How to Navigate Induction of Labour and its Reasons for a Positive Birth Experience

In the empowering journey towards childbirth, knowledge becomes the cornerstone of a positive birthing experience. As your dedicated antenatal teacher, my mission is to inspire expecting mothers to question, seek evidence, and make informed decisions for a birthing journey that aligns with their desires. In the current landscape, approximately 60% of women in the UK undergo induction, often without genuine necessity, leading to potential harm and an increased likelihood of C-sections. Together, let's delve into the reasons behind inductions of labour, examining the evidence and fostering informed decision-making for a more positive birth experience.

Pregnant woman waiting to get into labour

Understanding the Statistics and Overmedicalisation: In an era where birth has become increasingly medicalized, inductions are often perceived as routine rather than tailored interventions. Despite potential risks, inductions are performed without adequate explanation or choice given to women. It's crucial to challenge these norms, demand evidence, and make decisions that prioritize your well-being.

Why Induction? Exploring Medical Reasons: Various medical reasons may prompt your healthcare provider to recommend induction, such as post-term pregnancy, premature rupture of membranes, fetal size concerns, maternal age, gestational diabetes, pre-eclampsia, or IVF treatment. It's imperative to question the evidence supporting each recommendation, considering the potential risks and benefits. Understanding these factors empowers you to weigh the risks against the benefits and make personalized decisions. Let's explore the evidence behind inductions. For instance, when inducing for going over 42 weeks, medical professionals worry about stillbirth risk. There is evidence that stillbirth risk increases for prolonged pregnancies. This risk is actually very low; the risk of stillbirth is 1.5 in 1000 births, i.e., 0.15% in 40 weeks of pregnancy. Or, let's reframe it as the "chance of stillbirth NOT happening," which is 99.9985%. When going over 42 weeks, this risk increases to 2 in 1000 births, i.e., the chance of not having a stillbirth is 99.998%. Still incredibly low. For this 0.5 a baby, you are being offered an induction. Of course, there is still a risk of stillbirth, but it is important to remember that there was always this risk even before. There is never a situation that is completely risk-free.

There is also some evidence that if there are no other known risk factors for a woman, there is no increased risk of waiting beyond 42 weeks to give birth.

Let's look into a couple of other cases, such as when your waters break before you go into labour. What often happens is you are given time, typically 24 hours to go into labor, and if you are not in labor within this time frame, you are offered an induction. The concern with your waters breaking is having an infection. The NICE guidelines (2017) state that the chance of not having an induction has increased from before your waters broke, 99.5%, to 99.0% if your waters have broken. So the actual risk has not increased significantly of having an infection.

It is important to note that waiting to go into labour is often a good option for a healthy woman without any other risk factors. Statistically, 60% of women will go into labor within 24 hours, 90% within 48 hours, and 95-98% within 72 hours (Hannah 1996/1997, Enkin 2000). There is also no increased risk of infection if labor starts within 24 hours or 48 hours (Seaward 1997, 1998). There is also a study that suggests that induction only speeds the labor by 8-12 hours. So when talking about waiting another 24 hours for labour to start, or having labour induced and starting just a little before might make you question if one might want to do that.

There are other factors, such as maternal age, high BMI, or baby's size. In high maternal age, the concern is stillbirth. With regards to baby's size, the concern is that the baby will get shoulder dystocia. I am not going to go into the details of these risks in this blog, but I will write another blog on these topics in time to come. Induction is offered for each of these reasons based on a risk, and it is important to review and quantify that same risk. What I mean is to demand this risk and decide what risk is worth taking for you and what is not. Remember, it is your right to decline an induction, and actually, you have no obligation to explain why. But, because it is difficult to challenge doctor's opinions, especially if you are not familiar with how the medical system works, it is important to have a few stats up your sleeve to discuss with your doctors and midwives.

In reality, what often happens is the so-called cascade of interventions; you get induced without having been given a choice, the induction does not work for some reason, and often this ends up in a C-section. Because of this, the system calls labors that have been induced, but the labor did not start, "failed inductions." It is important to remember that the system has got to label everything, and not to take it personally. In reality, this does not mean that your body failed you; it means that the medical system failed you. They did not give the right environment for your birth to thrive. It is not your fault. This is why it is important to understand the risks and the chances of these consequences happening before your induction happens. If you opt in for Induction: Preparation is key The Importance of Preparation: If you choose induction, thorough preparation is essential. Acknowledge the potential lengthiness, increased pain, and associated risks. Being well-informed and mentally prepared ensures you approach the process with realistic expectations, empowering you to advocate for your preferences. Conclusion: Ideally, childbirth should be a process where trust in your body and the natural course of events suffices. However, in the prevalent medicalised setting, induction is increasingly common. To safeguard against unnecessary interventions, arm yourself with knowledge about the risks and benefits. Be the informed advocate of your birthing journey, ensuring that every decision aligns with your vision for a positive birth experience. Be the one, that does not go in blind, but informed! And if you decide induction is for you, make sure you know what to realistically expect.