Induction of labour
Induction means starting labour with medicines or other methods instead of waiting for it to begin on its own. It is usually done when the due date has passed or when a problem with the pregnancy puts the mother or baby at risk. Two large trials asked a different question: is it better to induce healthy women at a set time than to wait? ARRIVE looked at first-time mothers at 39 weeks. SWEPIS compared induction at 41 weeks with waiting until 42 weeks. They measured different things and found different results, so read each on its own page.
- Intervention
- In this atlas
Overview
Technical summary
A procedure with several methods: medicines (oxytocin, dinoprostone) and mechanical ripening of the cervix (a balloon device). Each method has its own record; this record is about the strategy of inducing labour at a chosen time. Sources: MedlinePlus Childbirth, NIH Labor and Delivery (cite only), ARRIVE (Grobman et al., NEJM 2018: abstract and registry record) and SWEPIS (Wennerholm et al., BMJ 2019: abstract and PMC full text, with its erratum). Neither trial compares methods of induction. The oxytocin record keeps induction apart from the use of oxytocin after birth to prevent bleeding.
About this intervention
- Type
- Procedure
- Mechanism
- Not reported
Claims and evidence
Context Fetuses and babies of low-risk first-time mothers randomised at 38 weeks 0 days to 38 weeks 6 days: perinatal death or severe neonatal complications (ARRIVE)
- Recipient
- Mixed recipients
- Population
- Fetuses and newborns of low-risk nulliparous women who were randomly assigned at 38 weeks 0 days to 38 weeks 6 days of gestation either to labour induction at 39 weeks 0 days to 39 weeks 4 days or to expectant management. The composite counts fetal and newborn outcomes together: the registry says perinatal death includes antepartum stillbirth, intrapartum stillbirth and neonatal death. The gestational bounds are the mother's gestational age at randomisation. Use this context only for the composite perinatal outcome.
- Care setting
- Multicentre trial in the United States; the abstract does not say what kind of site took part.
- Geography
- United States
- Life stage
- Antepartum pregnancy, birth and the newborn period to hospital discharge
- Gestational age
- 38 weeks 0 days (266 days) to 38 weeks 6 days (272 days), measured at enrolment
- Postnatal age
- Not reported
- Follow-up
- Per the registry, the composite runs from delivery through 72 hours after birth, except perinatal death, which runs from the antepartum pregnancy period through hospital discharge.
Eligibility: 1 inclusion criterion; exclusion criteria not stated
- Included
- Fetuses of nulliparous women with a singleton pregnancy randomised in ARRIVE, and the babies born of them
- Excluded
- None stated
ARRIVE randomly assigned low-risk first-time mothers at 38 weeks 0 days to 38 weeks 6 days of gestation either to labour induction at 39 weeks 0 days to 39 weeks 4 days or to expectant management. The primary outcome, a composite of perinatal death or severe neonatal complications, occurred in 4.3% of neonates in the induction group and 5.4% in the expectant-management group (relative risk 0.80, 95% confidence interval 0.64 to 1.00). The authors report that induction did not result in a significantly lower frequency of the composite adverse perinatal outcome.
Applies to Mixed recipients- Fetuses and newborns of low-risk nulliparous women who were randomly assigned at 38 weeks 0 days to 38 weeks 6 days of gestation either to labour induction at 39 weeks 0 days to 39 weeks 4 days or to expectant management. The composite counts fetal and newborn outcomes together: the registry says perinatal death includes antepartum stillbirth, intrapartum stillbirth and neonatal death. The gestational bounds are the mother's gestational age at randomisation. Use this context only for the composite perinatal outcome.
- Multicentre trial in the United States; the abstract does not say what kind of site took part.
- United States
- Antepartum pregnancy, birth and the newborn period to hospital discharge
- Gestational age 38 weeks 0 days to 38 weeks 6 days, measured at enrolment
- Postnatal age Not reported
- Certainty method
- Not assessed
- Limitations
- The abstract and the registry record were read; the full text was not, because the PMC copy is not in the Open Access subset, so the analysis methods are not described here. The registry lists the composite's components: perinatal death, respiratory support within 72 hours after birth, an Apgar score of 3 or less at 5 minutes, hypoxic-ischemic encephalopathy, seizure, infection, meconium aspiration, birth trauma, intracranial or subgaleal haemorrhage, and hypotension needing vasopressor support. The registry lists masking as none. The percentages are as printed in the abstract, and the abstract does not give the number of neonates in each group, so none is computed. The result applies to low-risk first-time mothers offered induction at 39 weeks; it does not apply to induction for a medical reason or at other times. The registry shows the expectant-management arm continued until at least 40 weeks 5 days unless a medical indication arose.
- Last checked
- 2026-10-14
- Next evidence check due
- Not scheduled
Sources and citations (4)
-
Supports Labor Induction versus Expectant Management in Low-Risk Nulliparous Women
- Locator
- Abstract, METHODS: design, population, timing and primary outcome
- How it applies
- PubMed abstract; the full text was not retrieved.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
c79b91cfa406107c6a1429fe91e12fcf822498e6f6a48e8b77f0b06f4d8bb4ae- Reuse basis
- PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.
-
Supports Labor Induction versus Expectant Management in Low-Risk Nulliparous Women
- Locator
- Abstract, RESULTS: primary outcome
- How it applies
- PubMed abstract.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
c79b91cfa406107c6a1429fe91e12fcf822498e6f6a48e8b77f0b06f4d8bb4ae- Reuse basis
- PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.
-
Supports Labor Induction versus Expectant Management in Low-Risk Nulliparous Women
- Locator
- Abstract, CONCLUSIONS, sentence 1: no significantly lower composite
- How it applies
- PubMed abstract.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
c79b91cfa406107c6a1429fe91e12fcf822498e6f6a48e8b77f0b06f4d8bb4ae- Reuse basis
- PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.
-
Background A Randomized Trial of Induction Versus Expectant Management
- Locator
- protocolSection.designModule.maskingInfo and outcomesModule.primaryOutcomes[0]
- How it applies
- Registry JSON: masking value and the primary outcome measure and time frame.
- Retrieved
- Source effective date
- 2019-02-21
- Source state
- Current
- Snapshot hash
aad404d33fbefc6f8993abc098f036ef780d261dca87ef3e3e63bea4505ffe94- Reuse basis
- Registry record. The raw API JSON is committed. The ClinicalTrials.gov terms page is rendered by JavaScript and its text was not read by a script, so the redistribution basis is unverified; any quotation stays short. The raw file is committed at research/snapshots/mg-ctgov-NCT01990612.json.
Context Fetuses and newborns of low-risk women randomised from 40+6 to 41+1 weeks: perinatal composite and perinatal death (SWEPIS)
- Recipient
- Mixed recipients
- Population
- Fetuses and the babies born of them, fetal and newborn together, because the trial counted stillbirth and neonatal outcomes in one composite and counted perinatal deaths (stillbirths and early neonatal deaths) together. The mother's gestational age at randomisation was 40+6 to 41+1 weeks (the paper spells the window out in weeks and days joined by a plus sign; no age bound is recorded in structured form because that spelling cannot be bound to a quote). Use this context only for the composite outcome and perinatal deaths.
- Care setting
- Fourteen hospitals in Sweden: five university clinics and nine county hospitals.
- Geography
- Sweden
- Life stage
- Late term and the perinatal period
- Gestational age
- Not reported
- Postnatal age
- Not reported
- Follow-up
- Randomisation to the perinatal period; the abstract does not give the follow-up time.
Eligibility: 1 inclusion criterion; exclusion criteria not stated
- Included
- Fetus of a woman with an uncomplicated, low-risk pregnancy with one baby who was randomised in SWEPIS, and the baby born of it
- Excluded
- None stated
SWEPIS randomly assigned women with an uncomplicated, low-risk pregnancy of one baby, one to one, to induction of labour at 41 weeks or to expectant management with induction at 42 weeks. The composite perinatal outcome (stillbirth, neonatal death and a list of serious newborn problems) was found in 33 of 1381 pregnancies (2.4%) after induction and 31 of 1379 (2.2%) with expectant management. The relative risk was 1.06 (95% confidence interval 0.65 to 1.73; P=0.90), so the difference was not significant. After induction there were no perinatal deaths. With expectant management there were six, made up of five stillbirths and one death in the early neonatal period (P=0.03). The study was stopped early because deaths around birth were more frequent in the expectant management group (the monitoring board advised stopping on 2 October 2018; recruitment ended on 13 October 2018). The authors call the lower mortality a secondary outcome and ask for cautious interpretation.
Source problem. A cited source is corrected. Check the sources before relying on this claim.
Applies to Mixed recipients- Fetuses and the babies born of them, fetal and newborn together, because the trial counted stillbirth and neonatal outcomes in one composite and counted perinatal deaths (stillbirths and early neonatal deaths) together. The mother's gestational age at randomisation was 40+6 to 41+1 weeks (the paper spells the window out in weeks and days joined by a plus sign; no age bound is recorded in structured form because that spelling cannot be bound to a quote). Use this context only for the composite outcome and perinatal deaths.
- Fourteen hospitals in Sweden: five university clinics and nine county hospitals.
- Sweden
- Late term and the perinatal period
- Gestational age Not reported
- Postnatal age Not reported
- Certainty method
- Not assessed
- Limitations
- Open-label, stopped early (the independent monitoring board advised stopping on 2 October 2018), so the mortality difference rests on a small number of deaths and an early stop; the authors say the results should be interpreted cautiously. Perinatal mortality was a secondary outcome. The expectant management group could still be induced at 42 weeks, so this compares timing, not induction against no induction. Only low-risk women were included. A published erratum corrects the neonatal intensive care admission figures in table 3; those figures are not used here, and the erratum does not change the numbers above. PubMed and the PMC full text were read. The ISRCTN registry record was not fetched.
- Last checked
- 2026-10-14
- Next evidence check due
- Not scheduled
Sources and citations (6)
-
- Locator
- Abstract, DESIGN, PARTICIPANTS, INTERVENTIONS: design and groups
- How it applies
- PubMed abstract.
- Retrieved
- Source effective date
- Not reported
- Source state
- Corrected
- Snapshot hash
bbeb7e6085a7f3cc6b2b3183bbd9988c9af403699da782a5d11c8435c58bc6a6- Reuse basis
- PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.
-
- Locator
- Abstract, MAIN OUTCOME MEASURES: composite
- How it applies
- PubMed abstract.
- Retrieved
- Source effective date
- Not reported
- Source state
- Corrected
- Snapshot hash
bbeb7e6085a7f3cc6b2b3183bbd9988c9af403699da782a5d11c8435c58bc6a6- Reuse basis
- PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.
-
- Locator
- Abstract, RESULTS, sentences 1 to 3: early stop, composite and perinatal deaths
- How it applies
- PubMed abstract.
- Retrieved
- Source effective date
- Not reported
- Source state
- Corrected
- Snapshot hash
bbeb7e6085a7f3cc6b2b3183bbd9988c9af403699da782a5d11c8435c58bc6a6- Reuse basis
- PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.
-
- Locator
- Abstract, CONCLUSIONS, sentences 2 and 3: secondary outcome and caution
- How it applies
- PubMed abstract.
- Retrieved
- Source effective date
- Not reported
- Source state
- Corrected
- Snapshot hash
bbeb7e6085a7f3cc6b2b3183bbd9988c9af403699da782a5d11c8435c58bc6a6- Reuse basis
- PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.
-
- Locator
- Results, para 1, sentence 1: the monitoring board's recommendation to stop
- How it applies
- PMC full text, CC BY-NC.
- Retrieved
- Source effective date
- Not reported
- Source state
- Corrected
- Snapshot hash
a28804ac2098f66cc7ea3688f46df1aa8d895cc976e7467c4c06010c7eb7b252- Reuse basis
- PMC Open Access subset article, but its licence (https://creativecommons.org/licenses/by-nc/4.0/) is not one this tool treats as redistributable (CC0, CC BY, CC BY-SA, CC BY-ND). Only the hash of the bytes is kept. Short quotations under 25 words.
-
- Locator
- Erratum text: neonatal intensive care admission row of table 3
- How it applies
- PMC erratum text, CC BY-NC; cited so that a reader knows the figure was corrected.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
1171935330fdb0c9371d083757728222cf9935849d80543cba60def0094c3879- Reuse basis
- PMC Open Access subset article, but its licence (https://creativecommons.org/licenses/by-nc/4.0/) is not one this tool treats as redistributable (CC0, CC BY, CC BY-SA, CC BY-ND). Only the hash of the bytes is kept. Short quotations under 25 words.
Context Low-risk first-time mothers randomised at 38 weeks 0 days to 38 weeks 6 days: caesarean delivery (ARRIVE)
- Recipient
- Maternal
- Population
- Low-risk nulliparous women (no previous pregnancy beyond 20 weeks per the registry) with a singleton pregnancy who were randomly assigned at 38 weeks 0 days to 38 weeks 6 days of gestation either to labour induction at 39 weeks 0 days to 39 weeks 4 days or to expectant management. The gestational bounds are the gestational age at randomisation.
- Care setting
- Multicentre trial in the United States; the abstract does not say what kind of site took part.
- Geography
- United States
- Life stage
- Pregnancy from 38 weeks 0 days, to delivery
- Gestational age
- 38 weeks 0 days (266 days) to 38 weeks 6 days (272 days), measured at enrolment
- Postnatal age
- Not reported
- Follow-up
- To delivery (caesarean delivery was the principal secondary outcome).
Eligibility: 1 inclusion criterion; 1 exclusion criterion
- Included
- Nulliparous women with a singleton pregnancy at 38 weeks 0 days to 38 weeks 6 days
- Excluded
- Registry exclusions include a plan for induction before 40 weeks 5 days, a plan for caesarean delivery or a contraindication to labour, breech presentation, any diabetes mellitus, any hypertensive disorder, and other major maternal illness. The registry list is longer.
In ARRIVE, caesarean delivery was the principal secondary outcome. It occurred in 18.6% of women in the induction group and 22.2% with expectant management (relative risk 0.84, 95% confidence interval 0.76 to 0.93), a significantly lower frequency with induction. The women were low-risk first-time mothers randomly assigned at 38 weeks 0 days to 38 weeks 6 days of gestation to induction at 39 weeks 0 days to 39 weeks 4 days or to expectant management.
Applies to Maternal- Low-risk nulliparous women (no previous pregnancy beyond 20 weeks per the registry) with a singleton pregnancy who were randomly assigned at 38 weeks 0 days to 38 weeks 6 days of gestation either to labour induction at 39 weeks 0 days to 39 weeks 4 days or to expectant management. The gestational bounds are the gestational age at randomisation.
- Multicentre trial in the United States; the abstract does not say what kind of site took part.
- United States
- Pregnancy from 38 weeks 0 days, to delivery
- Gestational age 38 weeks 0 days to 38 weeks 6 days, measured at enrolment
- Postnatal age Not reported
- Certainty method
- Not assessed
- Limitations
- This is a secondary outcome. The abstract and registry were read, not the full text, so adjustment, missing data and other methods are not described here. The abstract gives no number of women in each group for this outcome, so none is computed. The result concerns low-risk first-time mothers and does not apply to other women. The primary composite outcome measured in babies is a separate claim in a separate context, and it did not differ significantly between the groups.
- Last checked
- 2026-10-14
- Next evidence check due
- Not scheduled
Sources and citations (3)
-
Supports Labor Induction versus Expectant Management in Low-Risk Nulliparous Women
- Locator
- Abstract, METHODS: population, timing and principal secondary outcome
- How it applies
- PubMed abstract.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
c79b91cfa406107c6a1429fe91e12fcf822498e6f6a48e8b77f0b06f4d8bb4ae- Reuse basis
- PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.
-
Supports Labor Induction versus Expectant Management in Low-Risk Nulliparous Women
- Locator
- Abstract, RESULTS: cesarean delivery
- How it applies
- PubMed abstract.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
c79b91cfa406107c6a1429fe91e12fcf822498e6f6a48e8b77f0b06f4d8bb4ae- Reuse basis
- PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.
-
Supports Labor Induction versus Expectant Management in Low-Risk Nulliparous Women
- Locator
- Abstract, CONCLUSIONS, sentence 1: lower cesarean frequency
- How it applies
- PubMed abstract.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
c79b91cfa406107c6a1429fe91e12fcf822498e6f6a48e8b77f0b06f4d8bb4ae- Reuse basis
- PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.
Context Low-risk women with a singleton pregnancy randomised from 40+6 to 41+1 weeks: maternal outcomes (SWEPIS)
- Recipient
- Maternal
- Population
- Women with an uncomplicated, low-risk pregnancy of one baby, head down. They were assigned at random, one to one, through the Swedish Pregnancy Register, either to induction of labour at 41 weeks or to expectant management with induction at 42 weeks. Their gestational age at randomisation was 40+6 to 41+1 weeks (no structured age bound is recorded, as for the babies' context).
- Care setting
- Fourteen hospitals in Sweden: five university clinics and nine county hospitals.
- Geography
- Sweden
- Life stage
- Late term, from randomisation to delivery
- Gestational age
- Not reported
- Postnatal age
- Not reported
- Follow-up
- To delivery and maternal discharge; the abstract does not give the follow-up time.
Eligibility: 1 inclusion criterion; 1 exclusion criterion
- Included
- Singleton pregnancy, fetus in cephalic presentation, 40+6 to 41+1 weeks by ultrasound dating
- Excluded
- Women who had had a caesarean or other surgery on the uterus, women with diabetes before pregnancy or diabetes in pregnancy treated with insulin, women with a high blood pressure disorder of pregnancy, and women whose baby was small for its gestational age. The list in the paper is longer.
In SWEPIS, the groups did not differ in how often women had a caesarean birth, an instrumental vaginal birth or any major maternal morbidity. One group was induced at 41 weeks and the other was managed expectantly and induced at 42 weeks. The study compared the two timings in 2760 women with an uncomplicated, low-risk pregnancy of one baby, and was stopped early.
Source problem. A cited source is corrected. Check the sources before relying on this claim.
Applies to Maternal- Women with an uncomplicated, low-risk pregnancy of one baby, head down. They were assigned at random, one to one, through the Swedish Pregnancy Register, either to induction of labour at 41 weeks or to expectant management with induction at 42 weeks. Their gestational age at randomisation was 40+6 to 41+1 weeks (no structured age bound is recorded, as for the babies' context).
- Fourteen hospitals in Sweden: five university clinics and nine county hospitals.
- Sweden
- Late term, from randomisation to delivery
- Gestational age Not reported
- Postnatal age Not reported
- Certainty method
- Not assessed
- Limitations
- The abstract gives no figures for these maternal outcomes, so none are stated. The study was open label and stopped early. The women were low-risk and the expectant group could be induced at 42 weeks. The perinatal results are a separate claim in a separate context. The SWEPIS paper has a published erratum (BMJ 2021;375:n3072) that corrects only the neonatal intensive care admission row of table 3; it does not touch these maternal outcomes.
- Last checked
- 2026-10-14
- Next evidence check due
- Not scheduled
Sources and citations (2)
-
- Locator
- Abstract, PARTICIPANTS and INTERVENTIONS
- How it applies
- PubMed abstract.
- Retrieved
- Source effective date
- Not reported
- Source state
- Corrected
- Snapshot hash
bbeb7e6085a7f3cc6b2b3183bbd9988c9af403699da782a5d11c8435c58bc6a6- Reuse basis
- PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.
-
- Locator
- Abstract, RESULTS, sentence 4: maternal outcomes
- How it applies
- PubMed abstract.
- Retrieved
- Source effective date
- Not reported
- Source state
- Corrected
- Snapshot hash
bbeb7e6085a7f3cc6b2b3183bbd9988c9af403699da782a5d11c8435c58bc6a6- Reuse basis
- PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.
Record details
- Record id
maternal:induction-of-labour- Content hash
f9b0701917802e7f383ef236bae5ffe6770c3f0dacda2e4afb6a8c4d23cc9eed