Following on from my due dates post, let’s talk about induction. Quite often when you approach your due date, your midwife will start discussing inducing you if you don’t naturally go in to labour. You may also be offered an induction if your waters release and your surges don’t start (premature rupture of membranes or PROM), if you’re over 40, have gestational diabetes or a “big baby”. Often this can cause panic in the mother, cue frantic eating hot curries, pineapple, long walks and any other possible way to try and get baby our naturally. Induction is always suggested and discussed as a way to prevent hard to mother and baby, but it’s also important to ask what the risks are. As with any intervention, a balanced view should be presented and you should make an informed decision based on this information and research. If you are not offered information on both the benefits and risks, ask for information. There are several methods of induction which you may be offered. These are:
A sweep (sometimes called a stretch and sweep or membrane sweep)
a pessary, tablet or gel containing hormones (prostaglandins) inserted in to the vagina to induce labour
artificial rupture of membranes (breaking your waters)
an IV drip of drugs (artificial oxytocin) to induce labour
Each of these methods have pros and cons and it’s important that whoever is recommending these procedures explains to you what these are. None of these interventions are completely risk free, although they all have a place in birth in certain circumstances, so you need to understand what the implications of consenting or declining all of the above methods of induction are.
One effect to be aware of is the cascade of intervention. Accepting an intervention increases your chances of further interventions, which in turn increases the chances of more interventions and so on. It has a knock on effect. Women who are induced often experience much more painful surges, as the drugs they use are powerful and your body doesn’t have the slow and steady natural build up of sensations. Artificial oxytocin means you will not benefit from the natural production of endorphins, which are nature’s own pain relief hormones. This and the fact that you’re being monitored, can’t move around, would require regular vagina exams to check the progress of labour and your cervix dilation, may mean you feel stressed and anxious and in turn cause more pain, and you’re more likely to ask for pain relief such as an epidural. Having an epidural increases your risk of an instrumental delivery via forceps or ventouse, episiotomy and caescarean delivery. The side effects of these further interventions can include pelvic floor damage, birth trauma, reduced breast feeding rates, difficulty bonding with baby, and more.
So what are the risks of not accepting an induction? Each case is unique and you need to ask your midwife the risks specific to your pregnancy. For example, if your waters released and labour takes a long time to progress, there’s an increased risk of infection. The risks of waiting may be different if you’re further along in pregnancy, or have gestational diabetes for example. In general, the risk of neonatal death increases as you go post dates. But how high IS that risk? 30 out of every 10,000 for those declining induction vs 3 out of every 10,000 for those induced. Statistically the chances are small either way, but admittedly higher if not induced. The risk does significantly increase post 42 weeks, however as with a lot of research, it doesn’t ask what happened. Was there pathologically something already wrong with mother or baby or the placenta? However this is still a risk that needs to be considered given the seriousness of the potential outcomes.
Ultimately the importance here is to ensure you are presented with all the facts in order to make an informed decision for you and your baby, and not accept an intervention because it’s “routine”. Each pregnancy is unique and you should ensure the procedures you accept are right for your own situation. Accepting induction because medically it’s right for you is absolutely right thing to do. However you may wish to question if it’s best four you and your baby to accept one because you’re over 40 weeks and “that’s hospital policy” with no further information or consideration for your own personal circumstances.
If you’d like to read more about induction, I recommend the following articles: