I’ve had three ‘overdue’ and ‘big’ babies. I’ve been told on each one that I’m ‘measuring over’. I’ve been sent for a ‘sizing scan’ in the last few weeks of pregnancy. I’ve had to say ‘no thank you’ to the offer of induction on all three. In the end they were all born without medical intervention... and they weren’t that big at all.
In my course of work, I see more and more women who are being induced, or at least coming under pressure to have their pregnancy induced.
There are medical situations that make induction the best and safest option for women and their babies; conditions like preeclampsia or foetal distress for example, can require emergency induction.
There are also times where induction is medically unnecessary. You should inform and educate yourself and discuss your case, in depth, with your care provider. Also don’t be afraid of asking for another medical opinion. Make informed decisions – it is
your choice.
So what is induction and how is it carried out?
The WHO define induction of labour as ‘the initiation of labour by artificial means prior to its spontaneous onset at a viable gestational age, with the aim of achieving vaginal delivery in a pregnant woman with intact membranes.’
In other words, it's an artificial manipulation of the labour process to bring on labour before the woman’s body (or possibly the baby) is ready.
Amazingly, we still don’t know exactly what it is that makes labour begin. It's a combination of events. You can eat all the curry in the world (as I did) but it's probably not going to make that much of a difference.
Firstly, let's look at due dates. These are guess dates for the majority of us, unless you know exactly when you ovulated and when implantation took place. In medical terms, a
pregnancy is only ‘overdue’ or ‘post dates’ after 42 weeks so bear that in mind!
The
WHO recommend that induction is only considered when the pregnancy is 40 weeks plus seven days or more. And they say that unless you are certain of your dates, that's not a reliable guide. The WHO also recommends that induction should not be carried out prior to 41 weeks in an uncomplicated pregnancy. This, includes women with gestational diabetes – as long as it's the only complication.
Depending on your circumstances, the induction of your labour can include one or some of these methods:
- A sweep of the membranes
- ARM (artificial rupture of membranes) or ‘breaking the waters artificially’
- Prostaglandin Gel
- Syntocinon Drip
All of the above methods can be effective, or not. It is not uncommon for one to ‘fail’ and be followed by another and possibly another. Also it's not uncommon, if the woman and baby are ready, for one to be all it takes to ‘get things going’. The problem is, you don’t know until it happens.
Why would I want to avoid induction?
If there’s a medical emergency, obviously you just need to get baby out as swiftly as possible, so your caregiver should make it clear to you that it is medically necessary and why.
If it is not an emergency situation, consenting to having your labour induced is always your choice.
I have been ‘overdue’ three times by over a week. I totally understand how hard it is, how frustrated you can feel, how tired and fed-up of pregnancy you can be, how anxious you are. Induction might sound like a great option, especially when your consultant says something like ‘would you like to have your baby today?’.
But know that, for the majority of women, induction makes labour much more intense and much harder. Here are some of the reasons why:
You have to be in hospital
You’re admitted into hospital not in labour. You’re now a ‘patient’. You’re probably in a ‘pre-labour ward’ with 10 other women who want to be in the labour and are not, 10 anxious partners, 20 phones.... you get the picture! And you could be there for a day or two before you’re in labour.
There’ll be lots of ‘traffic’ up there
They’ll have to have a look and see if anything is happening, then they might insert a finger to sweep the membranes, then they’ll have to put up a hook to break the waters. Then they’ll check if you’re dilating at all. Then they might put a prostaglandin gel up there. Then they’ll check again... This does not do much for the labouring woman’s ‘mojo’ or sense of empowerment.
Induction can make contractions more intense and more painful
ARM, Prostaglandin gel and syntocinin can make contractions more intense and more painful. Most women will require pain relief when they’ve been induced in the form of an epidural. This can slow down labour and greatly increases the need for assisted delivery with forceps or vacuum.
So, what are the alternatives?
Wait, trust your body and your baby, and go into labour naturally
Even though you are completely fed up and so OVER being pregnant, if there’s no medical reasons to induce, this is definitely the easier option for you and baby. Relax and trust the process. They all come out eventually.
Get jiggy with it!
This could be the best news he’s heard all week (or all nine months!). Semen contains prostaglandin - the same ingredient as ‘the gel’. This, coupled with the release of endorphins and oxytocin you get from sex can be all you need to get going.
Do it for the team!
Full HSE recommendations on labour induction are available here.
Emily McElarney is Hypnobirthing practitioner and pre-natal and post-natal yoga teacher, naturalbirth.ie or on Facebook.
