Induction of labour and how it shifts the goal posts of birth.

I’ve had 3 ‘overdue’ and ‘big’ babies. I’ve been told on each one that I’m ‘measuring over’. I’ve been sent for a ‘sizing scan’ in the last few weeks of pregnancy. I’ve had to say ‘no thank you’ to the offer of induction on all 3. In the end they were all born without medical intervention and weren’t that big at all!!

In my course of work I’m seeing more and more women having their pregnancies induced at the moment, or at least coming under pressure to have their pregnancy induced.

There are medical situations that make induction the best and safest option for women and their babies; conditions like preeclampsia, low amniotic fluid or foetal distress for example, can require emergency induction.

There are also times where induction is medically unnecessary. You should inform and educate yourself and discuss your case, in depth, with your care provider. Also don’t be afraid of asking for another medical opinion. Make informed decisions - it is your choice and you have a choice.

So, what is induction and how is it carried out?

The WHO define induction of labour as ‘a common procedure in obstetrics defined as the initiation of labour by artificial means prior to its spontaneous onset at a viable gestational age, with the aim of achieving vaginal delivery in a pregnant woman with intact membranes.’

In other words it is an artificial manipulation of the labour process to bring on labour before the woman’s body or possibly the baby is ready.

Amazingly, we still don’t know exactly what it is that makes labour begin. Its a combination of events and you can eat all the curry in the world (as I did!) but its probably not going to make that much of a difference!

When is baby Due?

Firstly lets look at due dates. Due dates are guess dates for the majority of us, unless you know exactly when you ovulated and when implantation took place! In medical terms, a pregnancy is only ‘overdue’ or ‘post dates’ after 42 weeks so bear that in mind!

The WHO recommend that induction is only considered when the pregnancy is 40 weeks plus 7 days or more. And they say unless you are certain of your dates thats not a reliable guide. The Word Health Organisation also recommends that induction should not be carried out prior to 41 weeks in an uncomplicated pregnancy. This, according to the WHO, includes women with gestational diabetes - as long as its the only complication.

Depending on your circumstances, the induction of your labour can include one or some of the methods below:

• Sweep of the membranes

• ARM (artificial rupture of membranes) or ‘breaking the waters artificially’

• Prostaglandin Gel

• Syntocinon Drip

All of the above methods can be effective, or not. It is not uncommon for one to ‘fail’ and be followed by another and possibly another. Also its is not uncommon, if the woman and baby are ready, for one to be all it takes to ‘get things going’. The problem is, you don’t know which you are until it happens.

Why would I want to avoid induction?

If there’s a medical emergency, obviously you just need to get baby out asap, so your caregiver should make it clear to you that it is medically necessary and why before you give your consent.

If it is not an emergency situation, consenting to having your labour inducted is again, always your choice.

I have been ‘overdue’ 3 times by over a week. I totally understand how hard it is, how frustrated you can feel, how tired and fed up of pregnancy you can be, how anxious you can be etc. Induction might sound like a great option especially when your consultant says something like ‘would you like to have your baby today?’.

But know that, for the majority of women, induction makes labour much more intense and much harder. Here’s some of the reasons why:

• You have to be in hospital

You’re admitted into hospital not in labour. You’re now a ‘patient’. You’re probably in a ‘pre-labour ward’ with 10 other women who want to be in labour and are not, 10 anxious partners, 20 phones....you get the picture! And you could be there for a day or two before you’re in labour

• There’ll be lots of ‘traffic’ up there

They’ll have to have a look and see if anything is happening, then they might insert a finger to sweep the membranes, then they’ll have to put up a hook to break the waters. Then they’ll check if you’re dilating at all. Then they might put a prostaglandin gel up there. Then they’ll check again... This does not do much for the labouring woman’s ‘mojo’ or sense of empowerment.

• Induction makes contractions more intense and more painful

ARM, Prostaglandin gel and syntocinin all make contractions more intense and more painful. Most women will require pain relief when they’ve been induced in the form of epidural. This can slow down labour and greatly increases the need for assisted delivery with forceps or vacuum.

So, what are the alternatives?

• Wait, trust your body and your baby, and go in to labour naturally

Even though you are completely fed up and so OVER being pregnant, if there’s no medical reasons to induce, this is definitely the easier option for you and baby. Relax and trust. They all come out eventually.

• Get jiggy with it!

Best news he’s heard all week (month, 9 months...!). Semen contains prostaglandin - the same ingredient as ‘the gel’. This, coupled with the release of endorphins and oxytocin you get from sex can be all you need to get going. Do it for the team!

• Nipple stimulation

If you just can’t go there, tweaking the nipples will sort out your endorphins and oxytocin.

• Eat Dates

Yes believe it or not there is a study to prove that eating 6 dates a day from 36 weeks can help avoid artificial induction.

Walk

• This only works if baby’s head is engaged so get your midwife/consultant to check that. Once the head is engaged, a good brisk walk will help keep the pressure of baby’s head against the cervix which is what helps the cervix to open.

• Acupuncture, Reflexology or Homeopthy

All have great success rates in avoiding induction if taken regularly from 36 weeks and are less invasive. I recommend the elbowroom clinic, River Holistic and Nanni Schluenz for holistic treatments

This article is not intended to act as medical advice or to replace advice given to you by your doctor or midwife. Always discuss your options with your qualified caregiver.

Suggested further reading:

http://evidencebasedbirth.com/evidence-on-inducing-labor-for-going-past-your-due-date/

http://evidencebasedbirth.com/evidence-for-induction-or-c-section-for-big-baby/

https://www.nice.org.uk/guidance/cg70/chapter/1-Guidance

http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004945.pub3/full

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