Objective To compare maternal and neonatal outcomes of induction of labour at term to those of expectant management in women over 40 years of age. Design Retrospective cohort study. Setting Data were derived from the Hospital Álvaro Cunqueiro birth cohort (Vigo). Population Women at ≧40 years of age and ≥39 weeks of gestation that delivered from 1 January 2012 to 31 December 2017. Methods Women were classified into two groups: expectant management group (women who delivered from 1 January 2012 to 31 December 2014) and nonmedically indicated induction of labour group (women who delivered from 1 January 2015 to 31 December 2017). These two groups were described and compared. Main outcome measures The primary outcome was the route of delivery. Perinatal results were also studied. Results There was a total of 603 pregnant women in the expectant management group compared to 634 women in the induction group. The rate of cesarean section did not increase in the maternal age-based labour induction group compared to the expectant management group. Subgroup analysis did not demonstrate an increased risk by parity. Women in the expectant management group were more likely to require neonatal intensive care unit admission and need pediatric support. Conclusion Compared to expectant management, induction of labour at 39 weeks of gestation results in significantly better neonatal outcomes without increasing the cesarean section rates in older women. Tweetable abstract Induction of labour in women over 40 years of age associates better perinatal outcomes without increasing the rate of caesarean sections.