What are Inductions? And How does an Induction Affect Your Labour & Birth Experience

Anne Matei
Sep 25, 2025
14 min read

Updated: Jul 10

Many think induction simply starts labor early, but synthetic interventions like IV oxytocin change the hormonal and physical experience of birth. This post explains how induced labor differs from spontaneous labor, the evidence on risks and benefits, and why making an informed, personal choice with your care team is essential.

When people hear the word “induction,” many imagine it as a simple jump-start to labor.

The idea goes: if contractions haven’t started yet, the medical team gives you a little help, and from there your body takes over. But research and physiology tell a different story.

Induction is not simply a kickstart. It is a medical intervention that changes how labor unfolds — hormonally, physically, and emotionally. It comes with risks, and will affect labour and birth. Birth works best when the baby/body leads. It is important to be aware of this and take an informed decision.

It is important to understand that sometimes inductions are recommended for medical reasons, and can be absolutely needed. Or that you may choose it, electively.

As a doula, I am not a medical professional, and my goal is not to push people toward or away from induction. My role is to help families understand what induction involves so they can make a real decision with their care team.

Often, before consenting to an induction, you have the time to ask questions, and the right to get them answered with accurate information. And if you choose an induction you have the right to be part of the conversation to understand the method that will be used. The important thing to remember is that the reason for induction matters. Inducing at 41 weeks for a healthy pregnancy is not the same as inducing at 36 weeks for preeclampsia.

What is an Induction?

Usually, spontaneous labour begins naturally: the body releases its own hormones, such as oxytocin and prostaglandins, which gradually soften and open the cervix and trigger regular contractions. Labour starts when both the baby and the body are ready.

In contrast, an induction of labour means that labour is started artificially by medical means before it begins on its own. This is usually done for medical reasons, for example when there are concerns about the mother or baby’s health, or when complications like high blood pressure arise. But some people may choose it electively too.

A medical induction typically involves two main steps: cervical ripening, and artificial stimulation of contractions.

The first step is cervical ripening, which helps the cervix soften, shorten, and begin to open if it is not yet ready. This can be done with medication, such as prostaglandin gel or tampons inserted into the vagina, or mechanically with rods (Dilapan) or a small balloon.

Once the cervix has become favourable, the second step is to stimulate contractions. Sometimes this is not necessary as the ripening process already triggered labour.

But sometimes you need the extra step, and this can be achieved by giving an intravenous oxytocin drip, and/or breaking the waters (artificial rupture of membranes) which encourages the uterus to contract and labour to progress.

What Methods Exist for Inductions in Berlin?

There are multiples methods to induce labour.

Some are mechanical methods: drug free, using hands or a medical device. For example: membrane sweep, balloon cathether, or rods inserted in the cervix called hygroscopic cervical dilators (Dilapan). These have notably less risk of uterine overstimulation. But can be uncomfortable, ineffective.

Some are pharmacologic: using drugs (alone or in combination), such as Angusta which is a form of prostaglandin hormones, or syntethic oxytocin etc. These are the most effective methods, but can take a while to be effective.

Prostaglandins are often used when your cervix is not ripe yet (you get a dose every 4 hours, and either your body picks up and gets into labour or it doesn't. It is not rare for this process to take 2+ days. In the meantime you get intermittent monitoring (CTG) This can lead to on-off contractions over days and be uncomfortable/painful.) Oxytocin is used on a ripe cervix, as an intravenous, with a gradual increase of the dose. As this can lead to overstimulation of the uterus and distress of the baby you need constant monitoring (CTG) with this method.

Choice of method is not always up to you, but depends on your unique medical case and birth setting's protocols. What matters here is that you ask questions to you care team, and also do your own research to understand the pros and cons of each method that is offered to you. Most clinics use Angusta and Oxytocin as standard methods. But ask about alternatives to understand what is available, possible and what your preferences are.

Why Inductions Are Offered

Inductions are becoming increasingly common. In many high-income countries like Germany, more than 20–25% of labors are now induced. The trend goes up...

The reasons for inductions vary, but the most frequent include:

Going past the due date – This is one of the leading reasons for induction. Research shows that the risk of stillbirth and complications does rise gradually after 41–42 weeks. Trials found that induction in some cases slightly reduced risks like high blood pressure or stillbirth.
You can find objective data on inductions for passing your due date here

Official recommendation in Germany about inductions for due dates (from DGGG, official German college of obstetricians):

"Starting from 41+0 weeks of pregnancy, induction of labour can be offered (elective)

Starting from 41+3 weeks of pregnancy, induction of labour should be recommended.

Starting from 42+0 weeks of pregnancy, induction of labour should be strongly recommended."

PROM: ("prelabour"rupture of membranes) - When your water breaks but labour does not start (at term), usually you will be monitored for 24 hours, and then offered an induction - or earlier. The risk of ruptured membranes for too long is an infection of the membranes. There is insufficient evidence on how long an expectant management can be carried out without increasing peripartum complication rates. In Germany, the official guideline (DGGG Leitlinie) says "Therefore, despite the overall low quality of the studies, induction of labor no later than 24 hours after PROM is recommended". In reality you will be monitored closely after your water bag opens, baby's heart beat checked, your temperature measured, your white cell count measured to spot signs of infection. If all is well, doctors usually let you go on for 2+ days. If this is your preference as you want to avoid an induction, make that clear, and have a discussion about risks/benefits of inductions VS waiting (=expectant management) in your case.
Medical conditions – Examples include preeclampsia, high blood pressure, or certain chronic illnesses, (gestational) diabetes (that is not controlled with insulin... not just your "regular'GD... In these cases, induction may be recommended because the risks of continuing the pregnancy outweigh the risks of intervention.
Concerns about the baby – Slow growth (intrauterine growth restriction), low amniotic fluid, or changes in fetal monitoring can prompt providers to suggest induction.
Elective induction – Some people choose induction for reasons such as scheduling, living far from a hospital, or anxiety about waiting, or being tired of being pregnant at the end of pregnancy. In Germany this would only be offered after 39 weeks and based on an individual assessment.

The important thing to remember is that the reason for induction matters. Inducing at 41 weeks for a healthy pregnancy is not the same as inducing at 37 weeks for preeclampsia.

In some cases, inductions can be life-saving. They can also do more harm than good. Ultimately, what matters the most is that you discuss your situation openly with your care team, so that you fully understand risks/benefits/alternatives in your specific case and talk about your emotions and wishes.

How Spontaneous Labor Works

To understand why induction is not “just a push,” let’s look at how labor starts naturally.

In spontaneous labor, the body releases oxytocin.

It causes the uterus to contract, helping the cervix dilate and the baby to descend.
Because oxytocin is also released in the brain, it influences emotions, bonding, and pain perception. It reduces anxiety, promotes calm, and supports the release of endorphins, the body’s natural pain-relieving chemicals.

Your natural oxytocin is released in pulses, which gradually increase in frequency and strength as labor progresses.

Labor is also supported by a cascade of other hormones, all of these are carefully balanced in a feedback loop between the body and the baby.

How Induction Works, in Principle.

Inductions come in different shapes and sizes, as mentioned there are multiple reasons why one would want/decline an induction, and types of methods used.

When induction is started with synthetic hormones, the process is very different than the natural spontaneous labour process.

Synthetic hormones will ripen your cervix and stimulate contractions. But they do not come with the calming, and pain-relieving effects of natural endorphins that are normally released by your body when you get into natural labour. You also get a one-dose-fits all of synthetic hormones, which may be higher or lower than what your body actually needs.

Hence, induced labour, can cause stronger, more frequent contractions, and prolonged exposure may reduce uterine responsiveness, sometimes requiring higher doses...

It can lead to more interventions. In general, most inductions require being on CTG (electrocardiograms and tocogram) during most of your labour, being held in the hospital for days before things get started (depends on method but usually that's the case), more frequent examinations, sometimes breaking your water bag artificially etc.

In short: Induction is a medical intervention. It doesn’t just speed up what would have happened naturally. It creates a fundamentally different hormonal environment.

Inductions lead to higher rates of epidurals, instrumental births and C-sections.

Induction may also not "work", or they can be very slow. This is just a fact: it's common for an induction for a first birth to take 1-4 days (!). You will most of the time be in a shared room, where your partner can not stay (unless you are lucky to get a private room or "Vorweheraum". The clinic is not the best setting for resting, feeling relaxed and in control... It is therefore important to be prepared mentally for what comes.

During this time it is very important that you guard your headspace! Don't look at the clock, google too much, compare to others inductions or birth stories. It is important that you try and stay rested, hydrated and fuelled. Have your earplugs and sleeping mask ready!

Sleep and rest whenever you can, eat nourishing food, try to stay in your bubble (dim light, music, block noises, avoid conversations that make you stress...). Your partner here has a key role, to support you morally and protect your space, and guard rest. Make them bring you entertainment, nice food, support you advocating for yourself and ask your questions (you can ask for a consultation with the doctor anytime), filter who enters the room when you try to nap.

In some cases you may even ask to stop the induction (especially at night to rest), take a break or even go home (if there was no medical counter indication).

How Induced Labor Feels Different

Because the hormonal cocktail is altered, many people experience induced labor differently from spontaneous labor. Research and lived experience suggest:

Contractions may feel stronger, sooner. Without the gradual build-up of natural hormones, contractions can become intense quickly.
Less rest between contractions. Continuous infusion can create back-to-back contractions with shorter breaks, leaving less recovery time.
More pain management needs. Studies show that people who are induced are more likely to request an epidural.
More monitoring. Continuous fetal monitoring is usually required, which can limit mobility unless wireless monitors are available.
Risk of overstimulation. Too-frequent contractions can reduce blood flow to the baby, requiring careful dose adjustments and can lead ultimately to fetal distress or uterus rupture.

It’s important to note that not every induction feels the same. The experience depends on the starting point (whether the cervix is “ripe”), the medications used (prostaglandins, oxytocin, or both), the hospital’s protocols, and the individual’s coping tools and support.

Communicate with your care team about how you feel and what your fears and preferences are.

Having the support of a doula can help you feel held and have a better experience.

What the Evidence Says About Induction

Evidence Based Birth has reviewed dozens of trials on induction. Here are some key takeaways:

Past the due date: Inducing at 41 weeks, compared with waiting until 42 weeks, is associated with fewer stillbirths and fewer babies admitted to NICU. (read my article on passing your due date in Berlin)

At 41 weeks, out of 10,000 pregnancies --> 17 babies may experience stillbirth.
At 42 weeks, out of 10,000 pregnancies --> 32 babies may experience stillbirth.

This means that inducing at 41 weeks could potentially prevent about 15 stillbirths per 10,000 pregnancies. For the other 9,985 people, induction won’t change the outcome (source). What matters here, is to discuss with your care team what the risks/benefits mean for you, in your specific case, because each case is different!
Cesarean risk/ Instruments: Having your labour induced may increases your chance of having a caesarean or birth with instruments. However, this is a topic that is really controversial, as there have been over time, multiple small and larger studies on the topic, which found sometimes controversial results.
Birth experience: Some studies looked at how induction affects the parent’s emotional experience: qualitative research suggests that induced labor can feel more painful, slow, medicalised, less flexible, and more intense.

What I can say, as a fact, is that inductions lead to more medicalised births. This is a simple objective observation: labour is triggered by a medical procedure, you most likely will be in the hospital for most of your labour (rather than doing your pre-labour at home, unless you have the opportunity to have a ambulatory induction), you will most likely get synthetic oxytocin to boost your labour, your induction may make labour longer and more painful leading to satellite interventions such as multiplication of medication (e.g. for pain, IV drips etc.) This is a reality to consider, to have a realistic expectation of inductions.

Making the Decision: Questions to Ask

Whether induction is suggested for medical reasons or offered as an option, it’s worth pausing to gather information.

Usually this is not an urgent decision,

Take the time. Research, communicate with the medical team, tune in with your gut feeling and baby.

Some useful questions to ask your care team:

Is induction medically necessary for me, or is it being recommended as an option?
How “ripe” is my cervix (Bishop score)? What does it mean for me?
What methods will you use to induce (prostaglandins, balloon catheter, oxytocin)? Why? What are the pros and cons of each method?
What is your cesarean rate with inductions? From the last 10 inductions you had, how many resulted in a cesarean?
Do I need to stay in the hospital during the induction or can I go home? Why? If I prefer to go for an ambulatory method, where I can go home, is this possible? How? If I need to stay in the hospital, will I get my own room?
How long will you let the process take before suggesting more interventions?
What are the monitoring requirements? Will I be able to move around?
What support will be available for coping with contractions (medicated/unmedicated)?
If I have a birth plan where I want to avoid an epidural, how can I be supported in this process with an induction? What other pain management methods can I use if pain is too much during the process?

A simple tool you may use is the BRAIN framework:

B – Benefits: What are the benefits of induction in my case?
R – Risks: What are the risks, both short-term and long-term, for me and my baby?
A – Alternatives: What are the alternatives to induction? (e.g. waiting, extra monitoring, natural methods).
I – Intuition: How do I feel about this option? What does my gut say?
N – Nothing: What happens if we wait and do nothing for now?

Use my safety card for informed decision at birth

The Bottom Line

As a doula, my role is not to convince you one way or another. I respect that every pregnancy, every baby, and every family’s circumstances are unique.

What’s essential is that you understand the difference: induction is not just “flipping the switch” on labor. It creates a distinct birth experience, usually more painful, longer and leading to more interventions. You may not be able to "avoid" one based on your medical and personal circumstances. Communicate with your care team to make an informed decision based on your circumstances, and prepare yourself mentally and logistically for the process.

Every labor is unique. What matters most is not whether your birth is spontaneous or induced, but that it reflects informed choice, open communication, and respect for your wishes.

Here are some sample sentences as an inspiration that you can put in your birth plan (just as inspiration, see what feels best for you

In case of an induction:

I would like to be informed about my options for methods of induction to make an informed decision
🇩🇪Ich möchte über meine Möglichkeiten zur Einleitung der Geburt informiert werden, damit ich eine fundierte Entscheidung treffen kann.

I prefer to start the induction in an outpatient setting with unmedicated options such as acupuncture, membrane sweep, as long as my baby’s health and mine’s are not at risk. If a more invasive method is needed, I would prefer using Dilapan, so that I can go home during the induction.
🇩🇪Ich bevorzuge es, die Einleitung der Geburt ambulant zu beginnen und zunächst nicht-medikamentöse Methoden wie eine Eipollösung (Membrane Sweep), Dilapan oder Akupunktur zu nutzen, sofern die Gesundheit meines Babys und meine eigene Gesundheit dadurch nicht gefährdet sind.

If an induction in an inpatient setting is needed, I would like to have a gradual increase of dosage and to take breaks from the induction to be able to sleep (e.g at night, if no urgency). Throughout the induction I desire to be accommodated in a private/family room.
🇩🇪Falls eine Einleitung unter stationären Bedingungen erforderlich sein sollte, wünsche ich mir eine schrittweise Dosiserhöhung und die Möglichkeit, Pausen während der Einleitung einzulegen, um schlafen zu können (z. B. nachts, sofern keine Dringlichkeit besteht). Während der gesamten Einleitung möchte ich nach Möglichkeit in einem Einzel- bzw. Familienzimmer untergebracht werden.

I wish to decline routine cervical examinations during the induction process to minimize the risk of infection, particularly if my waters break. Please only propose a cervical exam if the findings are absolutely necessary to guide immediate medical decisions.
🇩🇪Ich möchte routinemäßige vaginale Untersuchungen während der Einleitung vermeiden, um das Infektionsrisiko so gering wie möglich zu halten (insbesondere nach einem Blasensprung). Bitte schlagen Sie eine Untersuchung nur dann vor, wenn die Ergebnisse für anstehende medizinische Entscheidungen zwingend erforderlich sind.

I want to avoid an amniotomy (artificial rupture of membranes) as a method of induction. While I understand it can speed up labor, I am concerned about the risks of infection, increased contraction discomfort, fetal positioning difficulties, and umbilical cord prolapse. I would like to discuss alternative induction methods instead.
🇩🇪Ich möchte eine Amniotomie im Rahmen der Einleitung vermeiden. Mir ist bewusst, dass dies den Prozess beschleunigen kann; ich bedenke jedoch die Risiken wie ein erhöhtes Infektionsrisiko, stärkere Schmerzen, Einstellungsanomalien des Babys und Nabelschnurvorfälle. Ich bitte darum, stattdessen alternative Einleitungsmethoden mit mir zu besprechen.

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Anne Matei is a birth and postpartum doula based in Berlin, supporting French-, English-, and German-speaking families. She accompanies births in hospitals, birth centers, and home births alongside midwives. Read what families say about working with her in client testimonials. Feel free to get in touch to schedule a non-binding introductory call.

A Note on inductions for VBAC:

Risk vs benefit is something that should be considered for each person and birth- VBAC or other wise. There isn’t just one reason for inductions, type of induction, and they are carried out in different ways.

According to the Leitlinie (Guideline) from DGGG (Deutsche Gesellschaft für Gynäkologie und Geburtshilfe) says the following, based on systematic evidence review and structured expert consensus:

The pregnant woman should be informed that induction of labor leads to a two- to threefold increase in the risk of uterine rupture (approximately 1–1.5%) and to a 1.5-fold increase in the likelihood of cesarean section.
Labor induction using mechanical methods (transcervical balloon catheter, amniotomy) is associated with a lower risk of uterine rupture compared to prostaglandins.
The lowest risk of uterine rupture is observed with the use of a balloon catheter.
With a favorable cervix (Bishop score ≥ 6), labor induction after a previous cesarean section using oxytocin and amniotomy represents a low-risk method.
With an unfavorable cervix (Bishop score < 6), labor induction after a previous cesarean section using prostaglandin E2 (dinoprostone) is considered a low-risk method, although the risk of uterine rupture is increased.
Misoprostol should not be used in the third trimester for labor induction or cervical ripening after a previous cesarean section or any surgery involving opening of the uterine cavity.
In pregnant women with a low risk of complications, outpatient management of labor induction is possible under certain conditions. Counseling about the possible risks of outpatient labor induction must be provided. should be preferred for outpatient induction (235–240). In this context, balloon catheters are particularly suitable, as the risk of hyperstimulation is very low and no infections, placental abruption, umbilical cord prolapse, uterine rupture, or maternal or neonatal deaths were found in any of the randomized controlled trials examined
With regular uterine contractions, continuous fetal monitoring (CTG) should be performed until birth in women with a previous cesarean section.
Uterine rupture often occurs suddenly, and reliable antenatal predictors are not available
The most common sign of uterine rupture, however, is abnormal fetal heart rate patterns, which are present in up to 70% of cases of newly occurring uterine rupture. Hence continuous CTG being recommended.