How to cancel a labour induction?

How do you cancel labour induction?

“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?”

 

Induction of labour is one of the most commonly searched-for topics on my website. A good many people arrive here after searching for variations on the question, ‘How to cancel a labour induction?’

This also comes up often in online courses. We hear many 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, here’s some information.

 

Induction isn’t compulsory

The ‘how do I cancel an induction?’ question is a sad indictment on the maternity services. 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. In the words of Beverley Beech:

“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 one size doesn’t fit all. Many midwives and birth folk know this, and feel frustrated that there exist recommendations about what all women should do, for instance at a particular stage of gestation. This doesn’t just relate to formal methods of induction, but also to the ‘stretch and sweep‘ which is all too routine in some areas. (More on that here).

For some women and babies, induction of labour is a life-saving intervention. And some women can’t wait to have their babies – they are delighted at the idea of their labour being induced. (Although some come to regret this, sadly). But many women would much rather go into labour on their own. Yet induction is recommended simply because they have reached a certain point in pregnancy. Or because they have a certain risk factor, although the actual risk is very small.

It is more important than ever to ask questions. The key one is why induction is being recommended. Is this a routine recommendation, or are there specific reasons why it is recommended for you in particular? It may be the case that the population statistics tell you that A is a bit safer than B. But you are not the population, you are an individual. And both A and B will have consequences. There are no guarantees, and no ‘no risk’ option. Sorry. It’s up to you which path you take, as each one has pros and cons. (If you’d like to look into this more, you might like my book, What’s Right For Me?)

If you are told that induction is a safer or better option than waiting for labour to start on its own, ask for an explanation. Why is the person saying that? Ask for the research on which this statement is based. And ask for the actual numbers. And the paper which they came from. If someone tells you that something is twice as safe, that’s not a helpful statement on its own. Has the chance gone from one in four to one in two? That’s a considerable change. Or from one in 2000 to one in 1000? Maybe not so much.

Having said that, however, you should know that there IS research which concludes that induction is safer/better than waiting. Unfortunately, it isn’t all good research. There seems to be an increasing trend to publish research which supports the decisions that the authors want people to make. What we need is to be able to make decisions based on good quality evidence. 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.

You are entitled to ask for a second opinion. And to go home and think about things in your own time. Remember that, if someone was desperately worried about your baby, they wouldn’t be recommending induction. Induction often takes two to three days before labour properly starts. If they were desperately worried, they would be recommending an emergency caesarean. As above, there are sometimes really good reasons for recommending induction of labour. But sometimes it’s offered routinely, without thought for the individual, or for convenience. One size doesn’t fit all.

 

Were you involved in the discussion?

I am, sadly, hearing from women who are given an induction date without any discussion. Some are ‘just told’ what is going to happen. In some areas of health care, systems automatically send or generate appointments. People may or may not want these. Frequently, they don’t even know about them. I have friends and colleagues who have been mailed unwanted appointments for mammograms, cervical smear tests and other kinds of screening. Even though they have previously declined and asked not to be sent these. 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. However, no amount of population-level justification will make it feel better to a person who is fed up at not being treated as an individual.

Sadly, some women are given an induction date almost as soon as their due date is calculated. What on earth does this say about our faith and trust in a woman’s body’s ability to grow, birth and feed her baby?

 

There are more than two options…

10609811454_ddca54fcdeMost women pay for the health care that they receive, either directly or through their or their family’s taxes. Generally, 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. Care should be tailored to our needs. And it doesn’t have to be an all-or-nothing, stark black or white decision, as I discussed in this post.

Many women who question a recommendation of induction don’t necessarily want to decline the induction outright, or forever. They might want to wait and see. Or to choose a different date. They may want induction only if there is a genuine concern about them. (Not “because everyone is induced at 41 weeks”. Or “because we always induce women who had IVF or are over a certain size or age”. Some want to negotiate the induction date by their date, not the one generated by the computer. Especially if the computer didn’t take into account that they KNOW they conceived two weeks later than their LMP date suggests. Or, worse, their date was changed after a scan, but this doesn’t gel with what they know.

Sometimes women want to discuss the decision with their partner or family rather than agreeing to a date straight away. They may want 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 2018).

Again, it’s individual.

 

The nuts and bolts of cancelling induction

So what do you do if you get given an induction date that you don’t want?

If you have a good relationship with a midwife (or other caregiver), just contact them and tell them your decision. They may have individualised information or suggestions to share. (They shouldn’t try to coerce you though. If you feel uncomfortable, review your options.) They might offer a timely antenatal appointment. They may ask her to get in touch if anything happens or if you change your mind.

Not everyone has a care provider they know and trust, though. Some don’t have a midwife at all. Perhaps they’re in a country where maternity care is obstetrician-led. Or they may have never seen the same midwife twice and don’t feel that they have a good relationship with anyone. What do you do then do? Well, some women decide to just ignore the induction date and not call anyone. But some are concerned that such action may have unwanted repercussions.

It also depends on what you feel you 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. Some ask their partner or a friend to make the call instead. They generally do that in the hope of keeping their stress levels down and their oxytocin levels up. Some women text instead of calling. 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 wanting to confirm or discuss their decision.

The important thing to remember is this: it’s your body, your baby, and your decision.

 

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 discussion. If she later changed her mind, she would already know where and how to call and postpone or cancel.

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. They would ask how the baby was and chat through their decision in a friendly, relaxed way. They’d ensure 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.

Sadly, this isn’t yet the reality. Information is key, and I invite you to sure this site and look at my blog posts, articles and books so that you can get informed. And not just my books – there are loads of great books out there! Just be sure you’re reading something up-to-date, as things change so often. And always have a quick look into the author’s qualifications, to see if they’re somebody whose information you can trust.

I really hope that, one day, 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.

 

photo credit: Sesión embarazadas Vanesa y Alicia via photopin (license) and Calendar via photopin (license)

15 comments for “How to cancel a labour induction?

  1. Rachael
    December 16, 2015 at 7:08 am

    Thank you so much for sharing this. I am 25 weeks and from the very beginning have felt I will end up being induced as my dates differ to those of the ‘professionals’. I now feel much calmer and prepared for that possibility. Many thanks & Happy Christmas x

    • December 16, 2015 at 10:07 am

      Well I am very glad it helped you Rachael, and I hope you have a very calm and relaxed festive season 🙂 x

  2. Jo
    December 16, 2015 at 2:54 pm

    Thanks for this Sara. As ever, a really good analysis and a good read BUT I’m just a tiny bit disappointed that you didn’t seem to include within your definition here the routine induction procedure of ‘just a little sweep’. Maybe it is a slightly separate topic, discussed by you elsewhere, but I see the normalisation of the sweep offer/ acceptance process as integral to the mainstream ‘induction socialisation process’ that articles such as this (quite rightly in my view) seek to challenge. I know that there are key differences – the sweep doesn’t generally start the clock ticking in the same way as a pharmacological induction, for example. But the signals it gives to women about the normalisation of intervening in the physiological process of birth, in his case its spontaneous onset, is surely similar. Maybe there is a rich vein of work on declining sweeps/ statistics about the proportion of women who birth after their EDD without having been ‘swept’ that I need to get onto ! Jo x

    • December 17, 2015 at 9:46 am

      I agree that ‘stretching and sweeping’ is a huge issue and that there’s overlap, but I have got posts and pieces on this elsewhere on the site and I wanted to deal directly with the questions that women are searching on around the actual date that they’ve been told to turn up for medical induction. The main post that I have done on that is here: https://www.sarawickham.com/articles-2/what-is-a-stretch-and-sweep/ 🙂

  3. Jo
    December 16, 2015 at 8:34 pm

    I have a question not about induction, as I have already said to my mw I am not having one unless it’s a medical emergency , mine is about strep b. I had a strain in my urine about 2-3mths ago after I had been very I’ll from flu like symptoms. I am now being told I can not have a baby in my local hospital, but have to have him 45 minutes away in another as” he has to have antibiotics just in case” I only had strep b that one time in 1 sample (I did 3 samples over 2 wks) which was treated. I don’t have it now. I am not happy to give my baby antibiotics for “just in case” this is baby 5 for me and I e never been tested for strep before.

    • December 17, 2015 at 9:48 am

      Jo, if you put ‘GBS’ into the search box on my website, you’ll find lots of info on that, including links to a book I wrote on this topic last year for women in your situation 🙂

  4. Nora
    December 17, 2015 at 2:25 pm

    I had an appointment at 39+6, where midwife wanted to book an induction at 41+5. This for no other reason than making sure the baby was born before 42 weeks and because our local hospital had “so many births per year and it is just to help them plan the work load”. The induction wasn’t discussed in more detail but I was informed I could cancel any time.

    While I was told that I could cancel anytime, I still found it very upsetting that this was even a topic. I had a completely uncomplicated pregnancy and usually felt confident and relaxed about birth. But at this stage, I actually started to feel a bit stressed with all the people asking: When is your due date? Oh, not long to go… and me and my partner wondering: When will we finally get to know our baby? I could have needed some assurance that I was doing just fine. That chances where very high that I would hold my baby in my arms within a week. That I should relax and enjoy myself. The question of induction fell into a period where I felt more vulnerable than before. I found it distressing and it made me insecure. I clearly felt it implies that the midwife did not trust my body would know the right timing. And this affected me.

    And to be honest, I don’t understand the “work load” reason. I assume many women won’t need an induction in the end. The booking doesn’t get rid of the unpredictability regarding how much staff is needed on a certain day.

    So with the possible negative effect on the mother and with not really making staff needs more predictable, I completely fail to understand the need to book inductions “just in case”. It’s a disservice.

  5. Laura
    December 17, 2015 at 3:11 pm

    I went 17 days over and had a natural home birth with my husband and 2 community midwifes the hospital booked me in for 3 inductions and as I was on every other day visits to the hospital for monitoring coz IDE gone past my “due date ” I just kept saying mmmmmm I’ve decided I don’t like Monday let’s do Thursday ! Mmmmmmm I’ve decided I don’t like Thursday let’s do Friday mmmmmm let’s go for Monday etc etc I just kept doing this untill I went into natural labour hector was born 7.13 after an active labour of 7 hours by the time I felt I needed the midwife I was already 7 cm lol my baby was not over cooked or too big he did not get stuck and my plecenter was fine it had not stopped working I had plenty of fluid I did not tear I think monitoring helped me make the decision as THERE WAS NOTHING WRONG ! I dident need induction x

  6. Jen Miller
    December 17, 2015 at 8:17 pm

    Last time I was given a provisional date for induction at the midwife app after my 12 wk scan. Definitely nothing to do with need, just another tick box exercise.

  7. Anna
    January 6, 2019 at 3:02 pm

    Thanks for this. Actually what is reassuring is hearing I’m not the only person hesitating about calling. I’m currently 37+5 with didi twins. At my 36 week appointment I calmly explained that I didn’t want to outright refuse induction but that my first two births were spontaneous at 38+3 and 38+5 so I’d prefer to go to almost 39 weeks and then I would be relatively willing to induce given the risks and that is ridden it out as long as my previous pregnancies. The doctor seemed understanding any yet came back and told me she actually had booked me in for 37+6 despite what I’d asked… Tomorrow.

    I went off feeling a bit daunted as I’d explained everything confidently but I feel annoyed I didn’t protest at the time, I couldn’t find the words. The truth is I also hoped spontaneous labour would just happen ahead of induction but here I am. I’m now stressed and struggling to sleep and doubting myself for wanting to delay. I feel so much pressure when I didn’t get supported in my request! I’m feeling very vulnerable and as If I don’t want to face phoning the Labour ward to cancel but I’m aware that I need to do so asap if I want to give them some warning. I’d love to get my husband to call but I have a feeling they’ll need to talk directly to me…

  8. Rebecca
    May 11, 2020 at 8:10 am

    I wish I had found your page before my 3rd baby, I felt pressured into induction due to a smaller baby, 5th percentile and 61b 2oz. on one scan at found at 39 weeks. Sometimes now I wish I had chosen monitoring as it was offered but I felt like I had to make decision there and then. Also do you have any information on moving a cervix forward in labour? as to just leaving it alone? I feel that once you start one intervention it is just accepted you will consent to others!

  9. Ludi
    May 14, 2020 at 8:06 am

    Hi, just wondering what are your thoughts on inducing at 38/39w because of ivf, old age – 45 and first baby born small, just over 6oz (i had a sweep and she was born next day, 39w, very fast labour, went from 1 to 10cm in 2.5h). With current pregnancy, the consultant wrote during my 12w scan – delivery at 38/39w…he didn’t explain much, i was put down as high risk coz of ivf, age and low weight first baby. otherwise i’m all healthy. Don’t really want to be induced, if i’m honest..can i ask for more scans, closer to the time, or sweep – would that be effective at 38w or rather have a c section..so confused and feel the consultant just wants to induce..

    • admin
      May 14, 2020 at 2:16 pm

      Can you get hold of a copy of Sara’s ‘Inducing Labour’ book? It might help you understand your options better. It’s on Kindle and Kobo as well as in paperback, and some libraries have it too.

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