Induction of labour when your baby is overdue or ‘post-dates’

An induction of labour is when your labour is started by medication or other artificial ways, rather than your body going into labour naturally. For more information about the induction process, please see here.

If your pregnancy has been straightforward, induction will be offered if you do not go into labour naturally between 41 and 42 weeks, as the risk of a stillbirth (when a baby dies before it is born) increases over time and having an induction from 41 weeks may reduce this risk.   

The quality of the evidence can vary about whether there really is an increased risk in these situations and if so whether induction would reduce it, but the information in a recent (2019) UK review of stillbirth rates from 15 million births is the one most commonly used as a guide. This shows that the overall risk of stillbirth in every 1000 births is: 

You may find it easier to look at these figures as pictograms: 

This graph below shows the overall risk of stillbirth (black line) and neonatal death (red line) per 1000 births by stage of pregnancy after 37 weeks. 

Although the stillbirth rate increases significantly from 40 to 43 weeks, the actual risk is still very low. The risk of a baby dying after birth (neonatal death) also remains very low.  

As there is no way of telling whether YOUR baby is at risk, the recommendation is to consider an induction by 42 weeks to reduce the number of stillbirths that happen with prolonged pregnancies.  

Your own risk may be different due to several factors such as being overweight (BMI over 30), underlying medical problems, your age, IVF conception, your ethnic background or clinical concerns that arise in your pregnancy. In these situations, your midwife and doctor will discuss an individualised plan with you.

The risks and benefits of having or not having an induction will depend the reason you’re being offered induction and your own personal circumstances. Some statistics that we know are: 

• An induction of labour around 41 weeks may have the best chance of you achieving a vaginal birth and is not usually associated with an increased likelihood of caesarean birth. 50% of birth happens before 40 weeks, 82.8% before 41 weeks, 99% before 42 weeks ( NICE, 2021).  
• Induction of labour between 41 and 42 weeks may reduce risk of still birth as per above graph.  
• Decrease likelihood of caesarean birth. 
• Decrease likelihood of the baby needing admission to a neonatal intensive care unit. 

However, an induction of labour is a medical intervention that will affect your birth options and your experience of the birth process. This could include that:  

• If your pregnancy has been straightforward, your chance of a vaginal birth is highest if your labour starts by itself (spontaneously) and you plan to labour and birth on a midwife-led Birth Centre near to a Labour Ward.  
• Your choice of place of birth may be limited, as you may be recommended interventions (for example, oxytocin infusion, continuous baby (fetal) heart rate monitoring and epidurals) that are not available for a home birth or in a midwife-led Birth Centre.  
• You may be less likely to be able to use a birthing pool.  
• You may be more likely to need a forceps or ventouse birth (assisted or instrumental vaginal birth), which come with other risks, such as a higher risk of a more severe perineal tear and some increased risks to your baby.   
• An induced labour may be more painful than a spontaneous labour. 
• Your hospital stay may be longer than with a spontaneous labour.

• Over 95% of labours will start spontaneously by 42 weeks so delaying an induction until then may reduce the need for this intervention at all.  
• But delaying it until after 42 weeks is associated with a higher likelihood of having a caesarean birth although these rates will be affected by the reason for the induction.  
• Where you plan to give birth (home, a hospital birth centre or a hospital labour ward) may also affect the chance of achieving a vaginal birth.  
• You may want to consider an informal method of induction known as a ‘membrane sweep’ at 40 and 41 weeks.   
• 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.

If you prefer to not have an induction, you can watch and wait instead – wait for your baby to come on its own and your natural labour to start, while keeping an eye on how you and your baby are feeling.  

If you choose to wait for your baby to come on its own, we will support you with this. Normally we would arrange for you to speak to your midwife or doctor about your personal risks and benefits of waiting, and help you to create your own plan for the rest of your pregnancy and birth.  

You may be offered closer monitoring of you and your baby and this may include some extra appointments at the hospital including an ultrasound scan and monitoring your baby’s heartbeat. This is often called ‘expectant management’.   

Monitoring and using scans do not help predict or avoid problems that might happen suddenly and none of these tests can accurately predict whether your baby is more or less likely to have a stillbirth in the future, but can help to tell you how your baby is at the time of the scan or test.  

You will be supported if possible to give birth where you had planned (Birth Centre, home or Labour Ward). If your baby doesn’t come on its own you will have the opportunity to revisit your options with your birth team. 

You will be offered an appointment with your obstetric consultant and / or a consultant midwife to make an individualised plan for you.  

You also have the option of having a planned caesarean birth rather than an induction if this is your choice. 

For further information on risks and benefits of induction of labour please visit the NICE website.