Let's Talk About; Induction of Labour

At some point during pregnancy it’s likely that someone will mention the word ‘induction’. The latest maternity statistics (2020-21) suggest that over a third (34%) of birthing people have their labours induced. Bear in mind that the data behind the statistic doesn’t include any ‘stretch and sweep’ or ‘membrane sweep’ procedures. These are not considered an induction by the NHS so they are not included. As a result, the number of labours which begin with some sort of induction or intervention is likely to be much higher indeed.

I’d be so bold as to suggest that if I were to ask, there would be a large number of women who could do a pretty good job of explaining what an induction of labour is - regardless of whether or not they have been pregnant or given birth before. They may even be able to tell you more about why inductions happen and what’s involved in the process. Induction of labour appears to be something that is so much a normal part of birth and birthing in the UK that the conversations about induction extend far beyond the boundaries of the consultation room and into popular culture.

WHAT IS AN INDUCTION?

The term ‘induction’ refers to an attempt to bring about a labour and birth which hasn’t yet begun. It’s a simple concept but an induction and the decision making that surrounds it is often not so simple. Now you know what it means, let’s look at why inductions are offered, what the different types are, what the process can involve and how induction may impact your birth experience.

WHY IS IT BEING OFFERED TO ME?

There are a number of reasons why you may be offered an induction of labour. The reasons range from being ‘beyond dates’ to a genuine medical emergency which means your baby needs to be born very quickly. Some of the most common reasons for suggesting an induction include:

• Being considered ‘overdue’ or concern that you will become ‘overdue’.
• Where your waters have broken but contractions and labour have not yet begun.
• Where infection is present or suspected
• High blood pressure.
• Diabetes.

Any other medical condition or situation where you or your baby are considered to be ‘at risk’ by your care team.

For all of the above, your care team should offer you information and support as to the evidence base to aid your decision making about whether or not you wish to accept the offer of the induction.

SO, HOW'S IT DONE?

There are a number of ways in which labour can be induced. As with all interventions and procedures they all come with their own benefits and risks. These should always be discussed with your care provider. It can however pay to do your own research. This may help you feel prepared to talk with your team so you consider what is being offered to you. Your informed consent should always be obtained before any intervention or procedure happens. Being informed is a key part of being able to give consent.

In a nutshell here are the different type of Induction:

A stretch and sweep - A vaginal exam where a midwife or Dr will insert a finger around or inside the cervix in an attempt to stimulate contractions.

• Synthetic prostaglandin gel/ pessary - The insertion of pharmacological prostaglandins to ripen (soften) the cervix.

• Catheters and Laminaria tents - These devices are inserted into the vagina and encourage the cervix to open physically rather than using pharmacological methods of cervical ripening (as above)

• Membrane rupture - Performed during a vaginal exam this procedure involves the breaking of the sack of waters using an amnihook (a long, flattened hook). This can help bring on contractions.

• Oxytocin drip - A synthetic form of the hormone oxytocin is delivered to the mother via IV drip to induce and sustain contractions.

Note: not all inductions include all of the above. You may be offered only one of these and that may result in your labour beginning. Alternatively, the induction attempt may not bring on labour so another method may be offered to you.

All of these procedures have their own benefits and risks to consider and weigh up as part of your decision making. Unfortunately, we don’t have the space to weigh up all the benefits and risks of each procedure here. So let’s save that for another post. These interventions will also have their own impact on the journey of birth and the experience for the mother. Perhaps it’s this last part, the experience of induced labours and births which prompts the most conversation between women and birthing people. Because it’s not just what happens that matters but also how it feels.

EXPERIENCE MATTERS

It follows perhaps that birth which is started artificially (for whatever reason) may be a different experience to a labour and birth which are spontaneous and undisturbed. Yet, in much of the conversations around induction of labour with all the ‘whats’ and ‘whys’ there is often little discussion of how it may feel. My personal opinion is that it can pay to put this factor higher up on the list of concerns when weighing up your options and making decisions.

Some things you may wish to consider when looking at an induced labour and birth:

There’s no real way of telling ahead of time what an induction will feel like or how it will unfold. Even if you have been induced before every birth it unique

An induction can work really fast. Or it can take a long period of time. Again, until you’re there it’s difficult to tell. Fast labours can be intense and overwhelming. Slower labours can be mentally demanding and exhausting.

A speedy induction and progression of labour can be intense. With contractions coming fast and being intensely felt. This can take some women by surprise and can make coping strategies and comfort techniques challenging.

With some forms of induction there will be some additional measures put in place to monitor your progress and the way in which you and your baby are coping. The drugs used in induction are powerful and require effective monitoring for safety. This includes continuous or regular monitoring which can restrict or reduce your ability to be mobile during labour.

Some of the drugs used in an induction also have the effect of limiting or blocking the production of the birthing person’s natural hormones, namely oxytocin. This can have a domino effect on the other hormones present during a physiological labour and birth and these can also extend beyond the birth itself into the early postnatal period.

IS THERE ANYTHING I CAN DO?

Many women will have an induction of labour each year. For some, induction will be an active choice. For others it’s a medical necessity. But for many more they may feel it’s something which they simply ‘end up’ with. (In fact, in my experience, it’s common to hear the word ‘induction’ in the list of things that pregnant and birthing people are ‘hoping to avoid’). It’s in this space of “it happened to me but I didn’t want it or feel prepared for it” where dissatisfaction is most likely to reside.

If an induction does form part of your experience there are lots of things which may help you feel prepared. Preparation can make a difference in how you experience an induction and how you feel before, during and after your birth.

Part of my role as a doula is exploring the possibilities of birth with you. Induction of labour is one of those possibilities. It can be helpful to explore ahead of time what your understanding, perceptions, beliefs, and fears may be. In doing so, we can get to understand what support you may wish for, what tools you can use and how your partner(s) can offer comfort and support.

Induction as a topic can be divisive. There exist a range of strongly held beliefs and it’s likely that you’ll come across one or more of these at various points in your pregnancy (maybe even before!). You may well have some ideas about it yourself. Asking these questions and considering how you can support yourself in feeling prepared for induction should it become something you choose or it’s something that you feel you need to do.

A FINAL WORD...

It’s true that induction of labour is an intervention and all interventions require your explicit and informed consent. You may encounter others who simply say, “Well they can’t do it without your consent - so it's simple, just say no.” Saying “No” to any and all aspects of your care which are offered to you remains your absolute right. But for me, this knowledge in itself can feel like a statement which serves to add to the layers of complexity rather than offering clarity. Simply knowing that you have a legal right to say no to something doesn’t always provide you with the sense of being able to.

We birth in context. We are impacted by the things which we carry with us - in both obvious and in more subtle ways. We take our whole selves into birth. The way we feel, our concerns, hopes and fears. These things can (and often do) impact our experience of birth. Having space to explore what you’re taking into birth can aid understanding and help to establish what feels safe for you. As a doula I am not here to make decisions about your care or advocate for you. I will not tell you whether or not I think you should opt for an induction or avoid it at all costs. Instead, I see one of my most important roles as supporting self advocacy by making space for you to explore and tap into what you feel and what is deeply held. In this way I can support you in your birth, however it unfolds, to help you feel your birth is safe, dignified and fulfilling.

Much love

Becca

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