Induction of Labour: When “Routine” Becomes Risk

Induction of labour has become so normalized that many pregnant women are told early in pregnancy when they’ll be induced, not if induction will actually be needed. What’s often presented as a routine, low-risk way to “get things started”, is framed as safer than waiting and a simple solution to the uncertainty of late pregnancy.[2] 

But for many healthy pregnancies, induction is not a neutral choice.

Labour is a complex hormonal process that works best when the body and baby initiate it together. Starting labour before that cohesive readiness can disrupt the physiology of birth and set off a cascade of interventions that increase the likelihood of complications, and the very outcomes induction is often meant to prevent.[3] 

There’s an underlying belief that waiting for labour is risky, unnecessary, or even irresponsible. While induction can be life-saving in certain situations, the reality is that many inductions are recommended for reasons that are not urgent or strongly evidence-based.

Understanding that difference matters.

Inductions are commonly recommended for things like going past a due date, a baby measuring large, diabetes, maternal age, high blood pressure, or simply because induction is viewed as “safer than waiting.” In some situations, induction is absolutely the right choice. In others, it falls into a grey area where careful monitoring and informed discussion are appropriate.

One important thing many parents are never told is this:

If an induction can be scheduled days or weeks in advance, it is almost always non-urgent.

True medical emergencies do not get placed on a calendar.

Induction is often framed as simple and reassuring.

“We’ll just get things going.”
“You won’t have to wait around.”
“Aren’t you excited to meet your baby?”

What’s usually missing from this conversation is how induction changes the physiology of labour and how dramatically it can affect the birth experience.

Labour is a hormonal process that works best when the body and baby initiate it together. When labour is started artificially before that readiness, it often becomes longer, more intense, and more difficult to manage - especially for first-time mothers.

Induced labours are more likely to involve stronger, more painful contractions, additional interventions, and longer timelines - sometimes lasting days rather than hours. For first-time mothers in particular, induction can be associated with a higher likelihood of cesarean birth despite what studies such as the ARRIVE trial state – I’ll provide more on that study later. It has been shown in real-world practice that inductions tend to be rushed.

This doesn’t mean induction is always harmful. But it does mean it is not a neutral intervention and shouldn’t be treated like a simple scheduling decision.

One of the most common fears used to justify induction is the idea that placentas stop working after 40 weeks.

While placental function can decline in some pregnancies, there is no automatic expiration date at 40 weeks. It is very normal for a pregnancy to go beyond 40 weeks, especially when we know due dates are estimates, not deadlines. However, because so many parents are pressured into induction, we rarely see how normal post-dates pregnancy truly is. Most placentas continue to function well beyond that point, especially in healthy pregnancies. The issue is not gestational age alone. It’s placental function.

You’ll often hear fear-inducing statements like “the risk of stillbirth doubles after 40 weeks.” While this may be technically accurate, it’s incomplete and misleading without context.

What’s usually missing is absolute risk. Estimates commonly cited show the risk of stillbirth to be approximately 0.039% at 39 weeks, 0.068% at 40 weeks, and 0.085% at 41 weeks. When numbers are presented this way, rather than using relative or sensational language, they are far less alarming and allow families to make more informed decisions.

In many cases, ongoing monitoring and individualized care can provide valuable information without immediately resorting to induction. When induction is presented as the only option based solely on a due date, fear, rather than physiology, is often driving the decision.

Another common reason induction is recommended is concern that a baby is “measuring big.”

This is one of the most fear-provoking messages a pregnant person can receive. So many women fear not being able to push their baby out. What’s rarely explained is that late-pregnancy ultrasound weight estimates can be off by one to two pounds or more. Artificially strong contractions can also make it harder for babies to rotate and descend through the pelvis, regardless of their size.

Outside of rare medical conditions or poorly controlled diabetes, the idea that a healthy body will routinely grow a baby that is “too big to birth” is not supported by evidence.

You may also hear induction justified using research like the ARRIVE trial, which is often cited as proof that inducing first-time mothers at 39 weeks is safer.

What’s less commonly discussed is how that study was conducted. The ARRIVE trial took place in hospitals with lower-than-average cesarean rates, strict induction protocols, continuous labour support, and carefully selected participants. These conditions don’t reflect the reality of most hospital birth settings.

Despite this, the results are frequently generalized and used to encourage routine induction without discussion of whether the findings apply to an individual parent, provider, or hospital.

Diabetes is another common reason induction is often recommended. Whether Type 1, Type 2, or gestational diabetes, induction at 38 weeks is often assumed.

As someone with Type 1 diabetes myself, I faced this pressure in both of my pregnancies. Despite well-managed blood sugars (A1C of 5.1%) and otherwise healthy pregnancies, I was automatically placed on an induction list. With my first, the hospital called daily “encouraging” me to come in, but I declined.

When you’re 40 weeks pregnant, emotional, and uncomfortable, going “against medical advice” is not easy. I had family and friends who believed I was making the wrong decision by waiting. But I trusted my body and my health.

I went into labour spontaneously at 40 weeks and 6 days. My baby was not large, just an average 7 lbs 7 oz.

Many women with diabetes are told induction is necessary simply because of the diagnosis, without consideration of individual health, control, or monitoring. It’s often assumed that a diabetic mother will have a large baby.

But diabetes alone is not a medical emergency.

What matters far more than the label is blood sugar control throughout pregnancy, evidence of placental function, baby’s growth over time, and overall maternal and fetal well-being. Well-managed diabetes with reassuring monitoring does not automatically require early induction.

Induction can absolutely be the safest choice in some diabetic pregnancies, particularly when there are signs of placental insufficiency or worsening control. However, when induction is recommended solely based on a diagnosis without evidence of a current problem, parents deserve a deeper, individualized conversation.

There are situations where induction is truly necessary and life-saving, such as severe pre-eclampsia, infection, significant growth restriction, or clear signs of placental compromise. In those cases, induction isn’t about convenience. It’s about safety.

The problem isn’t induction itself.

The problem is routine induction without true informed consent.

Learning about induction doesn’t mean you’ll never choose one. It means you’ll understand whether a recommendation is urgent or optional, what questions to ask, what alternatives may exist, and how to prepare if induction is needed.

Even when birth doesn’t go according to plan, parents who feel informed and involved in decision-making consistently report better emotional experiences and less birth-related trauma.

Induction of labour should never be treated as a scheduling tool.

You deserve clear information, individualized care, and the time to make decisions without fear-based pressure.

Because informed consent isn’t about saying no.

It’s about knowing when you have a choice.

If you feel coerced, it’s not consent.

If you are looking for more on birth prep, check out my FREE Workshop