Up to a quarter of births in the West are induced by one means or another. Only half of those inductions take place because of a medical or obstetric reason. The rest take place because of the woman’s dates.
The date on the calendar is not the best way of indicating that a baby should be born right now. Our Estimated Due Dates are based on a scale devised in the early 19th century and based on the assumption that the woman conceived on precisely day 14 of a perfectly symmetrical 28 day cycle. In nearly 10 years as a doula I had only one client who gave birth ON her due date.
Women may easily feel pressured into accepting induction because…
- Family members are arriving to help look after the baby on a specific date; perhaps some family member has made big changes to their plans to do this. Mother feels emotional pressure to “get on with it”.
- She is fed up of being pregnant: she feels uncomfortable and she’s sick of the sleepless nights (and by some obscure twist of logic imagines that the sleepless nights will disappear after the baby has been born)
- She is beginning to wonder if her body is really working properly.
- All the other women in her NCT class have had their babies…where’s hers? She doesn’t want to be left behind!
However a surprising number women and their partners who accept induction of labour are genuinely astonished to find that it rarely results in a fast or easy birth. Here are some comments by midwives in a survey of midwives’ feelings about induction of labour:
“Many first-time mums think that they are going to turn up in the morning and have their babies in their arms by tea-time”
“I see a lot of women induced at 7pm with Prostin and then asking at 10pm why nothing is happening…”
“Partners are often totally annoyed as they were thinking they would have a baby in a few hours once the magic potion was inserted”
Prostin, Propess, Synto or tablets are NOT magic potions! If the body is not ready to go into labour it will be like starting a very cold engine on a frosty January morning.. compared with starting a warmed-up engine on a spring day.
Induction of labour carries risks and the most striking in my eyes are those associated with syntocinon, especially the increased likelihood of postpartum hemorrhage and the risk of hyperstimulation of the uterus leading to severe distress to the baby.
If you know you and your baby would benefit from induction (perhaps you have a medical condition such as pre-eclampsia or obstetric choleostasis) then all well and good, go ahead. But if you are not too sure here are eight questions to ask:
– Where is the evidence to show that not going past 40 weeks has improved outcomes?
– Is induction REALLY necessary for ME personally?
– Why is it being considered?
– What will happen if we wait for a while?
– What percentage of women in your care are induced?
– How will induction of labour affect my birth plan?
– Is there an increased risk of further interventions if I agree to induction?
– Are there any risks associated with prostin/amniotomy (breaking waters)/syntocinon/stretch&sweep/balloon catheter/cervical stretching? (all methods of induction that may be offered)
And if you can’t remember all those just remember your BRAINS QUESTIONS! An easier way of remembering how to get information on any proposed intervention:
“How will this benefit the birth outcome for mother and baby?”
Risks or repercussions?
“What are the risks and what are the percentages of those risks? Big or small?”
“What else can you suggest?”
Intuition – what’s the most likely outcome here to your eyes?
“I’m sure you have seen this happen lots of times before. What usually happens after this point?”
Nothing? (Remember labour often speeds up in the evenings and at night and slows down in the day, of its own accord!)
“What if we just wait for another few hours? Will that cause damage to mother or baby?”
Oh…and remember to SMILE…it always goes down well.
Ref: Davies L: Induction of labour for post-term pregnancy MIDIRS June 2013 Vol 4 No 6