An induction can be life saving when performed for medical reasons, and the benefits then outweigh the risks.
Because artificially induced contractions are often stronger than normal ones, they are more likely to result in foetal distress and cause you to request pain relief.
Unfortunately the current rates of induction in Australia show that most inductions are not for medical reasons.
An induction of labour involves starting a women’s labour before it starts naturally. It is performed in three ways:
- artificial rupture of the membranes (ARM),
- the use of prostaglandin gel applied to the cervix,
- or the use of oxytocin in an intravenous drip; all of these are used to bring on contractions.
If you are induced you could be hooked up to an IV depending on the kind of induction and at the request of most obstetricians you will also be attached to a continual foetal monitor for the duration of your labour. If this is the case you will not be able to use movement, a shower or bath to help manage the severity of induced labour. This has shown to skyrocket a request for an epidural, increase the chance of foetal distress and double your chance of a caesarean.
The research shows that only those mothers and babies that really need induction for good medical reasons actually benefit from being induced. Those that do not need it, often suffer from being induced.
In 2006, 25% of Australian women had their labours induced, the most commonly reported reason being prolonged pregnancy.
[Induction] enables doctors to practice daylight obstetrics. It means that as a doctor, I can come in at 9 a.m., give you the pill, and by 6 p.m. I’ve delivered a baby and am home having dinner. — Dr. Marsden Wagner, a neonatologist who served for 15 years as a director of women’s and children’s health in industrialised countries for the World Health Organisation.
27.46% Private Hospital Induction rates (NSW)
23.21% Public Hospital Induction rates(NSW)
(Source: NSW Mothers & Babies Report 2009)
Check your local hospital induction rates here in our Birth Services Revealed.
Medical reasons for induction:
- Baby’s size (watch this one!)
- Placenta dysfunction
- Bleeding in late pregnancy
- Cholestasis of Pregnancy
- Heart conditions
- High blood pressure
- Over 42 weeks
It is quite normal for a pregnancy to last longer than 40 weeks. Many care providers will routinely induce women at 41 weeks. For most women, long pregnancies are safer and healthier than labor inductions- which carry far greater risks in and of themselves. Visit the Ten Month Mama page for more details.
- For serious medical conditions, induction can be life saving
- You and your care provider can schedule your labour.
- Restricted Movement – Non Active Birth
- Continual Foetal Monitoring
- More Intense labour
- More request for pain relief
- Increase in use of epidural
- Time pressures
- Huge increase in your chance of an caesarean
- Above average blood loss after birth
- May not be allowed to use bath or shower
- Strong uterus contractions may cause foetal distress
- ARM, can cause cord prolapse, bleeding and infection
- Nausea, vomiting or diarrhoea
Inductions rates in Australia are more than double and sometime triple of those recommended by the World Health Organisation, which states induction shouldn’t be above 10%. It interesting to note that some caregivers rates vary from 1% – 5% and others from 30% – 50%, showing that maybe it is not the health of the women and baby that is taken into consideration but that of the schedule of the care provider.
- What are the benefits?
- What are the risks?
- Are there any alternatives?
- Does this need to be done now?
- Can we have some time/privacy to make a decision?
“With some private obstetricians taking on more than 50 women per month, it’s only common sense that for them to manage these numbers, a lot of inductions are scheduled – always question the reason you are given for an induction!”
“Don’t be seduced by the induce!”
Tips to avoid labour induction
- Recognise that, according to almost all experts, a normal pregnancy lasts between 38 and 42 weeks. In your mind, add two weeks to your due date in case your pregnancy lasts 42 weeks.
- Understand that many researchers believe that it’s the baby that starts labour. Studies suggest that once the baby is fully mature and ready for life outside the womb, he releases a substance that tells the mother’s body to start the process of labour. In most cases, the best way to know that your baby is ready to be born is to wait for labour to begin on its own.
- Choose a care provider who induces labour only for medical reasons.
- Don’t be induced without a medical reason. Be aware that a large baby is not a medical reason for induction.According to experts, including the American College of Obstetricians and Gynecologists, induction for suspected large babies does not improve outcomes for babies and almost doubles the risk of a cesarean for mothers.
- Stay active and exercise at least 30 minutes most days at a moderate pace. Research indicates that healthy women who exercise regularly throughout pregnancy are less likely to need to be induced or have their labour speeded up.
- Stay well-nourished and drink plenty of fluids. If there’s a concern with the baby being overdue, tests (such as a biophysical profile and amniotic fluid index) may be scheduled to evaluate the baby. Several studies have found links between maternal dehydration and poor results on these. If you are scheduled for these tests, be sure to drink plenty of liquids and eat well in the days before the tests.
- If your water breaks before labour begins, ask your care provider to allow you time to go into labour on your own. Most women begin labour soon after their water breaks, and 90% will be in labour within 2 days of their water breaking. There’s no need to rush labor unless you or your baby are in danger or there are signs of infection. Follow your care provider’s advice for reducing the possibility of infection and ask him or her to do vaginal exams only when medically necessary.
- If labour induction is planned for non-emergency medical reasons or because you are getting close to 42 weeks, discuss alternative ways of inducing labour with your health care provider. To start labor, research suggests the use of acupuncture, nipple stimulation, and “sweeping the membranes,” a procedure in which the care provider uses her fingers gently to separate the bag of waters from the cervix during an internal exam. Many have suggested the use of sexual intercourse or castor oil to help labor begin, but these methods haven’t been studied in high quality research.
(Edited version from www.daraluznetwork.com)
Alternatives – Natural Methods
- Nipple stimulation
- Acupuncture. See the evidence for acupuncture being a good alternative to consider before consenting to medical or surgical induction.
- Stripping the membranes
- Relaxation and Visual Imagery
Ways to stop the Cascade of Intervention if you are induced
- Negotiate intermittent monitoring
- Minimise internal vaginal examinations to give yourself time to progress
- Use natural ways to cope with the labour
My doctor told me that I needed to be induced 10 days before my due date because my baby was going to be too big… I couldn’t handle the intensity of the contractions caused from the induction so I requested an epidural and then needed the assistance of forceps to get my baby out. I ended up with an episiotomy, blood in my urine and bad bruising to my beautiful baby’s face. My baby was only 8lbs but my doctor made me feel better by telling me that if she had been in their any longer he would have been over cooked resulting in me needing a caesarean. – (Sarah)
My blood pressure kept going up and down so I had to visit the hospital each day to get it checked. One of the doctors that I saw secluded me in for an induction on the Monday morning stating “Why wait you are due anyway, it will save you time in having to keep come in”. They broke my waters, strapped me to the EFM and made this enormous fuss every time I tried to move to handle the contractions. I ended up requesting an epidural which they were all very happy about as it made it easier to get a good reading from the EFM as I was now lying still on the bed. I couldn’t feel anything so when they told me that it was time to push not much happened and I couldn’t push the baby out. They decided to take me down to theatre for a caesarean but thankfully my doula talked them in to trying an assisted delivery before they cut me open. I was able to have a vaginal delivery with the help of forceps. — (Lindy)
“It was an ‘aha’ moment for me,” recalls Dr. Bryan Oshiro of his visit to a Utah intensive care nursery several years ago, where neonatologists pointed to babies there simply because they’d been induced too soon…..Most were being induced in week 37, such a small difference that local obstetricians argued it wasn’t a problem. So Oshiro pulled the medical charts and found those near-term babies had more than double the risk of ending up in neonatal ICU, suffering respiratory distress, even needing a ventilator.
The situation [induction] is analogous to holding an infant under the surface of the water, allowing the infant to come to the surface to gasp for air, but not to breathe. — (Doris Haire)
At 6am the obstetrician who started his shift came into my room with great urgency yelling at the midwives. He asked for an update on my status and without any explanation he proceeded to try to break my waters. A glimpse of a long sterile object I managed to see before it was thrust upon me. After a few minutes of excruciating pain I said “what the hell are you doing”. His reply was a grunt and he then got up and yelled something at the midwife. Read more.
Firstly, when they broke my waters they said we could go for a little walk – so we went outside and Robyn suggested I do some laps of the oval.. No seriously! So I was walking around the oval with Mark while Robyn, my mum and my sister relaxed on the grass! It was while I was walking that my labour started. Secondly, Robyn asked the head Obstetrician, and older Doctor who obviously had a lot of respect for Robyn, if we could have the monitors on for 20 minutes and off for 20 minutes which he agreed to. This gave me the freedom to move around and I found them extremely uncomfortable on my belly. Read more.
Check your local hospital induction rates here in Birth Services Revealed.