When deciding about a labour induction it is essentially like having a set of old-fashioned weighing scales and using them to determine whether it is safer for baby to be born or to remain inside his/her mother by considering all the pro’s and con’s to your individual circumstance.
Individual circumstance being a key point! This will look very different for everybody so try not to be influenced by external noise and instead look at the evidence specific to you, your baby, family, wants and wishes. A numerical risk may feel very different to me than it does to you and that is absolutely OK and why we should not allow our decision to be influenced by experiences of others.
Are there good reasons for Induction of Labour?
In short- Yes.
Whilst there are many ‘good’ reasons, supported by evidence that induction of labour for certain conditions at the correct time improve outcomes for mothers and babies such as pre-eclampsia there are also times whereby it may be offered with less substantial evidence and overuse of inappropriate induction of labour may in fact lead to more intervention and less positive experiences for women.
Therefore, that balance and informed decision making is so vital when it comes to induction of labour.
The first, perhaps most obvious, consideration is why am I being offered an Induction of Labour?
Postdates Induction of Labour
A common reason we hear for offering an Induction is to have gone ‘overdue’ in an otherwise ‘low risk’ straightforward pregnancy. There is a perceived idea that a pregnancy lasting beyond 42 weeks is dangerous to baby as the placenta may become insufficient and subsequently result in a stillbirth. However, even studies which appear to show induction before 42 weeks reduces stillbirth also that the associated stillbirth risk of continuing pregnancy is extremely low. We should note that the stillbirth risk was higher in women of Black (74/ 10,000) and Asian (53/ 10,000) backgrounds than White (32/ 10,000) women. Stillbirth in the most deprived areas (47/ 10,000) was also higher than in the least deprived areas (26/ 10,000). What these numbers highlight is how the overall risk is still low however for some women additional risk factors may be present or the elevated risk may not feel comfortable. There is no right or wrong when it comes to induction, making an informed and individualised choice is key.
How will my Labour be Induced?
Method of induction, just like reason for induction of labour varies between individuals. It is generally dependent on your medical/ obstetric history and what is happening with your cervix.
For example, a woman who has had a previous c section may be recommended to avoid prostaglandins as these are associated with an increased risk of uterine rupture and to opt for a mechanical rather than hormonal method such as a Balloon Induction. A woman whose cervix is posterior and yet to efface or dilate is likely to start with prostaglandin pessaries. Whereas a cervix that has begun to efface and dilate she may be recommended to have her waters broken without need for additional hormones.
The Balloon or use of Prostaglandins are designed for your cervix to be open enough that your waters can be broken and hopefully labour then follows. If it doesn’t then a drip of artificial oxytocin is usually recommended to stimulate regular, coordinate contractions.
Is an Induced Labour more painful?
Induced Labour is different to Spontaneous Labour, often contractions are more intense more quickly with less of the gradual build up you often experience with Spontaneous Labour.
Does Induction of Labour increase my risk of a Caesarean Birth?
There are some studies suggesting that yes it may well do. Zhao et al., (2017) and Kjerulff et al., (2017) found women undergoing induction were more likely to have a Caesarean Birth due to fetal compromise but noted no differences in perinatal outcomes.
Notably NICE (2021) state pregnancy beyond 41 weeks was associated with an increased risk of Caesarean Birth although acknowledge the absolute risk remains low.
Ultimately there are so many individual factors that may increase a woman’s risk of Caesarean Birth so it is difficult to ascertain the relatability of these statistics in such a generalised way.
Will Induction of Labour change my birth preferences?
Induction of Labour may alter your birth preferences, depending on the methods used and the hospital guidance where you plan to birth. Waterbirth for example may still be possible for some methods but not recommended for others, have an open and honest conversation with your care provider about your wishes. Continuous monitoring of baby is advisable when using the artificial oxytocin drip due to the risk of hyperstimulation of the uterus and fetal distress. This need not mean you must lay on the bed however, you an have Continuous monitoring and be upright and mobile.
It is important to know that an Induction of Labour does not mean shredded your birth plan, it can truly still be a positive and empowering experience. Understanding the stages and how these aim to mirror the stages in spontaneous labour, the coping mechanisms you can adopt and the creation of a positive atmosphere during an induction can be really valuable in supporting you on your journey. The reality is currently in the UK 1 in 5 women are induced, therefore equipping yourself with a comprehensive understanding of induction and the ability to make informed decisions in the antenatal period is important.
My ethos is very much that all birth can be positive and empowering with the right preparation and support. This is why my Antenatal and Hypnobirthing Course with Midwife Pip provides you with all your course content online to work through in your own time but also has the option of live calls with me and access to my community support group for 24/7 questions. This 360 degree, comprehensive support ensures as any twists or turns crop up in your journey your birth remains positive.
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