In the 10 years from 2006/07-2016/17 the rate of induction in the UK has increased from 20.3% to 29.4% [NHS Maternity] This means that almost 1 in 3 families are experiencing induction and even more than that will have been offered induction and declined. It is becoming almost assumed within our society that once you get to a certain point in pregnancy the medical establishment wont let you go any further and will induce your labour. However did you know that it is your choice? That it is an offer of induction not a compulsory action? That there are other options? This post is about collecting together different resources and discussions about induction and the choices a birthing person may have to make so that you can become informed and make the right decision for you. I will likely add to it as more things become available and any new researched is published. This not about telling you what decision to make, this is about information and evidence.
NICE guidelines surrounding Induction of labour are quite clear and can be found at www.nice.org.uk/guidance/cg70/chapter/1-Guidance#information-and-decision-making
When talking about induction for being "overdue" this is what it says-
" 126.96.36.199Women with uncomplicated pregnancies should be given every opportunity to go into spontaneous labour.
188.8.131.52Women with uncomplicated pregnancies should usually be offered induction of labour between 41+0and 42+0 weeks to avoid the risks of prolonged pregnancy. The exact timing should take into account the woman's preferences and local circumstances.
184.108.40.206If a woman chooses not to have induction of labour, her decision should be respected. Healthcare professionals should discuss the woman's care with her from then on.
220.127.116.11From 42 weeks, women who decline induction of labour should be offered increased antenatal monitoring consisting of at least twice‑weekly cardiotocography and ultrasound estimation of maximum amniotic pool depth."
Another relatively common reason that seems to be given for induction is suspected big baby based on scans or fundal measurement. The NICE guidelines say this-
"18.104.22.168In the absence of any other indications, induction of labour should not be carried out simply because a healthcare professional suspects a baby is large for gestational age (macrosomic)."
Now NICE guidelines are really helpful for clearly setting out what is advised however they are based on various strengths of evidence and are based on what is advised for the population as a whole not based on individual circumstances. So how do you make the best decision for you based on your circumstances?
Below are some blog posts and books that can support you to understanding the choices and the evidence when making your decision.
Firstly Dr Sara Wickham, she has published so much information on induction and really is a one stop shop for everything you need to know.
She has a book called Inducing labour: making informed decisons avaiable here
Dr Wickham also has a great website which is full of evidence and information on many many topics.
One of her great induction blogs can be found here
You may be offered a stretch and sweep as part of a process that is sold as reducing your chance of induction. Read about what this procedure involves and the evidence behind it here
Assessing risks is an important part of decision making and how we communicate that risk makes a huge difference. Sometimes you will here things like "Your risk of X has doubled" or "The risk of Y has significantly increased" relative and absolute risk are different things and it is important the people understand the actual risks and how they relate to their decisions. Dr Sara Wickham has another book that is great for explaining this. It is available here
If you consent to an induction there is a process. The usual order of things go like this, stretch and sweep, ripening the cervix with prostaglandins, artificially breaking your waters, artificial Oxytocin drip to stimulate contractions. You may not need everything on this list, sometimes labour i encouraged to start after one or two steps sometimes you get to the end of this list and may not be in active labour.
Artificial oxytocin comes with its own risks and you can read more about that here
There are so many things to take into account when making your decision and each person situation will be different with different things to consider. There is no right or wrong decision as long as you feel informed, respected and listened to.
Its always worth starting to read and research things during the later weeks of your pregnancy so that if the situation arises you already have some information to call on.
If you have any worries at all please discuss with your midwife or medical care provider. Don't be afraid to ask them for the NICE guidelines and evidence that supports the advice they are giving.
If you are looking for some support during this time I can offer birth doula services and/or antenatal workshops to help explore your options. Check out my services page for all the details or get in touch to discuss your needs.
There is also Cornwall's branch of the Positive brith movement which run free meetings around the county to spread positivity around birth and non judgemental peer to peer support. Check it out here