Induction of labour and avoidable harm

Many people are concerned about media stories relating to induction of labour. These often focus on possible benefits and yet fail to mention the possibility that induction can cause avoidable harm. A recent paper has focused on this issue, and I made it my ‘study of the month’ in my recent Birth Information Update.

The paper is a discussion paper by Seijmonsbergen‐Schermers et al (2019). It was co-authored by a string of experts and published in this month’s Sexual and Reproductive Healthcare.

In Your Own Time was written to help parents and professionals better understand the issues and the evidence relating to the current induction epidemic. Looks at the evidence relating to due dates, ‘post-term’, older and larger women, suspected big babies, maternal race and more.

The authors explain that induction and other birth interventions can cause avoidable harm and note that “experts at the World Health Organization and authors of the Lancet Series on Caesarean Section, have recently also warned against excessive use of obstetric interventions”. Seijmonsbergen‐Schermers et al (2019)

Here’s a really key sentence:

“A small absolute increase in risk on its own, without any other medical risks or complications during pregnancy, does not justify a policy of routinely offering induction of labor without strong evidence of the benefits of that policy.” Seijmonsbergen‐Schermers et al (2019)

But what about the downsides?

Proponents of routine induction of labour focus on the possibility that some women may face a very small increase in risk. But as I often point out, we do not have good evidence that induction will reduce that risk. And we need to be concerned about avoidable harm, because induction does have downsides.

Downsides that often go unmentioned and unmeasured in studies that focus only on short-term, physical outcomes.

Seijmonsbergen‐Schermers et al (2019) also note that:

“Inducing women to prevent small absolute risks based on trials undertaken with very discrete populations neglects these warnings. Besides, a small increase in absolute risk does not necessarily mean that outcomes will be improved if labor is induced. Without the full picture of longer term outcomes from single and multiple cumulative interventions, and in the absence of a clear understanding of the compiled morbidity that may eventuate over a woman’s life time of reproduction, it is not possible to achieve fully informed judgements.”

Sara Wickham’s bestselling book explains the process of induction of labour and shares information from research studies, debates and women’s, midwives’ and doctors’ experiences to help women and families become more informed and make the decision that is right for them.

Right for some, not right for some

It’s great to see more papers unpacking the evidence. Because it’s clear that the pro-induction argument is not as sound as its proponents would like us to think. And no matter what the evidence says, induction of labour will be the right decision for some, and not for others. Some women regret agreeing to induction for the rest of their life, and others are happy they took that path. We need to spend more time helping people to understand that there is a bigger story to understand here, and I am very grateful to Seijmonsbergen-Schermers and colleagues for giving us another perspective on this debate.

To find out more about induction: