Ten things I wish every woman knew about induction of labour: the article

small__150426193“In modern Western culture, most women know about induction of labour before they even become pregnant.  They know that it is suggested when it is felt that it would be safer for the baby to be born than to stay inside its mother, and I suspect many women know that one of the main reasons for recommending induction of labour is because pregnancy has lasted for a certain number of weeks and the baby is perceived to be ‘overdue’.  Many women will know a good few other women who have had their births medically induced, and so they are likely to know that other reasons are sometimes given for this.  These reasons include that the woman is older than average, that her waters have broken early and/or that she has a health problem or condition which if felt to necessitate the bringing on of her labour.

But this is not the whole story, and there are many, many other aspects to the decision that some women need to consider about whether or not to have their labour medicallty induced.  I have spent the past few months writing about this topic, and the result is the recently published and completely updated AIMS book, Inducing Labour: making informed decisions.  For the book’s launch event … I prepared a presentation entitled, ‘Ten things I wish every woman knew about induction of labour'” …………… and the paragraphs that you have just read are the first of an article that was based on that talk.  The article was published in AIMS journal earlier this year, and the lovely people at AIMS have let me upload it and share it with you, so here it is: Ten things I wish every woman knew about induction of labour.

Enjoy 😀

 

Post-term pregnancy course slideIf you’re a midwife or birth worker who would like to learn more about this area and discuss the issues with like-minded people, I’d love to welcome you to one of my online courses, including post-term-pregnancy: exploring evidence, inspiring confidence or you can keep up with my research postings via my free updates and monthly Birth Information Update.

 

photo credit: jef safi via photopin cc

 

17 comments for “Ten things I wish every woman knew about induction of labour: the article

  1. Nic
    October 27, 2014 at 4:40 pm

    Dear Sara
    Thank you for this awareness raising article. My worst fears were realised when I had an induction last July. At 40wks +2, the consultant I saw was dismissive & uncommunicative to my husband & I. He insisted that an induction (no explanations of his reasoning or what the process would involve) was necessary at 41+ 1 & brusquely told us to turn up on Wednesday evening for the induction. We were in shock at his rude attitude and left the office feeling scared & deflated. I had been feeling wonderful up to this point- energetic, practising yoga, swimming, walking, listening to hypnobirthing affirmations etc. I became very stressed & decided to see my acupuncturist for some “help” to move baby along & avoid medical induction, as everything I had read & researched convinced me that this was not the route for me & my baby. Buoyed by my acupuncturist’s support & advice, I decided to challenge the consultant’s decision.I could only access a midwife in the maternity ward by telephone.She told me she had no access to my medical file and advised to turn up & that they would check me out & if all was ok I could wait until I was 11 days over ( hospital policy). All was perfectly fine on scan & trace & I explained my opposition to induction ( different consultant). In the end, fear of something going wrong with baby won out & I suggested a membrane sweep on day 10 to buy myself more time. My acupuncturist, a former midwife herself, had advised me against doing this as she said it would likely cause my waters to break & they did indeed break during the sweep. My labour in summary: 2cm dilated at sweep, anxious night spent in maternity ward listening to new mums crying with baby blues, 6 hours on drip unable to move much with all the wires, 2 painful internal examinations, ineffective contractions which were too close together, v strong & painful, vomiting, shock, fear & distress, baby showing signs of distress, occiput posterior baby & a c-section, followed by an infection for me, baby not breastfeeding properly because she also got my infection, special care babies unit for baby, guilt, separation & 8 days in hospital. Apart from the first consultant (rumour has it- no longer practicing)I found the staff at the hospital to be excellent within the confines of hospital policy. I got wonderful support with breastfeeding & 15 weeks later baby & I are doing well. My problem is with the outdated policies & lack of evidence based practice. I also found that fanily & friends, prior to my experience, would have seen induction as a positive and necessary thing. I really think that most women feel that they must obey their consultants. I was very well informed about the risks associated with induction but I still bowed to pressure. Maybe I still would have ended up having painful back labour and a c-section if I had held out and refused the induction until baby decided to come. I will never know. I hope that my next birth experience will be better and I will definitely be more assertive and trust my own judgement and instincts.Upon discharge, another consultant reassured me that VBAC would be encouraged & supported and that the hospital had a high success rate. I hope that other expectant mums read my story and carefully consider their options.

    • October 27, 2014 at 4:44 pm

      So, so sorry that you had such a difficult experience, Nic, but thank you for sharing it with other expectant mums.

  2. Denise Hynd
    October 27, 2014 at 6:44 pm

    Dear Sara
    Is it possible to get a copy of your poster about these 10 things??

  3. Melody Stojcevski
    October 28, 2014 at 2:56 am

    This is a good read and I must say all info given to me by the MH (local hospital) midwives and Dr didn’t say anything like this, but the reading I had done did, actually I would say 80 out of 100 story’s were terrible …. Unfortunately after 2 weeks of me begging for this not to be done they told me it wasn’t a choice as I would harm my baby otherwise I was 42weeks …. We’ll the rest of the story has changed our lives for ever and not for the better… After 5 mins of Gel Pebbles (my baby boy) heart beat dropped to 20 and then continued to torture my baby for 12 hours untell they called emergency c section 2 hours YES two hours Later I had c section and gave birth to our baby boy Pebbles he was only with us 30 minutes whilst they worked on him he was worn out from the induction and torture he had been put through all day with his heart rate going from 20/25 to 180 every few mins whilst they tell me it’s all normal (my first child) instead it wasn’t normal and resulted in them torturing and murdering my baby he passing away due to neglect … I would never recommend this to anyone NEVER… Heart broken for life…… And the pain was incredible …. I’d chop my legs of bfor going through that again …

  4. Maria
    October 28, 2014 at 5:04 am

    i have had two inductions by ARM, no other intervention was required, and no pain relief either. They were beautiful vaginal births. They were quick, but, my non induced birth was quicker and my husband delivered that time, I wasn’t willing to have my toddlers deliver their siblings. Induced births are not always awful, and I was calmer during my induced births than I was during my unplanned home birth. Induction is not always right, but, it’s not always wrong either.

  5. Jules
    November 1, 2014 at 7:54 am

    I’ve had two inductions, one ” normal” birth…. First induction my waters broke 6 days early (knew exact date of conception) but I wasn’t dilating/having contractions. I had the pessary -didn’t work then everything went so slow, two days of no sleep I caved in and had all the drugs going (gas and air, pethidene & epidural) to sleep/help with the pain. I didn’t know what each would do except relieve the pain.

    The nurses threatened a section 43 hours from my waters breaking, as all I did the second morning was sleep in between getting the drugs. When it came to when THEY thought I could push I was knackered! I pushed for an hour and couldn’t feel anything. I was told i had an hour to get him out or i WAS having a section (great choices lol) but I was able to try and turn over (much to the nurses objections) as the epidural fell out. With that he was out in 30 mins. I felt steamed rolled an un informed in my choices!

    Baby 2 was born in a different country and also induced because I asked after I was over due 41+1. I also said I didn’t want they drugs I had before, so they ruptured the waters, gave me an hour walking around to see if that helped-it didn’t then started the drip. They kept upping it every so often, I was checked and had only dilated a small amount, when I counted how long it would take to get to 10cm (1cm an hour) I started freaking thinking its going to be dinner time or later! But an hour or less later I felt really uncomfy, I said I felt odd and the mw said she’d check me later as I hadn’t long been checked…I said I would prefer her check now/soon…turns out I went from 4-5cm to 9cm in less than an hour (with nothing). My mws changed shifts at 3pm and the one I had all day was great an anti drugs so helped me not take anything, soon as she left I shouted give me drugs (lol meaning gas and air) but by the time I got it I was just getting ready to push so only used it for 15mins. Baby came out no bother!

    Bub three I could feel he was bigger than my other two, could feel him right high in my chest and low in my pelvis for weeks and wasn’t so big. I had an estimate scan at 38wks and they said he was 7.7 to 8lb and would be 8-7lb born. I knew he’d be late but didn’t stress over how long, I saw my consultant at 40+1 and said he’d discuss options next week, following week at 41+2 we discussed options, I asked for a stretch and sweep which I had then and there, and they booked me for an induction in two days. I ended up having him the morning of my planned induction with gas and air, he was a big baby for me (had 7.7 &7.8lbers) and he was 9.08lb. As his head was coming out they said the cord was shorter than it should be plus his shoulders were stuck! I had the two nurses try to pull him out as I pushed, it worked eventually but he was harder for my body to push out because of his shoulders being so large.

    Inductions in my belief, aren’t that scary, labour is scary if you haven’t done it before. The drugs IMO aren’t all that… Yes they help the pain but they delay things. I read up on the drugs after having my first and expecting my second. That is when I found out the chances of having sections are higher in inductions…but IMO I’d say its from the drugs rather than the actual induction.

    Many nurses and doctors, think they no better and that the mother should go along with what they deem to be correct. With my third baby he was measuring a week larger than my 6 week scan dated him at, when I questioned the female consultant in the due date she got all snotty and said how “SHE was the doctor as SHE knew best!” She would not put my due date back to what my period AND the two later scans dated him to be but offered to give me a stretch and sweep at 39 weeks to start me off early (would of been my 40 week date, her 39 wk date). I promptly refused and said how I did not like her or her ways and would be changing doctors! My baby as it says above) was 7.7 at (my) 38 wks (her 39wk) and 9.08 at my 41+2 (her 42+2).

    I do believe had I kept her I would of been induced!

  6. Jo
    November 2, 2014 at 8:53 am

    Dear Sara

    This is a wonderful article and sums up nicely all the reasons I fought against intervention. At 40+12 I had a discussion with consultant who insisted most babies were born by 40 weeks and used the term stillborn umpteen times a minute. At this point I agreed to sweep but no induction but they were unable to do sweep as they couldn’t reach. They tried to do a sweep a further three times always unsuccessfully and monitored daily. Although it took under half an hour to confirm bump and I were fine I was kept in all day up to at worst 8 hours which I believe was bullying to make me concede which I finally did on 40+17. They weren’t even able to put the pessary where it needed to go and after 24 hours my cervix was even higher and I was taken for a section on +18. Biggest regret was not waiting longer but how long is safe to wait before measures are taken? Trying to balance nature and the wonders of modern science which saves countless lives is incredibly difficult when one only has the knowledge of university of Google. I’m now pregnant again and the one consultant I’ve seen to date refused to discuss vbac, refused to discuss section and he’ll they even refused to tell me if I was safe to fly. It really is that you’re on your own unless you toe the line with hospital policy. Currently five months pregnant and terrified of what’s to come as I’d do anything not to have another section. Interested in your views of how long one can hold off having intervention if all tests show baby and placenta healthy. Also, how long one can hold off intervention after previous section assuming all healthy.

    Thank you again for such an informative and succinct article.

  7. Tam
    November 11, 2015 at 11:24 am

    I have been reading the article and all the posts with interest. My heart goes out to Melody who’s story was so sad. I am currently 37 weeks pregnant with my second child, after a very traumatic induced birth 10 yrs ago. After having 2 unsuccessful sweeps I was induced at 42 wks with only one pessary application. Suffice it to say I experienced very sharp, close together contractions very quickly, ended up with a drip as i wasn’t dilating, and was in agony for hours. I then pushed for an hour (on instruction) before they realised i wasn’t quite fully dilated, after which i had an epidural as i just couldn’t cope anymore. Eventually my baby became increasingly distressed and was delivered in a panic via ventouse (theatres were all full so no c-section). I then had to stay in hospital for several days after major blood loss, and it took me weeks to be mobile again. I am pleased to say that although my daughter was born ‘blue’ she soon recovered and is now a healthy 10yr old, but it was a very stressful situation for all at the time.
    I am now 40yrs old and the consultants are very keen for me to be induced at 40 wks due to an ‘increased risk of stillbirth’. I am in good health, low BMI, don’t smoke, have had a straightforward pregnancy and additional scans have shown the baby to be a healthy size with good fluid levels and a healthy looking placenta and cord. Despite doing my research and explaining my preferences for a natural birth I am still feeling under tremendous pressure to be induced. I am just hoping that my baby decides to come on time as the battle I think I will have to have with them will be so stressful, but i just don’t want to be induced again! I understand that induction is not always a bad thing but after my previous experience i really don’t think it’s for me. I just don’t seem to be able to convince the consultants of that!

    • November 12, 2015 at 7:33 am

      Thanks for sharing your story, Tam, and am sending you tons of good wishes for this birth x

  8. Rosie
    November 27, 2015 at 8:57 am

    Thank you for this article Sarah, it has given me a lot to think about. Unlike some of the other comments here, my midwife is suggesting I have an induction at 38 weeks because I have been diagnosed with gestational diabetes. I am still trying to figure out if induction is essential now or if it is only if the baby is too big, which mine is not. This article has made me realise I need to find out if I have options as I had just assumed I had to have an induction.

    Many thanks,
    Rosie

  9. Rebecca Pugh
    December 27, 2015 at 8:56 pm

    Brilliant article, would have been great to have had it as back up to my gut feeling for my first. Sadly felt pressured into an induction at +11 days. The pessary caused hyper stimulation of the uterus but no baby moving contractions. Daughters heart rate dropped dangerously low, pessary was whipped out (I actually felt like a cow or sheep at this point as the doctor rooted around) we were rushed to labour, waters broken, drip in hand. As mentioned in the article I did find the candula painful and distressing. Heart and contraction monitors meant my movement was restricted. Fortunately this only lasted 6 hours, the midwife respected my no vaginal examination wish. She even let me delay cutting the cord until it had stopped pulsing despite having the injection to deliver the placenta. I refused a sweep or to be booked for induction for my second, it became apparent at this point that my partner didn’t realise it was the induction process that had endangered our daughter. Second labour was easy, spending the day playing with my daughter, looking after my horses. Daughter number 2 turned up quickly on the bathroom floor caught by a paramedic! Thank you for this article, I have book marked it for future reference. I would never encourage anyone to be induced unless remaining pregnant risked the health of mother or baby, your article provides the facts to my gut.

  10. SFBJ
    May 4, 2016 at 7:48 pm

    Hi Sara, really useful article, thanks. I am 39 weeks + 2 and 40 years old with my first child. The obstetricians are adamant that I should be induced on my due date (next week) but I would really rather avoid this. I’ve been healthy throughout my pregnancy and the baby is active and healthy as far as we no. I’ve got no other complications apart from my age. Its proving almost impossible to get good information/research-based advice about what to do aside from that which comes from the obstetrician. My midwife will support me if I decide not to be induced next week but isn’t really providing me with much in the way of advice/evidence. Everything is deferred back to the obstetricians. Like someone else above, I’m really just hoping baby arrives of its own accord so I can avoid the pressure. Baby’s head is 3/5 engaged and is in a great position, so we have our fingers and toes crossed. Thanks for the useful article!

    • Tam
      May 11, 2016 at 10:10 pm

      I felt i had to reply as i was in exactly your situation 5 months ago. After holding out for an extra week (under what felt like tremendous pressure) i had my lovely little boy naturally. After a very traumatic induction with my first baby this was a painful but exhilarating and empowering experience that’s left me feeling very proud. My advice would be to follow your instincts and hang on in there if that is what you feel is right.

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