To induce or not to induce – is impatience the question?

Your due date approaches, you are tired and possibly even ‘over it’…your care providers offer a ‘stretch and sweep’ or ‘membrane sweep’..a simple procedure, they will place a finger in your cervix and sweep around it, the idea being that the membranes will come away and release ‘go into labour’ hormones.  Evidence suggests that it works 50% of the time within 48 hours…seems to me that labour post this procedure probably would have happened anyway, so really, all this procedure does is introduce a seed of self doubt and possibly increased risk of infection.  At the same time as this is done, a ‘cervical exam’ will provide you with information such as ‘softening’ or ‘2cm dilated’.  This does not really tell you much, beyond what you cervix is doing in that moment.

You are now past your due date, and induction is being discussed: gels, synthetic oxytocin, breaking waters/membranes…to speed thing along….seems like a good idea..I mean really…you’re over it, everyone is asking “haven’t you had that baby yet”?

What is Induction? Induction of labour is a medical intervention that artificially brings on labour. Often induction is coupled with the use of drugs to intensify the contractions. This usually leads to an epidural. This increases the likelihood of an ‘assisted delivery’ (forceps or vacuum suction) or a caesarean.

Far more inductions are done than are medically necessary, with most actually for logistical reasons or to reduce a perceived risk. You may live rurally or remotely, and induction is suggested as a way to avoid an unassisted birth (on the roadside or at home).  Perhaps your birth location cannot provide you with care if you go past 42 weeks, and your care will transfer to a bigger hospital – possibly a great distance away.   

The risks associated with induction include increased likelihood of caesarean or assisted delivery.  Assisted delivery uses vacuum extraction or forceps, with an increased risk of 3^rd and 4^th degree tears.  Induced births also increase the likelihood of your baby needing assistance after birth, and a separation from you.

If you are feeling fed up towards the end of your pregnancy, or your due date has passed, you may be tempted by this option.  Consider these questions in advance to help you make informed decisions at the time:

• Are you well?
• Is your baby well?
• Is it medically required and urgent?
• Is it being offered to reduce a perceived risk (your age, weight, multiple pregnancy, IVF, gestational diabetes)?
• Is it logistically required (distance to travel, FIFO considerations)?
• What method will be used (balloon catheter, pessary, gel, artificial rupture of membranes with or without synthetic oxytocin?
• Are you aware of the ‘cascade of intervention’? (time limits will be placed on you, monitoring required, you may not be able to move around)
• Have you considered the Benefits, Risks and Alternatives?
• Do the risks of induction outweigh the risks of waiting?

It is well known that continuity of midwifery care, and in particular continuity of midwifery carer (ie having a known midwife throughout your pregnancy, the birth and several weeks beyond birth), has the best outcomes for mothers and babies.  Unfortunately, modern maternity practice rarely offers this model of care. Most maternity policies are based on insurance-drive limitations or staff management protocols, they are not woman-centred and not supportive of informed decision making.

Keep this in mind as you prepare your Birth Map, and consider the potential induction pathway.

DO NOT LEAVE THE INDUCTION DISCUSSION TO THE LAST MINUTE! 

Birth should not be on a ‘need to know basis’.  Take time throughout your pregnancy to understand the modern maternity landscape, and make informed decisions in advance for various scenarios: and considering the ‘induction based on due date’ scenario is sensible given how common it is.

What follows are links to help build your understanding of normal, and find your comfort zone.  

Induction – a step by step guide (Midwife Thinking)

Induction associated with adverse outcomes (Sara Wickham)