You have been offered a medical induction at your last antenatal appointment, it may even have been very strongly suggested. Now you have a million questions. What IS the deal with induction? Should you or should you not? Or do you have to?
There are a number of reasons why you might be offered an induction
If you go past your estimated due date (post-dates)
If your waters have broken and spontaneous labour has not started within 24-48 hours
If you are over 35 years of age and are expecting your first baby (advanced maternal age)
If you have been diagnosed with gestational diabetes
If a big baby is suspected
Other medical reasons like infection, pre-eclampsia etc.
Your own request
(Click on the links to Evidence Based Birth® for further up to date information and stats on these topics)
Before deciding whether or not a medical induction is the right decision for you and your family, take a pen and paper and think about what you want to ask so you won’t leave your appointment with unanswered questions. Here are just some of the things you can discuss with your consultant:
Find out what your Bishop’s Score is. The Bishop’s Score entails a vaginal exam where your cervix is assessed. It takes into account cervical position, dilation, effacement (thinning) and ripeness (softening) as well as baby’s station in your pelvis. After the assessment, you are given a score which gives an indication of how likely you are to go into labour without induction. If your score is above 6, an induction is likely to be successful.
What is your hospital’s protocol for induction? You can also ask about the protocol for eating, monitoring and vaginal exams when being induced.
Which medication will be used for your induction (gel, AROM (artificial rupture of membranes or breaking your waters, Syntocinon (synthetic oxytocin from a drip)?
One of the risks of induction with Syntocinon is hyperstimulation of the uterus (defined as contraction frequency being more than five in 10 minutes or contractions exceeding 2 minutes in duration) which can lead to decreased oxytocin flow, a decrease in oxygen saturation and changes in your baby’s heart rate. A question to ask here is if there are precautions in place and how is hyperstimulation managed, if it occurs.
Of course, as with any procedure, there are risks.
The most important thing, when you are deciding whether or not to accept the offer of induction, is that you are given ALL the information. The benefits as well as the risks and the absolute risk (the actual risk of something happening to you or baby) if you chose to wait for labour to start spontaneously.
Although all health care providers are supposed to offer information in an unbiased and clearly understandable way, not all conversations feel supportive and empowering. It is important to realise that every pregnant person has the right to make their own decisions, it is their body and their birth. Always be sure to ask your health care provider to give you all of this information, only then are you able to make an informed decision and give informed consent!
A small study conducted in the US in 2016 found that
Among women of advanced maternal age, induction of labor at 39 weeks of gestation, as compared with expectant management, had no significant effect on the rate of cesarean section and no adverse short-term effects on maternal or neonatal outcomes.
While a much larger study conducted in Australia in 2012 found that inducing labour in pregnant women when it's not medically necessary is more likely to result in complications at birth.
What these studies have not taken into account are important factors like the impact on a mother’s mental health when her birth preferences have not been met, the family’s values and whether the experience left them happy and satisfied with the care they received or traumatised.
While all these statistics and evidence are helpful in aiding decisions, the interpretation of risk is highly subjective. For one woman, the thought of a failed induction and subsequent caesarean birth (including all the risks that go with it) are much less scary than the thought of labour and birth. For another woman, a caesarean birth could be her idea of hell! In the end, the choice is yours. You will likely be faced with other people’s (often strong) opinions on the matter so find out what feels right for YOU.
What we do know for certain is that if women feel in control of their choices, respected and listened to in pregnancy, labour and birth, they are far more likely to feel that they are having a positive experience. Birth trauma is a reality for many women, let’s do what we can to minimise it!
Opting for an induction can mean having to let go of your Plan A - but that does not mean you have abandon having a positive birth experience! Induction can absolutely be positive and there are many aspects of it that you can be in control of. Choosing the right support for you and getting into a positive mind set are critical aspects for having a beautiful birthing experience.
Is induction more painful than natural labour?
In order for your body to go into labour spontaneously, oxytocin has to be released in the body which will then stimulate contractions in the uterus. When being induced, synthetic hormones are used to achieve cervical ripening and dilation and uterine contractions.
Natural oxytocin is released gradually by your body in an interval pattern, like waves, so the uterus builds up contractions in both intensity and frequency, usually over a number of hours. This avoids continuous contractions or very strong contractions from the start of your labour. During an induction, large amounts of synthetic oxytocin, given to you via IV drip, can be necessary to start contractions that are effective and to keep them going. As induction normally happens before your body and your baby are ready, if the amount of synthetic oxytocin given is too small are decreased, contractions stop. That means your uterus goes practically from 0 to 100 in a short space of time, producing contractions that are longer, stronger and more intense from the start than natural contractions would start out as.
When labour begins spontaneously, the oxytocin released causes a cascade of reactions in the body that result in your brain getting the message to release endorphins, a sort of natural pain relieve that is 10 times stronger than morphine. Synthetic oxytocin does not have the same effect on the body. It does not cross the blood-brain-barrier and therefore your brain does not receive the instruction to release endorphins which is often perceived as painful. As a result, women who are induced are more likely to request an epidural or other pain relief.
A good way to prepare yourself is to discuss your Birth Preferences. Think about what is important for you at every stage of the induction process and make sure to discuss your points with your consultant and midwife. Knowing your options goes a very long way in helping you feel confident and in control of your birth.
If you decide that you wish to avail of the offer of induction, here is a list of essentials to bring with you:
A copy (or a few copies!) or your Birth Preferences to give to midwives and your consultant
Snacks for both you and your partner. You need your strength for labour. You wouldn’t dream of running a marathon without having breakfast!
Water bottle and coconut water to keep your electrolytes up and keep you well hydrated
Your phone, headphones or speakers (don’t forget the charger!), essential oils to put on a tissue/pillow, birth affirmation cards, peanut ball etc.
Book/tablet/ebook reader or other things to keep you occupied
Whatever else makes you feel safe and at home