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Induction - Is it right for me?

Induction is a hefty topic and many people have very strong views about induction of labour and whether or not it’s right for them. As with everything here at Grow+Gather, we always aim to provide honest, evidence-based information so that you could make up your own mind about various aspects of the pregnancy, birth and parenthood journey. So let’s have a look at induction; what it means, what the research shows and what your options are.


Why does it matter?

During our antenatal classes we spend a good deal of time talking about inductions and the process involved in being induced. The reason we do this is because more and more women are being offered an induction of labour. In a recent study looking at induction rates in 2021, hospital trusts in the UK reported an induction rate of 35% with some trusts having rates over 40% (Harkness et al, 2021). If the process is becoming more common and if it is more likely that you might be offered an induction, it is so important that you have good quality information to base your decisions.

What does induction mean?

In a nutshell, induction means getting your body into labour artificially. So rather than waiting for spontaneous contractions and your waters going on your own, this process is started for you either by a sweep, mechanically or through medication. You might be offered a sweep around your due date (more on this in the next post!). If your cervix is closed and it’s difficult to do a sweep then you may end up with a pessary (sort of like a tampon) that releases hormones to start labour or if your cervix has opened a little then a cervical ripening balloon may be inserted. It’s worth noting that different hospitals may have different processes for induction, so what happened to your pal down in Bristol may not be the same in Edinburgh. It’s also a really variable process depending on how ready you are to have a baby. The purpose of both the balloon and/or pessary is to soften the cervix enough that the waters around baby can be artificially ruptured. This might lead to contractions or…it might not! If not, then a hormone drip would be started. This medication is given through a small plastic pipe which is inserted into a vein. And then you would be monitored quite closely whilst we wait for baby.


Why might I be offered an induction of labour?

There are a whole host of reasons as to why you would be offered an induction. Perhaps you have a medical condition or there is a worry about your baby’s growth, maybe your blood pressure has gone up. You could also be offered an induction because of your BMI or your age or if you conceived via IVF. Most commonly though, it is offered because you have gone past your due date. And many, many first time mothers go over their due date, afterall ‘women aren’t machines’ (Wickham, 2021, p37). The research about due dates is pretty interesting and it’s definitely worth delving a little deeper into the history of due dates and where they come from.


Most likely you would be offered an induction around 7-10 days over your due date and the rationale for this is because of a concern about stillbirths. Which sounds pretty scary. Sometimes the language used around this can be quite frightening and sometimes, a little coercive so if you are told there is a risk about something, ask for the actual numbers. In regard to stillbirth rates for ‘low risk’ pregnancies see the box below.

39 weeks

0.14/1000

1 in 7142

40 weeks

0.33/1000

1 in 3030

41 weeks

0.80/1000

1 in 1250

42 weeks

0.88/1000

1 in 1136


What are the pros?

Well if there are concerns about the growth of your baby or the way that the placenta is functioning then an induction can be a big pro. There may be real medical need to get labour started with an induction. Or you may have also gotten to the point in your pregnancy where you are exhausted and uncomfortable and ready to meet your baby. That’s fine too. An induction doesn’t have to be a negative experience and you can ensure the environment is as oxytocin-producing as possible! There are plenty of really good reasons to opt for an induction.


What are the cons?

When we talk about induction in antenatal classes I don’t think people realise quite how long an induction can be. It can take a long time to get your body into labour, particularly if it wasn’t ready to do so for several more days or weeks. I worry that when people say yes to induction, the expectation is that the hospital have some magic pill that makes babies appear in record time! Oh for that to be true! Having looked after women being induced, it seems to me that it can also be a very intense process. Often it goes from zero to really full on without that slow build up of early labour during the latent phase. This can be quite overwhelming. We also know that during labour your body produces a wonderful amount of endorphins that help you to deal with the intensity of contractions but when you’re being induced that obviously isn’t happening.


Can I decline an induction?

As with everything within pregnancy and birth - ultimately it’s your body and your baby. If you do decide that induction isn’t right for you, then you should be offered monitoring in the following days. You can of course change your mind should you then want to be induced. It’s worth also mentioning that if you decline induction and then go into labour at 42 weeks or beyond, you may not be ‘allowed’ to use the birth centre. Although you can obviously continue with a homebirth if that’s what you are planning.

How else can I prepare?

Speak with your midwife about inductions - ask questions, look at the documents that the hospital provides. Use your BRAIN - what are the benefits of both being induced and not being induced? What are the risks? There is a fantastic booked called ‘In Your Own Time’ by Sarah Wickham which I would strongly recommend. Evidence Based Birth is a great resource and has lots of info about induction. Many women will be offered an induction for various reasons. I would urge you to find out more information about inductions, ask questions and talk any concerns through with your midwife. Trust your instinct. Make the decision that feels right for you and your baby, only you know what that is.


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