Who should decide when your baby is ready to be born? It’s a bit of a strange question isn’t it? But think about it in context of the natural world first, a world we are a part of but sometimes so far removed from, especially when it comes to birth.
In nature we trust in the cycle of birth, life and death to occur as it should, when the timing is right. It’s always of course the baby and mother in dyad who know the specific and intricate timing for when and where birth should take place. We don’t needlessly interfere in the process of a baby chick being born, breaking through its membrane and shell on its behalf. We don’t pull apart the caterpillars cocoon because we are too impatient to see the colours of the butterflies beautiful wings. We know that by interfering in this way, or with any mammalian species at the time of birth, the mother is likely to reject its offspring and the baby is not likely to survive. We know to leave well enough alone.
With our human babies and mothers, we sadly don’t offer the same level of respect.
As soon as a labour is induced, at a time that suits the obstetrician or hospital intake, or even the mothers social desires, it becomes a medical event and it ceases to be a natural one.
It then proceeds quite differently from how a spontaneous labour would, and despite what many people think, a medically managed labour is often less safe for a mother and her baby.
Labour inductions are reaching epidemic levels in this country. In Australia’s Mothers and Babies Report 2014, 28% of women had their labours induced, a figure that has continued to rise over the years, and I dare say the figure is even higher three years on from that. These current rates of inductions are extreme and very concerning. Why? Because when powerful drugs are used on essentially healthy and low-risk women, the harm that can occur does not outweigh the potential benefits.
Lamaze Healthy Birth Practice #1, Let Labour Begin on It’s Own comes from sound evidence that letting your body go into labour spontaneously is almost always the best way to know that your baby is ready to be born and that your body is ready for labour.
When truly needed, however, inductions can be a valuable, even life-saving intervention.
So what would really make an induction medically necessary?
1. Severe hypertension (preeclampsia)
If you have severe pregnancy-induced hypertension it would be safer for your baby to be born than remain in utero. Preeclampsia is a serious condition that can result in damage to the placenta; damage to the mother’s kidneys, liver and brain; low birth weight and a preterm birth. In rare but extreme cases eclampsia can result, where mother experiences seizures, and even more rarely, death.
2. Intrauterine growth restriction
If your baby has a growth problem in utero and isn’t thriving. This condition (intrauterine growth restriction) is commonly caused by a problem with the placenta, a vital organ delivering oxygen, nutrients and eliminating waste from the baby. It can also be a result of certain medical conditions or lifestyle habits of the mother.
If you have obstetric cholestasis which is a buildup of bile salts in the blood that can cause severe itching in the mother and an increased risk of stillbirth. The baby is usually induced before 40 weeks and is then very likely to survive.
4. Poorly controlled gestational diabetes
If you have gestational diabetes that can’t be controlled by diet, lifestyle or medication and is posing a risk to your baby an induction may be necessary. (Note: a suspected big baby due to diabetes is not an intervention supported by evidence.) Most babies born to mothers with well managed gestational diabetes are healthy.
In my next post I will discuss the most frequent reasons why inductions are carried out and why they are not supported by best medical and scientific evidence (ie. you have a suspected big baby, you are ‘overdue’, and you have premature rupture of membranes).
I’ll also cover what critical things mothers and babies miss out on when labour is not allowed to start on it’s own as well the risks and disadvantages of induction.
The most important thing for expectant parents is to be fully informed and able to assess the benefits, risks and alternatives to all management practices (induction versus patient waiting) and make the best decision for themselves. In the end it is your choice.
- Lothian, J., DeVires, Charlotte. (2010) The Official Lamaze Guide. Meadowbrook Press.
- Simkin, P., Whalley, J., Keppler, A., Durham, J., Bolding, A. (2016) Pregnancy, Childbirth and the Newborn, The Complete Guide. Meadowbrook Press.
- Goer, H., Romano, A., (2012) Optimal Care in Childbirth, The Case for a Physiologic Approach. Pinter and Martin Ltd.
- Dempsey, R., (2014) Birth with Confidence, Savy Choices for Normal Birth. Boat House Press.
- Buckley, S. J. (2009) Gentle Birth, Gentle Mothering. Celestial Arts, Crown Publishing Group.