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 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 everyone need to make decisions based on a careful assessment of their individual situation and needs and ideally after a discussion with a caregiver who understands their situation and needs, here’s some information.
Induction isn’t compulsory
The ‘how do I cancel labour 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 can be a genuinely risk-reducing intervention. And some women can’t wait to have their babies – they are delighted at the idea of their labour being induced. (Although, sadly, some do regret it). 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 to them or their baby 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 option A is a bit safer than B. But you are not a population. You are an individual. And both option A and option B will have consequences and side effects. There are no guarantees. There is 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 generally, you might like my book, What’s Right For Me? Or if you’re looking specifically for more on induction, try Inducing Labour: making informed decisions.)
Always ask for information
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. Then ask for 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 might be worth paying attention to. Or from one in 2000 to one in 1000? The chances are still low in that case. How about if the chance has gone from one in two million to one in a million? Those are all “twice as much” but the actual risk is very different.
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. You’re also entitled to go home and think about things in your own time, and that can be a really good option. It can be stressful to be put on the spot in an unfamiliar environment. 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.
So, 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. That’s not ideal at all. It’s too important a decision to happen that way.
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…
Most 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. That their cycle was long or short, or that they know that something about them (perhaps their height or ancestry or family history) means that are more likely to have a long pregnancy.
Worse, some find 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.
You may want to gather information which will help you 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 you 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’re a midwife or birth worker and you’d like to learn more about issues like induction and post-term pregnancy and/or build your confidence with the evidence on a range of topics, I’d love to welcome you to one of our online courses 😀 And you can keep up with my research postings via my free updates and monthly Birth Information Update.