6 Things You Need To Know Before Induction Of Labor

Whether you choose to have your labour induced or not is a HUGE decision and one that needs to be made with up to date and relevant information that works for you as an individual.

My biggest worry with many hospitals who are offering or at times coercing women into induction is that there is a one size fits all policy at play. This is less and less about the individual, you, and more and more about how that hospital likes to do things.

So, here are 6 things that I would like you to know before you sign on the dotted line:

1.  There Are Many Strong Opinions About Induction Of Labour.

Whatever you hear and whoever says it, some women will be very, very glad that they chose to have their labour induced. However, some women will regret that decision for the rest of their lives. Our feelings are complicated. There is no doubt that there are some humans walking around on this earth today because they were born sooner, there is also no denying the awful rates of birth trauma that have emerged in line with induction rates. You will hear a variety of different thoughts, feelings and opinions on induction but the one that matters the most is your own, so don't be afraid to walk a path that works best for you. Just because your friend, Aunt, work colleague or random person online chose induction - doesn’t mean that it will be the best choice for you or that you have to.

2  Spontaneous Labour And Induced Labour Are NOT The Same.

They feel absolutely different and they will behave differently from each other too. 

Induced labour may take a while to get started, depending upon the type of induction chosen, but once it gets started it will drop you much further into labour than if it were unfolding physiologically.

This can be really surprising and hard to deal with. This sudden jump into labour however doesn’t mean that you are further along in your labour and that you have less time to go… it just means that it becomes very intense very quickly.

So if you were expecting that physiological slow start to labour, opening and unfolding over days or hours then this won’t be it.

Induced labour can be mechanical or hormonal. Mechanical inductions would be a stretch and sweep, artificially breaking your waters, a foley bulb or dilapan rods, hormonal options would be prostaglandin gel or synthetic oxytocin. Once this process has started you are now on a different birth path. These choices cannot now be undone or rewound and they will come with their own restrictions such as potentially having to birth in the obstetric unit as opposed to with midwives, your birth partner not being allowed to stay with you until you are in active labour and continuous foetal monitoring, so now being stuck on the bed attached to the monitors.

As synthetic hormones do not cross the blood brain barrier  they will not trigger the release of endorphins that occurs normally during a physiological labour. This means that induced birth will be more painful. Does this mean that it is undoable? No, but if you at least understand that it will be more painful and intense then you can prepare for that more ably. It is sometimes the shock of the intensity and pain of Induction which can make it such a poor experience for so many women and it really grates on me that women are not advised of this when offered induction.

3. Induction Doesn’t Always Work

And it can take days to get going.

It is not a given that induction will actually work for you. As the midwife Mary Cronk stated, ‘labour, with all its different factors, like hormones and muscles and so on, is like a synchronised swimming team. It all works really beautifully together.

But induction of labour?

That’s like chucking one of the swimmers in the pool and just hoping the rest will jump in and know what to do’.

If induction does fail it is the induction that fails and not the birthing mother or her baby.

There are many times that trying induction of labour is a good option, pre-eclampsia for example, however we do know that it can lead to a higher chance of caesarean and that just because it is offered doesn’t mean that it will necessarily work. 

4. Induction is NOT risk free

For many women who are offered induction of labour they are told of the risks of not doing this but very rarely of the risks of induction itself.

Every choice you make in pregnancy and birth comes with an imaginary set of scales. What are the pros and what are the cons. 

Now we know in life that most things we choose come with positives and negatives and working through those can make us feel more confident in our choices and also more aware and capable should our choices not work out.

It does women a huge disservice to pretend that terminating a pregnancy earlier than it would have spontaneously come to an end is completely risk free. There are risks on each induction option and these need to be examined carefully. These may range from rupturing your amniotic sac during a stretch and sweep, to over stimulating your uterus and causing your baby distress during synthetic oxytocin. Some of these risks can then go on to cause more problems. Now, it’s not that everyone should avoid induction - it certainly has a good purpose, but if we know of the risks we are far more prepared to work with and around them should we need to.

5. You Do Not HAVE To Be Induced. It Is Not The Law

Induction of labour is a tool to try to get your labour started. It is optional. Your care provider needs to give you valid, up to date and individualised information before you can make a decision on whether you would like to follow this path.

It may be the hospital protocol to offer this to you. It is NOT however the law. You can choose yes or you can choose no.

If you choose not to be induced you have a right to further monitoring and support while you await your labour to start.

You can also change your mind either way if you want to. So, you can say yes to induction and then change your mind and cancel or you can say no to an induction and then change your mind and book in. 

Induction is optional, for whatever reason it has been offered to you. 

6. Where Can You Get Up To Date and Helpful Information About Induction?

I recommend 4 books and will also link you to three websites below this video in the text.

Book One: Inducing Labour - Making Informed Decisions by Dr Sara Wickham. This book covers the pros and cons of waiting for birth to start or being induced. It examines when it is better to induce and when it is better to wait. Sara also looks at the evidence and arguments surrounding due dates, bigger babies, Older maternal age. IVF and when your waters have broken pre labour. This book is evidence rich and really clearly written, it’s my absolute go to.

Book Two is the follow up to this book, again written by Dr Sara Wickham. In Your Own Time: How Western Medicine Controls The Start Of Labour And Why This Needs To Stop. This book is really examining how on earth we are now where we are.. Where over a third of all pregnant women are having their labours medically induced and why this trend is continuing to grow at an alarming rate. In this book she covers the advantages of waiting for spontaneous labour and teases apart why women are not getting to birth in their own way. With chapters such as ‘Does My Baby Look Big In This’ and ‘Too Old, Too Fat, Too Black, Too Risky?’ Sara takes you on a journey of why standard, fixed point expectations should not be over ruling individualised care.

I’d order these two together.

My third book is Rachel Reed’s ‘Why Induction Matters’. This little book is choc full of evidence based information and explains in detail the induction process and the reasons why you may be offered it. This book is great also if you are choosing induction as it contains a chapter on creating a birth plan for a medical induction which you will find enormously helpful. It is also a great go-to book if you are having to move swiftly as clearly it’s not a huge tome to work through!

My last book may feel more relevant for those of you in the UK as it has been written by the Association for the Improvements in the Maternity Services, AIMS, which is a UK based birth charity. The AIMS Guide To Induction Of Labour. If you are quite a visual learner (like me!) you will find the graphics, layout, highlighted sections and chapter round ups in this book really helpful. Again, like the other books the content in this book is to help you decide whether to have your labour induced. So there are plenty of facts and figures as well as support in preparing for induction. It’ll show you where the evidence is strong and where it is very weak and gives you plenty of discussion material for your meetings with your obstetrician or midwife. 

All of these books include comments and thoughts from women who have chosen induction and who have refused induction and their thoughts and feelings on the matter.

So there you have it. 6 things that I want you to know before induction of labour. Before you even have to have a conversation about induction of labour! And if you read this blog and buy the books and THEN go into spontaneous labour before you need ANY of this info please just pass it on to the next mum.  You don’t know what you don’t know. Induction is a BIG subject currently changing the face of maternity services - it really does need discussing.