To continue the theme from my last newsletter, stimulated by Helen’s question
Do I need my labour to be induced?
This a huge topic and could take up several newsletters!
Your EDD (estimated due date) has probably been in your mind since your first ante-natal check-up. It can be very disappointing and frustrating to find that you are still pregnant a week or more beyond this date. Added to the normal discomforts of the final weeks of pregnancy, you may well feel very fed up and desperate for labour to start, especially if the hospital is talking about booking a date to induce labour and everyone is asking you if baby is born yet! This can be a very vulnerable time.
In fact, you may not be genuinely ‘overdue’ at all, and unless there is a medical problem, or other valid reason, emotional or physical, that you or your baby may be at risk, you can take your time to assess the situation and consider the options.
Here is a great quote from Dr Sara Wickham:
“Bodies, babies and pregnancy lengths vary. In reality we exhibit individual variation, and there is a wide span of time in which babies can be born and be healthy.
In other words, normal is a range and not just one fixed point. One size hardly ever fits all
From her latest book, In your own time: How western medicine controls the start of labour and why this needs to stop. (A must read with all the research – get it on Amazon)
Many hospitals have a policy of routinely inducing after a certain date. Sometimes induction of labour is strongly recommended between 41-42 weeks as this has been shown by some research to reduce the overall (very small) number of babies who die in childbirth in the UK.
There are many who have not been convinced by this argument. Marjory Tew, the renowned statistician, said in her book ‘Safer Childbirth?’: ‘Confirmation is hard to find that induction reduces the danger of perinatal death’.
There are many doctors and midwives who are critical of routine induction policies and who prefer to follow a different approach. This involves assessing each woman who is ‘overdue’ individually and then deciding what would be best for her and her baby. The aim is to determine whether the pregnancy is normal (albeit longer than the estimated average length), or whether there are any genuine signs of post maturity such as slowing of the baby’s heart rate or a very low amniotic fluid level, or other factors which may give genuine cause for concern or possible intervention.
You also need to bear in mind that ethnicity can make a difference to the length of pregnancy. Research shows that women of black or Asian origin can have slightly shorter pregnancies.
Genuine post maturity can endanger the baby, so a thorough assessment will provide the information needed when deciding whether to induce or not. An induction would only be performed if the risk of the baby remaining in the uterus was considered greater than those associated with inducing. Sometimes, if the baby is thought to be at risk, a caesarean section may be the preferable option.
The decision-making process should always involve the parents and take their views into account. Legally you are not obliged to agree to an induction, and often it is routine hospital policy recommended to everyone.
However, if there are convincing signs of post maturity, if there is an existing or previous medical or health problem or if you are having twins, where the risks of prolonged pregnancy are greater, it is best to follow the advice of your midwife or obstetrician.
Other reasons to induce may include:
- Progressive high blood pressure or pre- eclampsia
- Convincing indications of placental insufficiency and slow growth of the baby,
- Significantly reduced amniotic fluid which is outside of the normal range.
- Premature rupture of membranes with an extended period of no contractions (beyond 48 hours).
- ‘Failure to progress’ in labour (in this case induction is called augmentation or acceleration of a labour which has already started). In this case an ‘in labour’ Caesarean section may be a preferred option as accelerating the labour can lead to further complications and then an emergency Caesarean.
So, there is a lot to weigh up and consider.
The first thing to do is to rule out any medical indications to induce such as the above. If there is a good medical indication, then your decision is easy – go for it – and I will be guiding you in a future newsletter how to make the most of a medically induced birth. In the absence of any convincing reason, then you need to weigh up advice and your own feelings and trust yourself to make the right decision. It may seem confusing, but unless the need to induce is unequivocal, there will come a point where you have a strong feeling about what to do.
With my best wishes,
Active Birth is designed for mothers who wish to give birth naturally and have had a healthy pregnancy and no medical complications during labour and birth. Aspects of an Active Birth can also sometimes be used in combination with medical interventions. The website and newsletters offer general information only. They are not a substitute for the professional advice, diagnosis or treatment offered by your midwives or doctors. The Active Birth Centre/ Janet Balaskas in general, accept no liability for the guidance herein, and advise that you do not disregard professional medical advice and inform yourself with other trusted evidence-based sources of information when making your decisions.