When it comes to your baby’s birth day, your baby knows best. In my last post, which you can access here, I discussed the true medical reasons induction may be safer than allowing labour to start on it’s own. However, many of the 28% of women in Australia who are induced do not have this true medical need.

So what’s happening? Why are induction rates so high and why should you be concerned like I am?

The liberal use of labour induction holds many attractions to obstetricians and hospitals. The ability to practice ‘daylight obstetrics’, and the economic benefits to hospitals and clinicians are obvious ones. Of course risk averse clinicians will provide reasons to expectant mothers as to why an induction is necessary but unfortunately these reasons are not always supported by best medical evidence.

The three most frequent reasons for inductions are

1) Impending postdate, that is, before 42 completed weeks.

Some mothers are offered a stretch and sweep (which is a form of induction), or a traditional induction with prostaglandin gel or Syntocinon (synthetic oxytocin) at 40+1. For some baby’s this could mean being born over two weeks early.

Considering the relative inaccuracy of estimated due dates (they are an estimate after all) and the variance of normal when it comes to mammalian gestation, it is sad and unfortunate that in the last weeks and days of pregnancy women are being pressured to induce their baby to be born, placing unnecessary and potentially harmful stress on the mother. The estimated due date of 40 weeks is also not accurate and recent research has show it to be more like 40 weeks and 5 days.

2) A suspected big baby.

Macrosomia is not a medical reason for induction (or caesarean!). I say ‘suspected’ big big baby because it is impossible to accurately estimate a baby’s weight at term with ultrasound. Not only this, being told your baby is too big to fit through your pelvis completely strips a woman of her confidence and power going into a birth and this makes me mad!

Women birth big babies out of their super stretchy vaginas and super flexible pelvises ALL THE TIME!

They do this without tearing, without complication, without medical pain relief.

Women’s bodies are perfectly designed to birth a baby of any size. What is needed is good physiologic and emotional care of the mother- patience, positioning, loving and supportive words, empowerment (Lamaze Healthy Birth Practices 1, 2 and 3!)! Letting nature take it’s course leads to the best outcomes.

3) Premature rupture of membranes at term.

95% of women will go into spontaneous labour within 24 hours of their waters releasing. The risk of infection is minimised if vaginal exams are avoided (VE’s increase neonatal infection risk by 2.5-fold, which increases for every VE performed). Research shows similar outcomes with infection risk between induction and expectant management. Mothers need to be able to make an informed choice, and waiting for labour to start on its own is a fair and reasonable option.

Now here are some other reasons to think carefully before requesting or consenting to induction;

1) Induction bypasses your baby’s ability to start labour at the best time.

This means induction may (and often does) fail because the MotherBaby hormonal systems weren’t ready for labour and when this happens a caesarean is usually performed. With women who choose elective induction, they are 2 to 4 times more likely to have a caesarean birth.

2) An induced labour is not a normal labour

and proceeds very differently than one started spontaneously. A more medicalised birth means more monitoring and restricted movement and thus a diminished ability to cope with labour. You won’t be able to use a warm tub for instance, which we know to be tremendously helpful in diminishing pain and progressing active labour.

3) You will have much more painful contractions

without the gentle build up experienced in spontaneous labour, increasing the need for medical pain relief and again interfering with the hormonal dance between MotherBaby. In normal labour your body produces beta-endorphins, the same beautiful hormone that elite athletes get when they reach peak performance. It’s that ‘runner’s high’, that euphoric feeling when you push your body to the max and realise you have broken through the wall and feel amazing and can keep on bloody going! It’s what many labouring women call ‘labourland’, some women even sleep between contractions at the time they are the most intense! This is not experienced with labour induction because your hormonal flow has been interfered with by synthetic hormones that your body does not process in the same way.

4) Induction can cause premature birth

even if it’s only a day or two earlier than what your baby was ready for. This increases your baby’s risk of needing resuscitation and of being placed in neonatal intensive care, separated from you and disrupting a critical time for bonding, attachment and breastfeeding.

5) You will have an increased risk of uterine hyperstimulation

(too strong and too frequent contractions) that can mean your baby won’t tolerate labour and will need to be born via caesarean. Uterine hyperstimulation can also increase your risk of postpartum haemorrhage.

6) Synthetic oxytocin use in the peripartum period

(the main drug used to induce labour) has been shown to increase risk of postpartum anxiety and depressive disorders by 32-36% in the first year after birth.

A baby born even a little early is more likely to have difficulties adjusting to life outside the womb than a full-term baby. The last days of pregnancy are vital for the baby’s and mother’s preparation for birth. Allowing nature to take it’s course means all the players are ready- the baby, the uterus, the delicate balance of hormones, and the placenta.

Have patience mummabear

Your baby will be earthside in your loving embrace at just the right time. Enjoy your last moments of pregnancy. Trust your body. Trust your baby. Nourish your body and soul with loving thoughts, loving words, loving and supportive people.

You’ll rock this this birth when your baby says it’s time to dance!

References

  1. Lothian, J., DeVires, Charlotte. (2010) The Official Lamaze Guide. Meadowbrook Press.
  2. Simkin, P., Whalley, J., Keppler, A., Durham, J., Bolding, A. (2016) Pregnancy, Childbirth and the Newborn, The Complete Guide.Meadowbrook Press.
  3. Goer, H., Romano, A., (2012) Optimal Care in Childbirth, The Case for a Physiologic Approach. Pinter and Martin Ltd.
  4. Dempsey, R., (2014) Birth with Confidence, Savy Choices for Normal Birth. Boat House Press.
  5. Buckley, S. J. (2009) Gentle Birth, Gentle Mothering. Celestial Arts, Crown Publishing Group.
  6. Evidence Based Birth- Evidence on Inducing Labor for Going Past Your Due Date https://evidencebasedbirth.com/evidence-on-inducing-labor-for-going-past-your-due-date/
  7. Kroll_Desrosiers AR, et al. (2017) Association of peripartum synthetic oxytocin administration and depressive and anxiety disorders within the first postpartum year. PubMed. https://www.ncbi.nlm.nih.gov/m/pubmed/28133901/

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