask if you're offered induction of labour? Here are 5 great questions and what you'll learn from the answers.

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What does this mean for my labour

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Care during labour

Meconium is the baby's poo, and is sometimes found in the amniotic fluid ('waters') during labour. If the fluid contains thick meconium or lumps, your midwife will advise that you are transferred to an obstetric unit for the birth if you are not already there. This is so that your baby's heartbeat and your contractions can be monitored continuously using electronic monitoring and doctors are on hand to help if needed.

After your baby is born

If there has been thick or lumpy meconium during labour, your baby's heartbeat, breathing and colour will be checked carefully straight after the birth. If these are not normal, your baby's airways will be looked at and cleared out using suction. Even if your baby's heartbeat, breathing and colour are normal, she or he will be observed by a healthcare professional every 2 hours for 12 hours after the birth.

If there has been light meconium (not thick or lumpy), your baby should be checked 1 and 2 hours after birth.

Your baby may be assessed by a neonatologist if checks suggest any concerns. You should be told what is happening.

You should be advised about what to look out for and who to contact if you have any worries after the midwife has left if you have had a home birth, or after you and your baby have gone home from a birth unit.

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If there is meconium during labour | Information for the public | Intrapartum care for healthy women and babies | Guidance | NICE

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This guideline covers the care of healthy women and their babies, during labour and immediately after the birth. It focuses on women who give birth between 37

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Natural ways to "encourage" labour to start

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Natural ways to "encourage" labour to start

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Some things to try - always check with your midwife first

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Information from the Royal College of Obstetricians and Gynaecologists

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Positions to encourage a slow labour or to get labour started

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Midwife Marley on Instagram: "How to get baby into an optimal position for labour and birth.

Long labour?
Breech?
Sunnyside up?
Head not aligned in the pelvis?

These can help adjust things.

You can do these exercises in pregnancy and /or during labour if it's taking a long time to get going. It's also  beneficial for labour that seems to progress well and then stalls.

Often, the position of the baby is to blame for a long labour. It could be that the baby is sunny side up (back to back/OP) or maybe their head is tilted to the side or deflexed in the pelvis, making it difficult to rotate and bring their chin to their chest.

The forward leaning inversion technique is also good for turning breech babies and helping the head to engage if its high at full term, but don't try without speaking to your care provider. This move isn't advised if you have high blood pressure, polyhydramnios or glaucoma. The position should only be held for 30 seconds or so to prevent dizziness. In pregnancy you can do this 2-3 times per day. In labour, only do this if you feel comfortable.

If you have a long prodromal labour, trying the sidelying position helps you to get some rest, as well as creating more space in the pelvis.

The open knee chest can be done as an alternative to the forward leaning inversion. Practising this once or twice a day in pregnancy and early labour can be beneficial.

Walking up the stairs sideways is not only a good way to keep fit, but another way to create more pelvic space!

If you're expecting a baby, save this video for future reference, you never know, it might just come in handy!"

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968 likes, 23 comments - midwifemarley on January 15, 2023: "How to get baby into an optimal position for labour and birth.

Long labour?
Breech?
Sunnyside up..."

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A post shared by Midwife Marley (@midwifemarley)