“I had an appointment with a consultant last week and was given a date for induction, although I wasn’t really asked whether I wanted it and it was all very fast. There’s no medical reason for inducing me, it’s just that I’ll be 41 weeks pregnant on that date. When I got home and thought about it and read more, I decided I wanted to cancel it. But how do I do that?”
If a pound dropped from the sky every time someone came to my website because they were searching for information about induction of labour, I wouldn’t need a crowdfunding page to support it! Induction of labour is one of the most commonly searched-for topics on my website and, this year, I saw that a good number of people had come to my site after searching for variations on the question, ‘How to cancel a labour induction?’ This has also come up in my workshops, as birth folk tell me stories about women who have been given an unwanted induction date. So, with the usual disclaimers that this isn’t midwifery or medical advice and that women need to make decisions based on a careful assessment of their individual situation and needs and ideally after a discussion with a woman-centred caregiver who understands their situation and needs, I felt this needed a bit of discussion.
Induction isn’t compulsory
The ‘how do I cancel an induction?’ question is a sad indictment on the maternity services in the area in which women are asking this question. It underlines the way in which many women don’t feel that they are at the centre of or in control of their maternity care. I am both immensely grateful to Beverley Beech for writing Am I Allowed and immensely sad that she needed to write it. But in her words,
“Since most women simply assume they should, or feel obliged to, do as they are told – in their first pregnancy anyway – doctors and midwives, who are often busy, and who rarely encounter women who decline tests and interventions, assume that consent has been given. They are supposed to be offering and providing care, not insisting on it. The reason they want you to have a particular test or procedure may not be because of your individual need, but because it fits in with the hospital protocol. This is a set of written guidelines, which women rarely see, aimed at providing safe care for the majority, for that unit, and often not based on research. One size fits all, but it might not for you. If in doubt, ask to see the protocol which applies to your type of care. You have a right to see it. And a right not to follow it.” (Beech 2015: 1-2)
There are pros and cons of induction
Women and babies are individual and, because one size doesn’t fit all, many midwives and birth folk feel frustrated that there exist recommendations about what all women should do, for instance at a particular stage of gesttion. For some women and babies, induction of labour is a life-saving intervention, and I absotely understand that there are quite a few women who can’t wait to have their babies and who are delighted at the idea of their labour being induced. But there are many women who would much rather go into labour on their own and who find that induction is recommended simply because they have reached a certain point in their pregnancy or because they have a certain risk factor. So why are systems still making population-level recommendations about the care of women and babies?
It is more important than ever that we encourage women to ask questions and find out why induction is being recommended in their particular case. Is this a routine recommendation, or are there specific reasons why it is recommended for their particular situation at this stage of their pregnancy? If women are told that induction is deemed to be a safer or better option than waiting for spontaneous labour in their case, they may wish to ask for an explanation of why this is, and/or to see the research on which this statement is based. Having said that, however, it is worth knowing that there IS research which concludes that induction is safer/better, but it isn’t necessarily all good research. Here’s a page which lists all the resources on this web site relating to the research on induction of labour, including discussion of that very issue. Women are also entitled to ask for a second opinion. As above, there are sometimes really good reasons for recommending induction, and sometimes not. One size still doesn’t fit all…
Were you involved in the discussion?
I am, sadly, hearing from some women who are given an appointment for induction without even having had a discussion about it, and from others who (in their words) felt that they were ‘just told’ that this was what was going to happen. In some areas of health care, there is a tendency for systems to automatically send or give out medical appointments that people may or may not want and have not been asked about, and I am thinking here of friends and colleagues who have been mailed unwanted appointments for mammograms, cervical smear tests or other kinds of screening. There are a number of reasons why, if you are managing a bureaucratic system, it is considered easier, better or more efficient to automate such things, but no amount of population-level justification will make it feel better to a person who is sad or upset that they are not being treated as the individual that they are.
I have also been really saddened this year to hear from more and more birth folk that women in their areas are now given an induction date almost as soon as their due date is calculated. What on earth does this say to the women about our trust in their body’s ability to grow, birth and feed their baby?
There are more than two options…
It can be helpful to remind ourselves that most women pay for the health care that they receive, either directly or through their or their family’s taxes. I’m not really a fan of thinking of ourselves as consumers, because I have concerns that that’s not an appropriate comparison, but, when we use health care, we are the recipient of a service. I wish more women knew that care should be tailored to their needs, and that it doesn’t have to be an all-or-nothing, stark black or white decision, as I discussed in this post. Many of the women who I’ve met who have questioned a recommendation of induction don’t necessarily want to decline the induction outright. They just want a different date, or to wait and see for another week. Or, as above, they want to be treated as an individual and negotiate the induction date that is right for them, not the one generated by the computer, which didn’t take into account that they KNOW they conceived two weeks later than their LMP date suggests.
Sometimes women want to discuss the decision with their partner or family rather than agreeing to a date straight away, or to gather information which will help them to know how the baby is doing before making a decision. None of this is unreasonable. In Inducing Labour: making informed decisions, I wrote, “It is quite reasonable for a woman to say, ‘No, I do not want my labour induced at 41 weeks, but I would like an appointment at (say) 41 weeks and 5 days in order to talk about whether I may want to be induced at 42 weeks’ or, ‘I do not want my labour induced at this point but I will let my midwife know if I change my mind'” (Wickham 2014). Again, it’s individual.
The nuts and bolts of cancelling induction
So what can we tell women? Well, if women have a good relationship with a midwife (or other caregiver), then the best way forward is for them to contact that midwife and share the decision with her/him. The midwife may have individualised information or suggestions to share, and will likely ensure that the woman has a timely antenatal appointment and ask her to get in touch if anything happens or if she changes their mind.
Not everyone has a midwife, though, and some of the stories I’ve been hearing are from women who either don’t have a midwife (for instance, they’re in a country where maternity care is obstetrician-led) or who have never seen the same midwife twice and don’t feel that they have a good relationship with anyone. It’s these women who are probably amongst those who search the internet on this question, as some of them just don’t know who or where to call. What do they do? I know that some women decide to just ignore the induction date and not call anyone, but others are concerned that such action may have unwanted repercussions.
It also depends on what the woman feels she can deal with at that stage of pregnancy. I know of women who have taken control, called the hospital and politely and firmly explained that they do not need the appointment, and I know of women who have asked their partner or a friend to make the call instead, generally in the hope of keeping their stress levels down and their oxytocin levels up. Some women decide to text their midwife or doctor instead of calling, and others have phoned the antenatal clinic out-of-hours and left a message on the answerphone rather than calling a 24-hour service such as the labour ward where they would be talking directly to a member of staff. Some have heard nothing after leaving such a message and have simply turned up at the hospital a day or two later in spontaneous labour. Others have received a phone call from a staff member who questioned their decision and this, again, is why I am delighted that we have books such as Am I Allowed as well as organisations which help women know what their rights are and where to go if they need support.
When will we move towards informed decision-making?
In an ideal world, there would be no reason to write this blog post. Each woman would only be given an induction date if it was something that she asked for or agreed to after a good discussion and, if she later changed her mind, then she would already know where and how to call and postpone or cancel it. I have a dream that these women’s phone calls would be answered by their friendly caseloading midwife who would gently and kindly ask how they were doing, how the baby was and chat through their decision in a friendly, relaxed way, making sure that the woman had up-to-date and individually tailored information on which to base her decision. The midwife would ask whether the woman would like to book another induction date now or to wait and see how things went. The midwife would have plenty of time to chat things through with the woman and her family, to make sure that the woman was OK and had all her questions answered and that they both had their next antenatal appointment on their calendars.
I wonder if Santa does maternity-service related gifts? If so, I look forward to the time when I can delete this post because women only get given an induction date if it’s something that they actively ask for after an individualised discussion of their needs.
If you’d like to learn more about post-term pregnancy and build your confidence with the evidence, I’d love to welcome you to my online course on this topic 😀 And you can keep up with my research postings via my free updates and monthly Birth Information Update.
This post was part of my 2015 blogfest, during which I wrote a blog post every day for two weeks as a way of saying thank you to those who are helping keep my free and ad-free information activities online. If my work helps you in yours and you would like to make a donation and help me keep all of these resources free and heart-funded through 2016, please click here and make a donation. Thank you for caring about women and babies.