Inductions and interventions in labour

Sometimes, extra help may be recommended by your midwife or doctor so you can give birth safely. You might hear this help referred to as ‘interventions’. 

Below we describe the different types of interventions in labour and why they might be needed, so you can feel prepared for different scenarios.

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Induction of labour

An induction is when your labour is started artificially through the use of a pessary, gel, hormone drip or breaking of your waters. This is sometimes done once you've been admitted to hospital so that health professionals can monitor you and your baby, but in other cases you might be able to go home while you wait for it to work.  

An induction can take hours or days, depending on the methods used and how your body responds to them. 

Potential induction complications include a higher chance of needing an emergency C-section and more painful labour contractions.

Why might I be offered an induction?

Labour can be induced for many reasons, but the most common are:

• You’re more than 41 weeks pregnant. Your baby is at a slightly higher risk of stillbirth or other problems if you are pregnant for more than 42 weeks, so as a precaution the recommendation is to induce labour at 41 weeks.
• Your waters have broken but contractions haven't started. You’re at higher risk of infection the longer your waters are broken without your baby being born, so official advice is to offer an induction 24 hours after your waters break if you’re more than 34 weeks pregnant. If your waters break earlier than 34 weeks, induction will be recommended depending on your circumstances.
• Giving birth is safer than letting your pregnancy continue. This can be due to a number of reasons, for either you or your baby’s safety. For example, it’s common to be offered an induction if you have been diagnosed with pre-eclampsia or gestational diabetes, or if your baby seems to have stopped growing.

How will I be induced?

There are several different ways to start labour and it's not unusual to start with one method of induction and move on to another if the first doesn’t work.

• Balloon catheter. A soft silicone tube with a balloon near the tip is inserted into your cervix and filled with a sterile salt water fluid. This puts pressure on your cervix to soften and open enough to start labour, or for your midwife or doctor to be able to break your waters.
• Pessary or gel. A small almond-shaped tablet or gel is inserted into your vagina to slowly release a substance that should soften your cervix and encourage contractions.
• Breaking your waters. Your waters may be broken by your midwife inserting a hook through your cervix to pierce the membrane sack to get contractions started. This is also known as ‘artificial rupture of membranes’.
• Hormone drip. A cannula is inserted into your hand which gives you an artificial oxytocin drip to get your contractions started. You’ll need to be monitored continuously while receiving the drip to make sure your baby’s coping with the contractions.

Use our guide to help you spot and understand the different signs and stages of labour. 

Can I say no to being induced?

Yes. It's your choice whether to have an induction or not, and your wishes have to be respected. Before making a decision you should always have the opportunity to discuss why an induction is being recommended and what's best for you and your baby with your doctor and midwife. 

If you decide to not be induced, alternatives include: 

• Waiting for labour to start naturally
• Having an elective C-section

If you’re overdue and don't want to be induced, you should be offered increased monitoring as an alternative. 

The charity AIMS has a useful list of induction facts to consider when deciding whether or not to have an induction. It's also worth adding your preferences when it comes to interventions in your birth plan. 

Assisted birth 

When instruments like forceps or ventouse are used during the second stage of a vaginal birth, it’s known as an assisted delivery. This is very common and can be recommended for a variety of reasons. 

Why might I need an assisted delivery?

Below, we've listed some of the reasons why you may need an assisted delivery:

• You’re too exhausted. After a long labour you may not have the energy left to push the baby out all by yourself.
• Your baby’s in an awkward position. If your baby’s head is in an awkward position, it may not be able to descend into the birth canal without the use of forceps to turn it around.
• Concerns about your baby’s heart rate. If you’re dilated and your baby needs to be born quickly, having an assisted birth may be recommended over a C-section.
• For your health. In rare cases, you may have been told in advance that you shouldn’t push during the birth.

Birth is unpredictable and complications can occur in any situation. However, there are some things you can do to reduce the likelihood of an assisted birth, including being in an upright position or lying sideways when giving birth and avoiding an epidural for pain relief. 

Are there any risks with a forceps or ventouse delivery?

Like all birth intervention, an assisted birth comes with some potential complications for both you and your baby.

• There is a risk the baby will have bruising and/or small cuts or marks from the instrument, but they’re usually only temporary. 
• You're more likely to experience severe tearing and blood clots, as well as urinary and anal incontinence, compared with if you have a straightforward vaginal birth.

However, it can be worth bearing in mind that sometimes the only safe alternative to forceps or ventouse is an emergency C-section, which comes with risks of its own. In other cases, the baby is already so far down the birth canal that it would be very difficult to even have a C-section, therefore an assisted delivery is the safest option. 

See our guide for more information on emergency C-sections. 

Forceps or ventouse – which is better?

Both forceps and the ventouse cap can be used but the decision will depend on the circumstances of your birth and the clinical judgement of the midwives or doctors involved.

• Forceps. This is a surgical instrument that looks like large tongs in two halves; each half is carefully placed around your baby’s head in the birth canal and the two handles fitted together before the doctor pulls at the same time as you push your baby out.
• Ventouse cap (vacuum). This is a silicone cap attached to a suction pump. The cap is fitted on your baby’s head in the birth canal, and it’s kept in place using suction while the doctor or midwife pulls at the same time as you're pushing.

Generally speaking, a forceps birth is more likely to be successful in allowing the baby to be born without need for a C-section, but a ventouse is gentler and less likely to lead to a severe tear for the woman in labour.

Home to hospital transfer when giving birth

If you’re giving birth at home or in a birth centre, you’ll be recommended to transfer to the nearest labour ward if your midwife is concerned for you or your baby’s health, or if you request stronger pain relief which can only be given in the hospital.

Some common reasons why you may be transferred from home to hospital include:

• Your labour is stalling (in the first, second or third stage).
• You want extra pain relief, such as an epidural, which isn’t available in the birth centre or at home.
• It seems like your baby may not be coping well with labour, for example if their heart rate is slowing or meconium is found in your waters when they break.
• You need more help after the birth, for example if you’ve had severe tearing or the placenta doesn’t come out in one piece.
• Your baby needs to be admitted to a special baby care unit at the hospital for monitoring or treatment.

However, it might be comforting to know that most transfers are precautions rather than emergencies.

Use our choosing where to give birth tool if you’re still weighing up your options. The tool lets you put in your personal circumstances and preferences to see whether giving birth at home, in a birth centre or in the labour ward might be best for you.

How does a transfer happen when you're in labour?

1. Once the decision to transfer has been made, your midwife will call an ambulance to take you to hospital, although in some cases you may be able to go in your own car. If you’re in an alongside birth centre you can go to the labour ward in a wheelchair.
2. Your midwife and birth partner will travel in the ambulance with you. 
3. Once you’ve arrived at the hospital, your care may be handed over to a midwife who works on the labour ward and is more experienced in hospital births.

If you or your baby need more help after a home birth or freestanding birth centre, you’ll travel together to the hospital by ambulance. If you need to be admitted to the postnatal ward for overnight care, your baby will stay with you unless they need to go into neonatal care.

Video: What does it mean to be transferred during labour

In this video, a consultant midwife explains what being transferred means in practice. 

Still thinking about where to give birth? Find out about your maternity options and the questions to ask in our guides to birthing options.