Induction of labour is one of those things you start to hear a lot about when you are pregnant. The issues around it are complex and unfortunately the detail and nuances often get lost. As with most things in pregnancy and birth there are no simple answers. So how do you know? Is induction right for you?
TRIGGER WARNING: stillbirth risk discussion
Ultimately there are two reasons for suggesting induction of labour – either that it is thought that baby needs to be born or because the parent now wants pregnancy to be over. This post concerns whether or not you should agree to induction. I will in future posts explore the experience of induction. and the different methods.
Many people start to feel fed up with being pregnant in the last weeks. The physical challenges of carrying the big bump around; the difficulty of getting comfy in bed & consequent lack of quality sleep; needing to pee all the time – it isn’t surprising that some people ask what can be done to hurry baby up. Sometimes there are social reasons, or concern that a previous baby came very quickly and so being concerned about being “caught out”. In these situations you need balanced information about the risks and benefits – do the benefits of baby being born now outweigh the risks of an otherwise unnecessary medical procedure. The risks apply to both you and your baby.
One of the risks is that baby may not be ready to deal with the responsibility of living as an independent person in the big outside world. We don’t yet fully understand what triggers spontaneous labour, but we do know that babies’ maturity varies. The majority of babies born after about 37 weeks cope very well with the challenges, but not all. If a baby was on a path to be mature and ready between 41 and 42 weeks but we induce labour and they are born they may be under-ripe and find the transition challenging. Hence the image of the pears. We are trying to guess when they will be perfectly ripe (but without being able to see and feel them).
Given our uncertainty about when an individual baby is ripe and ready to be born, it can be confusing and concerning if a midwife or doctor suggests induction of labour. How can you know is induction of labour right for you? Why is it being suggested?
There are a number of reasons why induction may be suggested by a midwife or doctor. There may be a specific concern about the parent which cannot be addressed or resolved until the baby is born. Sometimes a baby will be known to have an issue which will need treatment or specialist care after birth and so there is a drive to manage the time of birth to ensure that the optimal care is available. These are specific reason in which it can be judged that the potential risks are justified. Even so, just because something is advised does not mean that you have to accept it.
Much more commonly, induction is suggested because you have reached your due date or some other specific date. The ultimate driver for this advice is because we know that some babies will tragically be stillborn. If your healthcare provider is making this recommendation for this reason, please try to understand that they are driven by wanting to avoid anyone facing such an awful situation. The recommendation is not about making things easier for the organisation. It may however be simply following a guideline rather than providing individualised care. Unfortunately statistics are not very helpful in making a decision because however small the risk , if it happens to you it is a life changing tragedy. The main purpose of sharing statistics about this I feel is to make people aware that it is a real (though small) possibility. There are many factors which influence the risk of stillbirth. There are some assessments we (and you) can make to assess baby’s health and wellbeing in late pregnancy.
Some babies will be stillborn after 39 or 40, or 41 weeks, but there is no good evidence that I know of to say that was simply because of their gestational age that those babies died. Babies die at other stages of pregnancy too. Thankfully stillbirth is rare, but it does happen. The argument often offered is that once a baby reaches 37 weeks it is “term” and so can probably cope with being born. If every baby was born by 40 weeks there could obviously be no “post dates” stillbirths. However, most babies born after that time are well and healthy – but is there a chance that we might cause problems if we force them to be born earlier than they are ready? This is the complex balance we have to make. The national guidance for NICE can be found here. If the date is the sole reason for induction being suggested, I suggest you seek more information before making your decision. Florence Wilcock gives some interesting food for thought in a recent episode of The Obs Pod.
Sometimes it is valuable to use the BRAINS acronym – ask the healthcare professional to explain: what are the Benefits of induction for me, what would the Risks be, are there Alternatives we can consider; check what your Instinct is telling you (the healthcare worker is already sharing theirs), what would be the consequence of me saying No? The wonderful Sara Wickham adds an S to make BRAINS. S is for “excuSe me while I have a think about this”! A word of caution though – make sure that whoever you talk this through with actually understands the specific situation for you and your baby. There are many people who appear to be very fixed in their view that induction is always inappropriate/ unnecessary and/or bad If you want to access more detailed information about risk factors and personalising risk factors you may want to read Sara’s book In Your Own Time.
Hopefully from the information here you will understand that the reason may be a very good one, or it may simply be a general expectation by your provider that is a “one size fits all” recommendation. My approach is that as an adult and as the parent of this baby, you have the ultimate say when deciding is induction of labour right for you. Remember the pears. If you buy a pear with a “best before date” does that mean you don’t make your own decision? We all accept that not every pear will be perfectly ripe at the same time. There are many influences such as the type of pear, the environment it has been in, as well as how much it has been prodded about that can affect optimal ripening. Some will be perfect before the “due date”, others benefit from a bit longer to ripen. We are trying to predict the perfect point between not ready and overripe. Science doesn’t yet have an accurate predictor tool for either pears or babies. In order to make the decision that is best for you you need information and the opportunity to weigh that up. I support informed choice in all situations. If you would like the opportunity to discuss your specific situation I offer an extended consultation (lasting around 2 hours) in your home. This costs £165 Contact me now if you want to know more.