Can I have a natural placental birth after induction?

“Is it possible to have a natural placental birth after induction?”

That’s a question I get asked a lot.

My first reply to this question usually begins with me saying that I am not sure that any part of a labour that follows medical induction could accurately be described as ‘natural’. Especially when the induction involves synthetic oxytocin. But the really key point here is that, while I’m a strong advocate for women’s autonomous decision making, there is a really good reason not to suddenly remove synthetic oxytocin once it has been started.

Neither do I think that physiological placental birth is as risky as some would have you believe. In fact, I co-wrote the book in which we went through the evidence and explained this. And I have attended hundreds of women who have birthed their placentas naturally. So I would consider my own comfort zone to be really quite wide in this area. But induction of labour interferes with normal physiology. And hormones. So it is inadvisable to suddenly stop a synthetic oxytocin drip after a woman had been receiving this for several hours. Particularly if she had not yet birthed her placenta.

The reason for this is simple: oxytocin is needed to birth the placenta and to keep the uterus in good shape once it has done so, but synthetic oxytocin (as found in the drip used to induce or accelerate labour) inhibits the woman’s ability to produce her own natural oxytocin.

Symphonies and mountain climbing

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.

I have a lot of faith in a woman’s ability to release appropriate amounts of her own oxytocin if she is in natural labour. (If you are not already aware that oxytocin flows better if women are disturbed as little as possible, I would invite you to read up on this too. It’s not as easy to create an oxytocin-friendly environment in a hospital as it is at home, but it’s not impossible either). Women’s bodies are rather amazing and they do complex and powerful things to grow, birth and feed a baby.

Some people compare the hormones that are involved in labour to a musical symphony. They work together and in harmony, like a good orchestra. Over the course of the journey, a rhythm develops and builds to a crescendo. During the last bars of the ‘labour’ movement of this symphony, pulses of oxytocin help the placenta to separate and birth. Then, the now empty uterus can begin to return to its non-pregnant size. That reduction in size helps reduce bleeding from the placental site.

Yet this only happens if labour begins and progresses physiologically (naturally).

When labour is induced, synthetic oxytocin is often given. And the presence of synthetic oxytocin inhibits the woman’s ability to produce her own oxytocin. Under these conditions, we can’t expect a woman to suddenly be able to produce enough natural oxytocin to facilitate the birth of the placenta AND the vital postnatal clamping down of her uterus from a standstill. That would be like parachuting someone out of a helicopter to a point halfway up Mount Everest and then expecting them to be able to sprint straight to the top. No chance to warm up or get used to the freezing cold, oxygen-depleted air.

Worse still, what if our imaginary mountain runner had been given unlimited oxygen and a nice big chunk of dark chocolate every ten minutes from when they woke up that morning until they piled out of the helicopter? Then, the supply of both is suddenly taken away just as they start to run. What odds would you give them on reaching the top now?

The problem with synthetic oxytocin

I know. It’s not a perfect analogy, but it is important to recognize that induction of labour entails a serious amount of intervention. And that the consequences of synthetic oxytocin are significant. Synthetic oxytocin may be comprised of the same molecule that we produce in our bodies, but there is a crucial difference. When we produce oxytocin in our own bodies, “it is released into the brain, as well as into the circulation. Oxytocin released into the brain induces beneficial adaptive effects during birth and postpartum” (Uvnäs-Moberg et al 2019). The oxytocin that we make in our own bodies is hugely beneficial. It reduces stress and anxiety and gives us a sense of wellbeing. Pain is lowered, mother-baby interaction increases and the stage is perfectly set for breastfeeding. Natural oxytocin confers many other benefits too. One of the greatest risks of synthetic oxytocin – and thus of induction of labour – is that it takes all of those benefits away.

Induction as a package deal

So synthetic oxytocin interferes with the physiology and symphony of labour, and it has other potential side effects, such as causing the uterus to contract too much. This can cause a lot of pain for the woman. It can also have detrimental effects on the baby and, in some cases, these can be serious. It is for this reason that induction of labour might be best thought of as a ‘package deal’. Yes, there are some choices which can be made along the way. But some of the core elements of induction (including repeated vaginal examinations, ongoing fetal monitoring and medical management of elements of labour, such as the birth of the placenta) are an intrinsic and, sorry, fairly necessary part of that package. Even to those of us who spend our lives stretching the fabric and journeying the boundaries. It is not that we’ve stopped trusting women’s bodies. We absolutely trust the physiology of minimally-disturbed labour. But the drugs used to induce labour are potent substances which interfere with the ability of women’s bodies to ‘do their thing’ and which have side effects. Therefore, where labour is artificially induced, the effects of these drugs need to be monitored and sometimes compensated for.

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.

I really empathise with those women who feel they have no choice about having an induction but wish they did. I have lots of resources on my website that I hope will help you get full information before making your decision. It’s important that anyone offered induction of labour understands the rationale behind the package nature of the deal. This is not always explained well.

Perhaps my experience isn’t the norm, but I am asked this question so often that I am concerned that the differences between spontaneous and induced labour are not well enough understood. With more and more women having their labours induced, I would say this needs to be rectified.

If women don’t understand the differences well enough, then how on earth can their choices be informed ones?