Updated: January 2024
In Australia 34% of labours are induced (41.3% of first time mothers). When I first wrote this blog post in 2016 the most common reason for induction was to prevent a ‘prolonged’ pregnancy. Today the most common reason is ‘diabetes’ (see this post for more on that topic). Another change is that the timing of an induction to prevent a ‘prolonged’ pregnancy has shifted so that in some cases women are offered induction before they reach 40 weeks gestation. I am not going to get stuck into the concept of ‘due dates’ or rather ‘guess dates’ here – I discuss estimating birth dates in my book. This post will focus on induction of labour to avoid going past a particular gestation and the complexities of risk in this situation.
A quick word about risk
I don’t particularly like the concept of ‘risk’ in birth. There are all kinds of problems associated with providing care based on risk rather than on individual women’s needs and preferences. However, risk along with ‘due dates’ is here to stay, and women usually want to know about risks. Risk is a very personal concept and different women will consider different risks to be significant to them. Everything we do in life involves risk. So when considering whether to do X or Y there is no ‘risk free’ option. All women can do is choose the option with the risks they are most willing to take. However, in order to make a decision women need adequate information about the risks involved in each option. If a health care provider fails to provide adequate information they could be faced with legal action. Induction for gestational age is not right or wrong if the choice is made by a woman who has an understanding of all the options and associated risks.
What is a prolonged pregnancy?
Before we go any further lets get some definitions clear:
- Term: a ‘normal’ and healthy gestation period is between 37 weeks and 42 weeks.
- Post-dates: the pregnancy has continued beyond the decided due (guess) date ie. is over 40 weeks.
- Post-term: the pregnancy has continued beyond term ie. 42+ weeks.
The World Health Organization’s definition of a ‘prolonged pregnancy’ is one that has continued beyond 42 weeks ie. is post-term. However, induction is usually offered when a pregnancy becomes post-dates or even before, with the aim of preventing it becoming ‘prolonged’. Therefore, very few women experience a prolonged pregnancy – in Australia only 0.5% of pregnancies continue beyond 42 weeks.
The idea of a prolonged pregnancy assumes that all women naturally gestate their babies for the same length of time. However, it seems that genetic differences may influence what is a ‘normal’ gestation time for a particular woman. For example, Morken, Melve and Skjaerven (2011) found “a familial factor related to recurrence of prolonged pregnancy across generations and both mother and father seem to contribute.” Therefore, if the women in your family gestate for 42 weeks so might you. The length of gestation may also be influenced by factors such as diet (McAlpine et al. 2016).
It is also important to consider that it is the baby who initiates the changes their mother’s body needed for labour to work and sends a hormonal message that starts labour (Mendelson 2009). The baby chooses their birth date. Lots of important changes occur before labour starts that prepare the woman and baby for birth, breastfeeding and bonding.
The risks associated with waiting for spontaneous labour
Ageing placenta?
Some people believe that the placenta has a best before date and starts to deteriorate after 40 weeks resulting in reduced nutrition and oxygen for the baby. There is evidence that the structure and biochemistry of the placenta changes as pregnancy develops. Some scientists interpret these changes as the placenta growing and adapting to meet the changing needs of the baby: “There is, in fact, no logical reason for believing that the placenta, which is a fetal organ, should age while the other fetal organs do not…” Others argue that these changes are due to the ageing and deterioration of the placenta. However, tests of placental function show no changes in post-dates pregnancies (Madruzzato et al. 2010). In practice, I have seen signs of placental shut down (ie. calcification) in placentas at 37 weeks and I have seen big juicy healthy placentas at 43 weeks.
Big baby
People also have concerns that the baby will grow huge and therefore be difficult to birth. There is evidence that babies continue to grow bigger the longer they gestate, and this contradicts the above theory about the ageing placenta. If the placenta stops functioning, how does the baby continue to grow so well? Big babies are pretty good at finding their way out of their mothers expandable pelvis. The research about complications relating to big babies suggests that it is the interventions carried out when a baby is assumed to be big – rather than the actual size of the baby – that mostly contributes to complications (Sadeh-Mestechkin et al. 2008; Blackwell et al. 2009; Peleg et al. 2015).
Meconium liquor
There is an increased chance that the baby will pass meconium as his/her bowels mature. I have written about this scenario in another post.
Perinatal death
The general rate of perinatal death (stillbirth + newborn death) increases as pregnancies advance beyond term. The rate remains small but is statistically significant. For example a systematic review and meta-analysis (Muglu et al. 2019) reported that: “The overall gestation-week-specific prospective risk of stillbirth steadily increased with gestational age, from 0.11 per 1,000 pregnancies at 37 weeks to 3.18 per 1,000 at 42 weeks gestation… The risks of newborn death remained constant between 38 and 41 weeks, and only increased beyond 41 weeks” .
Post-dates induction of labour reduces the general rate of perinatal death. A Cochrane Review summarises the research examining induction vs waiting: “There were fewer baby deaths when a labour induction policy was implemented after 41 completed weeks or later.” However, it goes on to say: “…such deaths were rare with either policy…the absolute risk is extremely small. Women should be appropriately counselled on both the relative and absolute risks.” Hands up all the women who had a discussion with their care provider about the relative and absolute risks of waiting vs induction…
Essentially, according to the available research, if you are induced at 41 weeks your baby is less likely to die during, or soon after birth. However, the chance of your baby dying is small either way – less than 1%… or 30 out of every 10,000 for those waiting vs 3:10,000 for those induced. This research article reports the relative and absolute risk of stillbirth at various gestations with waiting vs induction. The authors state that 1476 women would need to have an induction to prevent 1 stillbirth at 41 weeks gestation.
Reviews are only as good as the research they review and there are some concerns about the quality of the available research. The World Health Organization recommends induction after 41 weeks based on the Cochrane Review above but acknowledges the evidence is “low-quality evidence. Weak recommendation”. Another review of the literature in the Journal of Perinatal Medicine (Mandruzzato et al. 2010) concluded: “It is not possible to give a specific gestational age at which an otherwise uncomplicated pregnancy should be induced.”
One of the main problems with quantitative research is that it rarely answers the question ‘why’, and rather focuses on ‘what’ (happens). For example, congenital abnormalities of the baby and placenta are associated with post-term pregnancy and this may account for the increased risk in some cases, rather than the length of gestation (Mandruzzato et al. 2010). Quantitative research also takes a general perspective rather than addressing the risk for an individual woman in a particular situation. For example, is the prolonged pregnancy as sign of pathology, or does this woman come from a family of women who have a longer gestational timeframe? For a woman who has previously gestated to post-term without complications, there is no increased chance of an adverse outcome (Kortekaas et al. 2015).
The risks associated with induction
It can be difficult to untangle and isolate the risks involved with induction because usually more than one risk factor is occurring at once (eg. syntocinon, CTG, epidural). In addition, there are differences in outcomes and risks between women who have previously laboured, and women having their first baby. It is important for women to consider their own individual factors and how they alter their individual risk profile. Care providers should also share individualised information when discussing induction options.
General risks associated with the induction procedure and medications
The induction process is a fairly invasive procedure which usually involves some or all of the following (you can read more about the process of induction here). There are a number of minor side effects associated with these medications/procedures (eg. nausea, discomfort etc.) There are also more significant risks:
- Prostaglandins (prostin E2 or cervidil) to ripen the cervix: hyperstimulation resulting in fetal distress and c-section.
- Rupturing the membranes: fetal distress and c-section (see previous post)
- IV syntocinon / pitocin: Mother – rupture of uterus; post partum haemorrhage; water intoxication leading to convulsions, coma and/or death; reduced breastfeeding rates; increased postpartum depression/anxiety. Baby – hypoxic brain damage; neonatal jaundice; neonatal retinal haemorrhage; death. There is also research suggesting that there may be a link between the use of syntocinon/pitocin for induction and ADHD (Gregory et al. 2013; Kurth & Haussmann 2011). For mothers syntocinon/pitocin is associated with reduced breastfeeding and increased depression and anxiety at 2 months postpartum (Gu et al. 2015).
The most extreme of these risks are rare, but fetal distress and c-section are fairly common. The potential effects of uterine hyperstimulation on the baby are well known (Simpson & James 2008), which is why continuous fetal monitoring is recommended during induction. This may also explain the association between induction and cerebral palsy (Elkamil et al. 2010)
Induced contractions are usually more painful than a physiological contractions. Syntocinon (pitocin) produces strong contractions without the gentle build up and endorphin release of natural contractions. The National Institute of Clinical Excellence (UK) state that health care professionals should discuss this with women when offering induction “recognising that women are likely to find induced labour more painful than spontaneous labour”.
Most research comparing induction with spontaneous labour combines populations of ‘experienced’ labourers with first timers. These studies report conflicting findings. For example, some studies report a lower chance of c-section with induction for this mixed group (Gülmezoglu et al. 2012; Mishanina et al. 2014; Wood et al. 2014). In contrast, more recent studies have found increased rates of c-section with induction (Zhao, Flatley, Kumar 2017; Ekéus & Lindgren 2016). A 2019 review compared the timing of induction for low risk pregnancies – 41 weeks vs 42 weeks (Rydahl, Eriksen & Juhl 2019). The review used stricter inclusion criteria than previous reviews to “enhance the methodological quality and increase the relevance for contemporary maternity care”; and reported that: “Induction at 41+0-6 gestational weeks compared to 42+0-6 gestational weeks was found to be associated with an increased risk of overall cesarean section.”
Some studies purport to find no difference in outcomes for women and babies undergoing induction at 39 weeks (Grobman et al. 2018; Hong et al. 2023). However, these studies did not compare induction at 39 weeks with spontaneous labour. Instead, they compared induction at 39 weeks with ‘expectant management’ which includes induction later than 39 weeks. These studies also found no improvement in outcomes for babies following induction at 39 weeks. However, as with most induction studies, they only looked at immediate outcomes ie. resuscitation, morbidity and mortality.
A large Australian study explored labour interventions and outcomes for women and children following induction of labour at term in uncomplicated pregnancies (Dahlen et al. 2020). This study looked at long term outcomes in addition to short term outcomes. This study found that an induced labour was associated with an increase in instrumental birth, c-section (first labours only), epidural, episiotomy, PPH, newborn trauma, newborn resuscitation, childhood respiratory disorders, childhood readmission to hospital for infections (up to 16 years).
Risks for women who have had a previous labour
Women who have laboured before respond more effectively to syntocinon (pitocin) because they have more oxytocin receptors in their uterine muscle. Therefore, this group of women are more likely to experience a successful induction and avoid c-section. They are the reason for lower or similar rates of c-section the mixed group research discussed above. However, they are at increased risk of hyperstimulation with prostaglandin medication and/or syntocinon. So doses are usually smaller and very carefully monitored to avoid fetal distress. Women who have given birth vaginally before, are also at increased risk of perineal tearing if they have syntocinon induced contractions.
Risks for women having their first labour induced
Inducing a first labour requires higher rates of syntocinon, and the length of labour is usually longer. It is not surprising that first time mothers are more than 3 x more likely to opt for an epidural during an induction (Selo-Ojeme et al. 2011); and epidural analgesia increases the chance of ending up with an instrumental birth – ventouse or forceps (Anim-Somuah et al. 2018)
The majority of research comparing induction (IOL) with spontaneous (SP) labour in populations of first time labourers report increased c-section rates:
- US: IOL = 35.9% vs SP = 18.9% (Kjerulff et al. 2017)
- UK: IOL = 39.5% vs 17.5% (Selo-Ojeme et al 2011)
- AUS: IOL = 26.5% vs SP = 12.5% (Davey & King 2016)
- AUS: IOL = 30% vs SP 24.6% (Butler et al. 2021)
Another US study (Ehrenthal et al. 2010) reported that after “adjusting for maternal demographic characteristics, medical risk, and pregnancy complications. The contribution of labor induction to cesarean delivery in this cohort was estimated to be approximately 20%.” This brings up interesting risk comparisons relating to c-section vs the risk of post-dates perinatal death (see above). For example, induction is recommended because there is a less than 0.3% chance of perinatal death in post-dates pregnancies (see above). However, the chance of a significant complication during c-section (eg. hysterectomy) is higher than the chance of perinatal death in a post-dates pregnancy; and after a c-section the chance of stillbirth during a subsequent pregnancy increases to 0.4% – again, a higher rate than a postdates pregnancy.
A recent study causing a stir is the ARRIVE RCT trial (US) which reported lower c-section rates in the induction group (18.6% vs 22.2%). This one study is now being used to justify recommending early induction at 39 weeks – primarily because the findings align with cultural norms and preferences (see this post re. implementation of research findings into practice). Whilst I don’t want to give this study unwarranted attention… it keeps popping up in conversations, workshops, and presentations. Like the perineal bundle – it is an unavoidable topic in the birth world. So here goes (briefly)… recommendations based on the trial are problematic in a number of ways. The findings and recommendations have been constructively critiqued by academics, midwives and obstetricians (Dekker 2018; Carmichael & Snowdon 2019; Davis-Tuck et al. 2018; Scialli 2019). In summary, the main points are:
- Only 27% of eligible women agreed to participate – Findings can only be applied to women who are willing to have a medically managed birth.
- 94% of the woman were cared for by private obstetricians in US medical settings – Findings cannot be applied to other types of care providers and settings which have much lower rates of c-section and higher rates of spontaneous vaginal birth.
- Care providers were not blinded – Knowing about the trial my have altered their practice.
- IOL reduced c-section rates by 4% – This cannot be used to recommend IOL to prevent c-section. Other factors have a much more significant effect on c-section rates eg. continuity of midwifery care; place of birth; intermittent auscultation in labour; etc.
- The primary outcome measure for this study was perinatal outcome (ie. the baby) – IOL made no difference to the immediate outcomes for the baby, and the study did not address the long-term harm of early birth for the baby (eg. brain development).
In relation to the primary outcome measure – perinatal outcomes. Another study (Selo-Ojeme et al 2011) found that outcomes for the baby were worse when a first labour was induced: “babies born to mothers who had an induction were significantly more likely to have an Apgar score of <5 at 5mins and an arterial cord pH of <7.0“.
The experience of induction
Research into induction tends to focus on physical outcomes rather than women’s emotional/psychological experiences of the process.
Choosing induction will totally alter the birth experience and the options open to you. Women need to know that agreeing to induction means agreeing to continuous monitoring and an IV drip, which will limit movement. Induced contractions are usually more painful than natural contractions and the inability to move and/or use warm water (shower or bath) reduces the ability to cope. The result is that an epidural may be needed. An induced birth is not a physiological birth and requires monitoring (vaginal exams) and time frames. Basically you have bought a ticket on the intervention rollercoaster. For many women this is fine and worth the risk, but I encounter too many women who are unprepared for the level of intervention required during an induction. This does not mean you have to hand over control of your decisions or your body; and in my book I include a chapter on creating a birth plan for induction of labour.
There have been some studies examining women’s experience of induction. A UK study by Henderson and Redshaw (2013) found that “women who were induced were generally less satisfied with aspects of their care and significantly less likely to have a normal delivery. In the qualitative analysis the main themes that emerged concerned delay, staff short- ages, neglect, pain and anxiety in relation to getting the induction started and once it was underway; and in relation to failed induction, the main themes were plans not being followed, wasted effort and pain, and feeling let down and disappointed.”. A German study (Schwarz et al. 2016) concluded that: “women’s expectations and needs regarding IOL are widely unmet in current clinical practice… and that “there is a need for evidence-based information and decisional support for pregnant women who need to decide how to proceed once term is reached.”
A recent systematic review (Coates et al. 2019) of qualitative research into women’s experiences of induction of labour concluded that induction “is a challenging experience for women, which can be understood in terms of the gap between women’s needs and the reality of their experience concerning information and decision-making, support, and environment. “
Alternatives to medical induction
Waiting for spontaneous labour
Around 90% of women who wait for spontaneous labour will give birth before 42 week, and only 1% will go beyond 43 weeks (Gülmezoglu et al. 2012). Most guidelines recommend additional monitoring of the baby – however no form of monitoring reduces the chance of complications (Gülmezoglu et al. 2012).
‘Natural’ induction?
There are a number of ‘alternative’ or ‘natural’ induction methods available (I have a chapter discussing the evidence for various methods in my book). However, trying to get the body/baby to do something it is not ready to do is still an intervention whether it is with medicine, herbs, therapies, techniques… or anything else. Interventions of any kind can have unwanted effects and consequences. Medical inductions take place with close monitoring of mother and baby and access to medical support if a complication arises. Alternative inductions do not have this level of monitoring or back up.
However, ‘interventions’ (massage, acupuncture, etc.) that are aimed at relaxing the mother and fostering trust, patience and acceptance may assist the body/baby to initiate labour if the physiological changes have already taken place.
Summary
A significant minority of babies will not be born by 41 weeks gestation. Whilst the definition of a prolonged pregnancy is 42 weeks+, induction is usually suggested during the 41st week. Women need to be given adequate information about the risks and benefits involved with either waiting or inducing in order to make the choice that is right for them. There is no risk free option. The risk of perinatal death is extremely small for both options. I know women who have lost a baby in the 41st week of pregnancy, and women who have lost a baby as a result of the induction process. For first time mothers the induction process poses particular risks for themselves and their babies. Each individual woman must decide which set of risks she is most willing to take – and be supported in her choice.
You can read more about induction in my book Why Induction Matters
Further resources
- Maternity Choices information sheet for parents
- NHS leaflet: Choices when pregnancy reaches 41 weeks
- News article: ‘I was pregnant for 10 months’
I’m really loving your blog. I’m so glad you decided to start one up. The way you present information is awesome and I love how you add in subtle touches of humor. I hope you find immense popularity!
Thanks – I’m pleased you like it.
Finally I get to read simething I have felt for years. My first child was 15 days over and I was induced it was the worse experience of my life I ended up with a c section after 4 hours of labour. After his birth I went on to have 4 more babies vbacs no tears or drugs all natural labours and delivery as I was determined never to have another c section. After 13 years gap I fell pregnant oops at 39 years old. Since I regustered all I have heard is high risk cause of your age are you sure you dont want a c section we need to monitor you more closely I have reached 41 weeks and now the pressure is on to induce im so fed up of hearing it. It gave me some hope that their are still professionals willing to give woman the chance to give birth in their own time without the extra anxiety and fear mongering
This blog is so helpful to me right now. I’m just over 40 and about to have my second child. I’m hoping for a VBAC but the consultant is already talking about induction at 40 weeks due to my age so I’m really trying to wrap my head around induction vs. CS (which I feel they’re keener on) vs. sticking to my guns and going VBAC at term plus however long it takes. I was put on the drip during the birth of my daughter and at no point were any of the risks or implications made clear to me. Re this pregnancy, I hate that they are throwing “statistical risk” numbers at me rather than having any useful info about my personal risk and are unable to offer support that focusses on prevention of possible problems.
Regina, I suspect I will be subject to similar pressures, even if I get them to agree to my plans. How did your birth pan out?
Hi ohh sorry to hear about the pressure you are under. Well I went 14 days over and refused the induction. In the last appoinment with the consultant we agreed a sweep amd she discovered the baby was breach. Again statistics that are not relavent to me exactly were thrown at us and unbelievable pressure to sign for a c section there and then we refused and decided we would like to try naturally other consultants were brought in but we stuck to our guns. I cant lie I was very scared hearing still born and other stuff but we decided breach delivery it is I went into labour naturally that night and after 6 hours delivered a healthy baby girl the next day the consultants were amazed. I had great midwifes a natural drug free breach delivery and went home after a few hours.
Congratulations Regina! 🙂
Great post! I was all set to fight with my provider about post-dates induction because I just knew that my daughter would be “late”, but she came right on her due date, much to my surprise. I wish that every pregnant woman would read this blog and really think about what it’s saying; they might have a very different birth experience than the majority of women do today.
Thanks. Some may find the information a little confronting but women need to consider the risks of induction before jumping in. I have spent too much time de-briefing women who ended up with the full induction ride but had no idea that it was a possibility. I have heard an obs describe induction as a ‘gentle’ pessary to help you into labour.
Hi, great blog, I just found you through a post on the UK midwives list. I am a US-based CNM (nurse midwife) and am really curious about the term “post-dates.” I graduated from school about 2.5 years ago and NEVER encountered this term while in school or in any of my written education materials. It is widely used where I practice, however, by both nurses and midwives, and is used exactly how you say: someone past the “due date” but not yet at 42 weeks (though some people seem to use it for 41 weeks or greater). I really don’t like this phrase, I actually thought that it was sort of made-up until I saw it here. I much prefer the WHO definitions–preterm, term, or postterm. (I do use “near term,” mostly in acknowledgment of the potential feeding problems in near term kids). Does anyone know where “post dates” comes from? I feel that it just saddles women with another negative label and am not sure how it is useful. The pregnancy is still term until 42 weeks! (Again leaving aside the problems with dating, a big issue in my current practice where many women present late for care with unsure or unknown LMP dates).
I don’t know where ‘due date’ came from. It is a symptom of our need to know and control that which is unknown and uncontrollable. In my own practice I write down EDD according to LMP and scan (if they have one). But I ask the mother to choose a ‘due date’ for documentation purposes whilst pointing out that the only person who really knows is the baby. I also watch the moon because most of the births I attend happen on or near a full moon (I keep stats).
34 years and more ago there were no calendars in Saudi Arabia the women used to tell me their babies would arrive between 9 full moons and 10 days. midwives are usually busy around the full moon thats a fact
So what qualifies as a good reason to induce?
That is up to the individual woman once she has the full information regarding the options and risks in her individual situation. For some they want inducation at 38 weeks, others will only agree if their baby is in significant danger ie. severe pre-eclampsia. The ‘good reason’ is up to the woman who is being induced.
I love this answer. When I first got interested in birth, I continually encountered this attitude that a woman must do her research and then she would inevitably chose The Right Way – because there was only one. It should be freeing and empowering to every woman that she can do research to chose the right way for herself and her baby, which may be very different from someone else’s right way. I love how you said that no choice is without risk so every woman must decide for herself which risks she wants to take. Such a great point, and surprisingly one that I rarely see in any discussion of birth.
Another great post! I have a question for you about calcification. When my daughter was born, on her EDD, I had calcification in(on?) my placenta. Had she waited and arrived at 42 Weeks or later, would that have made for an increased risk for perinatal death? Is it correct to assume that this may not happen this early with my next pregnancy, because every pregnancy, birth, and child is different?
Your daughter was born when she needed to be – who knows what would have happened if she waited until 42 weeks… because she didn’t. Every baby is different. My son was born at 40 weeks (41 according to my dates) and his placenta had no calicification. My daughter was born at 38 weeks and had a very calcified placenta and she was scrawny. She knew it was time to vacate and get some breastmilk. Your next baby will be born when he/she needs to be. Trust your body/baby : )
My bub was delivered by c/s. I had severe GD with polyhydramisis( not sure if this is the correct term, but tons of excess amniotic fluid). U/S showed decreased movement. Once she was born she needed to be in the special care nursery and was on NG feeds. She was not engaged hence the C/S rather than induction. So she didn’t know she needed to be born did she? It’s truly scary to hear you say that bubs know when to be born. Seriously poor advice.
This post is about induction for post dates (ie. prophlyactic) not about pathological complications such as yours. For your information I am attending an induction (in a private hospital) of a client next week for GD. And I don’t give advice. I think you are interpreting this post though the lens of your own experience. You had a complication, it was identified and your baby was delivered appropriately. You had not simply gone past a prescribed date.
You just said your baby was born at 38 weeks as it knew when she needed to be born. I would have thought a placenta calcified at 38wks would also be classified as a complication. Stop contradicting yourself.
Calcification of the placenta is fairly common epecially in smokers (which I’m not). It is not a complication just a sign that the placenta is beginning to reduce function as vessels ‘die’. It only becomes a complication if enonogh to compromise placental function severely… Which I have never seen (perhaps because the process initiates labour before this happens?). My daughter was a healthy baby born at home – 6lb 14 but not a lot of fat. If a placenta has reduced blood flow due to calcification it may not cope with an induced labour which makes greater demands on the placenta to provide oxygen.
I am not contradicting myself. I realize you had a complicated (and perhaps traumatic) experience and are therefore sensitised re. these issues. You want to hear that I am saying all babies should be born a particular way and that there are no complications or risks in birth. This is not me – this is who you want me to be to fit your agenda. Perhaps find out a little more about my work/philosophy?
No, I am not traumatized. Nor am I wanting to hear “that all babies should be born one way” as you suggest. I just think your belief that babies know when it’s time to be born is poor advice and not evidenced based.
Bloody excellent work Rachel, I am getting heaps out of the clear explanations and explorations of the post topics.
I started a job this week as a plain homebirth midwife (no VBACs, no twins, no breeches at term) – just as you described last year. Its a wonderful and complete change. I am already focussing on self-care and preservation, and have witnessed my first birth – at home, in the pool, in the caul. 4.6kg. Delightful.
Please keep up the great work.
Thanks Laura. There is no such thing as a ‘plain’ midwife – and you certainly aren’t! Ha ha. I’m so pleased you are enjoying it. I know that it annoys hospital midwives (and I used to be one) – but you really get to learn about birth by attending homebirths.
Last year I was looking at the cdc stats on neonatal deaths. It did in fact show an increase of deaths for those over 42 weeks ,but this is what I found interesting: babies that were born smaller after 42 weeks were more likely to die than those that were born large. What I’m wondering here ,then ,is if iugr is playing a role in both the time the babies are born and the reason for the deaths. It was just a thought I had. Rachel
Hi Rachel
Thanks for that info. Very interesting. It would make sense that an IUGR baby has a compromised placental circulation. Also if the baby triggers labour perhaps some congenital abnormalities prevent this normal response = those babies are more likely to go post term? Hmmm. What were the figures for 41 weeks by the way? In the UK we were not ‘allowed’ to induce for post dates until Term + 13 days. It was considered that the risk of induction out-weighed the risk of post dates therefore we had to wait until post-term occurred ie. 42 weeks.
http://wonder.cdc.gov/controller/datarequest/D31
Here’s the site with the data set I was looking at…
Here’s just some interesting figures. At the weight of 3000-3499g…at 39 weeks the mortality rate is 1.9 ,at 40 weeks it’s 1.97 ,at 41 weeks it’s 1.91 ,at 42 weeks it’s 2.09(it goes down to 1.79 in the next highest weight group) ,at 43 weeks its 1.99(it again goes down to 1.81 at the next highest weight group) ,at 44 weeks its 1.78.
It appears the increase in deaths comes with the higher gestation and lower weights. That’s were the differences are showing up. Of course, this is just me looking at data, not research ,but I would love to see something done on this. I agree with your assessment of what might happen with an iugr baby.
Just another interesting thought on our birthing mentalities: as you can see from this data ,bigger babies do better for the most part no matter what gestation ,so why do bigger babies scare the medical community. Also ,the total death rate for 38 weeks is 2.67(where I work, having a woman go into labor at 38 weeks is no big deal). This same death rate is not seen even up to 44 weeks….why is there the saying in the medical community that nothing good happens after 40 weeks, when the death rates are lower than at 38 weeks which seems to be no biggy(sorry just another tangent:)).
Thanks Rachel
The other thing to consider is whether some of the smaller babies were a twin? Small babies (true IUGR not just genetically small) are associated with mothers who are less healthy – poor nutrition, smokers etc. so again this could be a confounding variable
I did read some years back talk of inducing at 37 weeks to avoid the spike at 38 weeks. I am hoping that stupid idea was buried.
It was also to see in the data pregnancies up to 46 weeks!!! Either way the death rate is extremely small in any term group.
Just seen on a birth discussion board-
“I had to have a c-section because I went 42 weeks and didn’t go into labor”. Seriously. argh. her siggy announces that her babe had to be “evicted” at 42 weeks…
She probably believes that. I have heard of women being told that if they haven’t gone into labour by 42 weeks then their body is unable to labour and they need a c-section. I guess it’s a creative excuse for a c-section…
Perhaps you could clear something up for me, because I have done a lot of reading about this topic and there is something I am not clear on. If term gestation is 37 to 42 weeks, is everyone talking about 42 completed weeks? Like 42 wks and 6d? Or at the beginning of Week 42? Or is there even a consensus?
It is unclear but basically term pregnancy lasts up to 42 weeks. Once over 42 weeks and into the 43rd week it is considered ‘post-term’. Not many induction happen at or after 42 weeks. Usually they happen in the 41st week before the pregnancy reaches ‘post-term’.
Hope that makes sense.
great post! I would like to translate this into spanish… is that alla right to you?
thanks!
Of course – I would be honoured!
While I am agreement with the idea that postdates pregnancy can be safely managed, and generally try to avoid inductions, I cannot disagree more with the idea that every baby knows when it needs to come. In my opinion, this is nonscientific magical thinking nonsense, and has no place in medical advice. Many babies deliver at completely the wrong time. Some deliver quite premature, and some wait so long to deliver they die before they come. Did they know when to come? Individual anecdotes do not change the statistical knowledge that we have, or justify dangerous practice.
The reason postdates is a concern is exactly what you are saying – there is a risk of fetal demise. 1 in 200 is really a pretty high risk, and I’m pretty surprised you would minimize it (though honestly I think your numbers are high, 2/1000 is closer to correct from 42-43 weeks). But still, would you get on a plane that had a 1/200 risk of crashing? Is that actually a risk you are willing to rationally take?
Of course you would say no to this, but I suspect you would say yes to the continued pregnancy because you have an innate trust in pregnancy that makes you believe everything is going to be OK. As an obstetrician, I know that everything is not going to be OK if we wait for every baby to deliver. Some babies are going to die avoidably, and that is unacceptable.
Randomized trials have shown that routine induction at 41 weeks does not increase our cesarean delivery rate compared with expectant management, hence the typical practice pattern of induction at 41 weeks.
Another thing worth adding is that we can likely eliminate post dates fetal death through appropriate antepartum testing. As postdates fetal demise is almost certainly due to uteroplacental insufficiency (old placenta), we have a reasonable expectation that that fetal demise will be preceded by an abnormal fetal heart rate tracing. By employing fetal nonstress testing in women who prefer to await natural labor, we can likely identify those infants at greatest risk and recommend induction. However, if folks choose to await labor post dates without monitoring, they are taking the risk of a rare fetal demise that likely is avoidable.
In my opinion, your views of the dangers of induction are clouded by a pre-existing bias against the practice. The risks you list for pitocin are alarmist and completely unrealistic in real practice, as are those for the use of prostaglandins, which have been shown to be safe in induction in scores of studies.
I appreciate your blog and your passion, but cannot read your post without posting this information. Your readers deserve to have another view, and perhaps one that is a little more evidence based.
I appreciate your comments Nicholas but I think you have made a few assumptions about me. Of course I am aware that allowing nature to unfold can occasionally result in adverse outcomes. This is usually one of the main reasons women hire a midwife. We can identify deviations from the norm; carry resus equipment and oxytocics; have skills to manage emergencies; and have appropriate transfer plans. Modern medicine has saved many women and babies. I attend births expecting the best but prepared for the worst if necessary. But, I guess from experience I really do trust women and babies to get it right most of the time and I encourage women to trust themselves because empowered women birth better. To be fair, when I worked in the hospital setting I had far less trust of women because I witnessed them (although it was us) stuffing it up so regularly. So I do understand the lack of trust many have.
As for evidence… I have included links to the ‘gold standard’ Cochrane review and the risks of medications are directly from the manufacturers not made up by me. The dangers of pitocin are often underplayed. I worked with an obs who referred to it as ‘lethal’ in an attempt to get midwives to take the risks seriously and not to be so blasé about asking him to prescribe it.
I am sure you are aware that unless we fully disclose the risks of any procedure (regardless of how insignificant we consider them) we are liable for legal action. I am sick of counselling women who tell me ‘no one told me that if I was a induced…’
It is not our (mws and obs) risk to take, or not take as i have clearly stated – it is the woman’s. I have supported women who have chosen induction (and epidural before pitocin), and those who haven’t. All I ask from women is that they are fully informed and take responsibility for their birth choices. My job is not to make their decisions or judge their choices.
Some of us might get on a plane that had a 1/200 chance of crashing if we considered that staying in our current location was also dangerous.
Though I don’t have a thorough medical knowledge, however, what I have studied so far in this arena tempt me to agree with you on many accounts
Midwives have been dilivering for centurys and the country’s that have the best birth rate are the one who continue to use and respect midwives your mind set has a direct effect on your health and that has been proven, a laboring women is no different…. Are bodys are made to have baby’s
Thank you Nicholas for this post. I have 4 children, 2 inductions. At the start of my 3rd induction at 39 weeks we discovered my daughter was possibly in distress and delivered via c-section out of an abundance of caution. She had the umbilical cord wrapped around her body and neck and wouldn’t have been able to deliver naturally. If I had waited on her to decide it was time to arrive, she probably wouldn’t be here right now. I have 4 beautiful, healthy children and never suffered from induction.
Cochrane is nowhere near a gold standard. Meta analyses, of which Cochrane exclusively consists of, is a useful tool, but it has huge potential for bias in its construction. Many Cochrane analyses are deeply flawed, and often they make no conclusions at all, based on a lack of good data to work from.
There is no question that pitocin can be used in a dangerous manner, and in that sense you could consider it a lethal drug. The same could be said for just about any drug, as most drugs are dangerous if given improperly.
I agree with you completely that inductions have risks, and should not be undertaken without clear indication. Postdates is a reasonable indication, and in randomized trials doesn’t seem to increase the cesarean rate. That being said, this is randomized obstetrical care, and some midwives have expressed that they believe that they might have a lower cesarean rate had the expectant management group been randomized to midwife attendance in labor. Perhaps.
I think OBs and midwives often are working with very different populations of patients. I just came on as attending to a full labor and delivery, 75% of which is patients having inductions around 40 weeks or for questionable conditions like mild hypertension at 37 weeks. I don’t like it either.
I wrote ‘gold standard’ tongue in cheek. As I said in a previous post – meta analysis is only as good as the research reviewed. Research is usually flawed and always biased. Even the questions asked are biased and influenced by the researcher. Unfortunately, quantitative meta analysis of RCTs are considered to be the best available evidence and practice guidelines are written based on them.
I am a qualitative researcher and my bias is wanting to know about women’s experience of birth. I doubt my findings will find their way into practice.
Regarding indications for IOL – I actually think ‘woman’s request/choice’ is the only indication whether that is based on medical information eg. Postdates, pre-eclampsia, etc. or nothing at all.
There are many more adverse outcomes to induction than caesarean birth, even before we look at the flaws in the trials which appear to show that induction may not increase the CS rate.
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Hello
LOVE this blog and recommend it to all of my friends as I believe that you give the ‘other’ side of the story, from the side of baby and mother rather that the one-sided view that you seem to get thrust at you from hospitals, in my experience anyway.
Anyway, could I just ask a question? I had gestational diabetes with my son in 2008 and the hospital led me to believe that I needed to be induced at 38 weeks and refusing this would basically endanger my child. They told me the placenta would cease to be as effective and there was a strong possibility that my baby would grow too big to deliver naturally if left any longer.
This was my first child and I must say I never even thought about questioning their recommendations.
I was induced at 38 weeks and after two days and some very painful interventions and whilst strapped up to several IV lines including insulin, antibiotics and an epidural I gave birth to a 7lb 14oz boy. He wouldn’t feed, grunted on each breath and spent the next 2 days in NICU.
Looking back I fully realise that he simply was not ready to be born.
I am now pregnant again and may again have GD. Do you have any thoughts on whether babies born to mums with GD NEED to be induced at 38 weeks? From the research I have done in the last couple of months the evidence seems very thin and looks as though it may well be the hospitals covering their own back. I would so love to have a natural birth with minimal interventions at a time when my baby is ready but will the GD compromise this dream?
Would love to hear your thoughts
Carly
Hi Carly
I can’t comment on your individual situation and technically gestational diabetes is outside the scope of midwifery. Babies of gestational diabetics statistically are at more risk of morbidity and mortality. However, not much is know about the particular risks for particular factors ie. between insulin dependent and non-insulin dependent, well controlled, poorly controlled, etc. The individual woman and her situation needs to be considered rather than a blanket policy. The Cochrane review re. elective delivery is inconclusive (http://www2.cochrane.org/reviews/en/ab001997.html) about the benefits of induction whereas the NICE guideline recommends delivery after 38 weeks: http://guidance.nice.org.uk/CG63/NICEGuidance/pdf/English. Also check out Michel Odent’s perspective: http://rixarixa.blogspot.com/2008/01/michel-odent-on-gd.html.
It is about you weighing up the risks of your individual GD + ongoing pregnancy with the risks of induction and early delivery. Only you will know what is right for you and your baby – you don’t ‘NEED’ to be induced. It is one of your options but you choose your birth. Good luck and let me know how it goes.
You’re upset about being given insulin?!
question everything and dont b afraid by thinking your silly like me…my first 2 girls no problems.my 3rd a boy was induced due 2 gd they told me he was 2 big ha!ha! at 7/9 that was average.my last another boy they induced me at 38 weeks due to hbp i refused at 1st and they told me there could b complications if i didnt go ahead with it so i did .he definatley was not ready at 17mnts he still has health issues.i still feel like im in a nightmare thinking of the birth.so always question..best of luck
I am currently 3 weeks and 2 days overdue. I have been offered induction, and refused. This is my 10th baby, my 7th was also 4 weeks overdue, although I did not labour effectively and needed pitocin to regulate contractions. I am checking movement and having CTG tra ces done, but am healthy, have low BP, no swelling e.t.c.
I am hoping that labour will happen in the next week, but am a little anxious, as a friend went almost 6 weeks over and then had to be induced.
Wow – your friend went 6 weeks! Did the baby appear post-term? Did you have a ‘dating’ ultrasound in your pregnancy? I wonder if this was more common before we were able to ‘diagnose’ pregnancy so early and use u/s to predict due date. I would love to hear how/when this baby arrives. Good luck x
This was a vary informative blog, I enjoyed reading it. I am a young mom of 23 years old and I induce my first two children let my third one come on her own and am planning on letting my fourth do what ever she wants. I wanted to just comment that as a person who had two inducements with pitocin, they weren’t as hard on my body as letting my daughter choose her own time did. My daughters labor went really fast for me ( 4 hours compare to the previous 8 hours) and was really hard it was when I opted for a epidural. all three are healthy weights 8lbs 6 oz, 6lbs 8 oz, and 8lbs 8.2oz.
Great post! Thanks for the update. Women really need this information so they can make an informed choice. Health professionals need this information so that they are able to ensure women have an opportunity to choose in an informed way.
I thought that the definition of term was 37 completed weeks of gestation. It almost reads at the moment that it’s during the 37th week. What’s your take on that?
Term is ‘from 37 weeks to 42 weeks’. Not the 37th week as this would be ‘from 36 weeks’. Having said that most babies in their 37th week ie. 36+4 etc are perfectly fine on the outside. Maybe it is unclear in the post.
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Hi there
Both my children were ‘late’. The first at 41 weeks. The second at almost 42 weeks. With my second I had a great midwife who told me that hospital procedure required her to book the induction for 42 weeks, I advised her that I would not attend this appointment but would be happy to continue coming in for regular monitoring (every 2 days at that stage). Luckily he came along at 40+10 so I didn’t have to fight the system. With both pregancies I had a ‘stretch and sweep’ (with my second pregnancy I had THREE!) – how do you feel about those as a method of ‘induction’?
Hi Janet
Stretch and sweep can help to release prostaglandin and encourage labour to start IF the body is ready to respond. How do I feel about it? If a woman wants me to do it I will, but would want to explore why she wants to encourage her baby/body to do something that will happen anyway if left alone. Maybe there is a reason for the wait that we don’t understand. If we didn’t have due dates and expectations that babies arrive within precise timeframes there wouldn’t be such dramas over ‘late’ babies, nor the need to kick start labour. Doing a stretch and sweep is not my decision or choice – the cervix involved belongs to the woman and the decision is hers. I’m pleased you managed to have your babies within the prescribed time frame and avoid the hassle of ‘post-term’.
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hi, i am currently in my 41st week and am trying for an unassisted VBA2C at home. unassisted because the country that i live in does not support VBACs of any sort, and no no doctor, hospital or poly clinic is willing to give me a trial of labor.
my question to u is about the risks of going post date. my EDD was april 28th by earliest scan (at 8weeks) and april 14th by LMP (july 7th). if we assume i conceived 2weeks after my LMP, i am in my 41st week now. im hearing that going post date for a VBA2C can be highly dangerous. wat is the truth in that? do u think i should wait more or go ahead and schedule a c-section?
I don’t give advice only information. You must do what feels right for you. Going postdates is not highly dangerous. It does not increase your chance of uterine rupture. However, according to research being postdates reduces your chance of a vaginal birth – but the reasons are difficult to determine. You are still most likely to give birth vaginally without problems. I am hoping you are already in labour – or have your baby in your arms. It would be great if you could update us with your decisions and outcome. 🙂
thanx for this… since yesterday afternoon, ive been in pre-labor apparently (or watever term u guys use for it!) .. irregular contractions lasting close to a min, and some bloody mucus a couple of hours back. im in touch with a midwife in the US (u probably know her as she is the one who sent me ur links in the first place) and she is trying her best to monitor me from afar. i also have a doula who is abt an hours car ride away from me, and will come once active labor starts. i am really really hoping to have a vaginal birth this time around. will let u kno the outcome of this trial 🙂 thanx for responding. i find ur posts highly informative.
How exciting! Let us know when your little one is earthside 🙂 x
i had an unassisted home birth on may 3rd at 6:45am. it was really a very crazy experience! hubby caught our baby girl. alls well and we are both doing fine.
You have made may day! Congratulations you amazing birthing mama 🙂 Welcome earthside baby girl x
Thank you for your blog! I happened upon it last week and it is wonderful. I am a doula and childbirth educator, and spent some time as a homebirth midwife’s assistant, so I am nodding in agreement as I read along. 🙂
I am so happy to see your post about induction and “prolonged” pregnancy and to see birth beyond 42 weeks discussed as simply a variation of normal. It’s a topic I try to cover thoroughly and carefully in my classes because IOL at 41 weeks is definitely the norm around here. I will also admit that it’s my particular soapbox because my own babies came at 41 weeks + 6 days (induced in hospital), 41 weeks + 2 days, and 44 weeks (both homebirths).
If you don’t mind, here is a link to a short version of my 44 weeker’s birth story, in case any other mamas need encouragement as they wait for their little one to arrive!
http://www.theunnecesarean.com/birth-stories/taras-story-9-lbs-13-oz-home.html
Thanks Tara – I’ve added a link to your story in the post. It is important for women to hear/read positive birth stories from other mothers. 🙂
The link to “big babies” by Claire Hall is’nt working for me. Is there any other way for me to get to it? Thanks…btw great post 🙂
Hi Erica – I just checked and the site is no longer available 🙁
Thanks for letting me know. I will try and get around to writing a post about ‘big babies’ in the future.
I just came across this post and your blog generally and I think your analysis is very sharp and respectful of the complicated issues involved in pregnancy and childbirth. I particularly like the way you discuss risk, since nothing is risk-free and women must make choices based on the risks they are most comfortable taking on. Hope you don’t mind if we link to your blog every now and then.
Thanks Beth. Just checked out your site. It’s a great resource for women! 🙂
We are publishing statistics collated from all the hospitals in Ireland next Monday and I am trying to write a bit on our induction stats. Would you mind if I posted a link to this blog at the end of my piece please?
Of course you can 🙂
If only I had read more, and perhaps been informed by the medical team on waiting vs induction….
I am still emotionally ruined, nearly 6 years. Fear from the medical team in a hospital who gave me no support or options. They told me what was going to happen, they lied and when I questioned it, I felt like a fool…
Emotionally I have not been able to allow myself to get pregnant again. I wish for another child, but my fear is so huge and haven’t been able to shift this….I urge women to read this……If only I knew I could have waited.
My waters broke ‘2 weeks early’…..with no natural contractions. I was ‘high risk’……They gave me 1 day to have natural contractions, otherwise I had to be induced. The fear started there, and ended with an ’emergency c-section, epidural pethidine and 52 hours later I had a c’section. I didn’t see my baby for an hour whilst I was stitched up, I was so drugged and out of it. I got golden staff and was in bed for 2 months on anti biotics with a hole and puss oozing from me, my little girl was jaundiced, not to mention the anti biotics in her system.After 2 courses of antibiotics, the wound hadn’t healed.The Doctors then suggested that I should get my cut re-opened and done again…
I said no, I cleansed my system, bathed my wound, started on homeopathics and my wound closed over with in 3 days..
I sit here and cry and want so much for my fear of birthing to dissipate. I wish someone had of just told me that I could of waited up to 3/4 days at home and trusted myself as a woman to birth the way I was meant to Birth, in my power!….x Thanks for this site…x Em.x
Em I am so sorry. What you went through was awful. Please access some help to talk it through – can you talk to a local midwife or doula? *hugs*
I have, I have 2 very special friends who are midwives……No matter how much talking I do, this feels cellular and instinct has kicked in.. It’s too late now…I have had a healing with a beautiful woman, I have cried in the safety women’s circles with my friends. It still sits imbedded within me…..I never want to feel that invaded or out of my power again.x I am so blessed to have my little girl. x .
Grateful for this site and will pass this onto women I know.x Thanks again, great information, with love.x
It is so sad that the care you got (or don’t get) during birth has had such a devastating effect. A lesson for all practitioners 🙁
hun i really think you should see a maternity hypnotherapist for emotional release work. it’s great stuff and very safe and healing. it’s something i do when helping traumatised women approach their next labours (i’m a hypnobirthing teaching) and i’ve seen disempowered, frightened women become amazons, and have beautiful easy births.
If only I had read more, and perhaps been informed by the medical team on waiting vs induction….
I am still emotionally scarred and it’s nearly been 6 years. My Fear is from the medical team in a hospital who gave me no support or options. They told me what was going to happen, they lied and when I questioned it, I felt like a fool…….They were very neglectful in terms of my well being, emotion, spiritual and physical being…x
Emotionally I have not been able to allow myself to get pregnant again. I wish for another child, a sibling for my little girl and perhaps a boy, for my partner. Unfortunately my fear is so huge that I haven’t been able to shift this….I urge women to read this……If only I knew I could have waited.
My waters broke ‘2 weeks early’…..with no natural contractions. I was ‘high risk’……The Doctors said If I didn’t start having natural contractions soon, I would have to be induced. When i refused, the Dctor told “not to be silly, do you want your baby to die”. The fear started there, then the Oxytocin started, WOW…..there was no gradual welcoming, it was on and it didn’t stop, no breaks, or time to rest…I had plugs and, a fetal monitor on, a drip..pethadine up to the eye balls,to deal with the oxytocin ( only intensified it)….. I ended up having an ’emergency c-section with an epidural. I didn’t see my baby for an hour whilst I was stitched up, I was so drugged and out of it. I ended up contracting golden staff from hospital, where my c-section wound oozed puss from the hole that wouldn’t close. My little girl was jaundiced, not to mention the anti biotics in her system.After 2 courses of antibiotics, the wound hadn’t healed.The Doctors then suggested that I should get my wound re-opened cleaned out and stitched up again.. I could of punched the Doctor.
I said no, so I cleansed my system, bathed my wound, started on homeopathics and my wound closed over with in 3 days..
In the beginning,Imagine when my waters broke if the Doctor had of said ” it’s all fine, go home relax and give us a call and let us know how you are feeling, you are safe and in good hands…You aren’t high risk and your baby isn’t going to die”….perhaps I would have had the pleasure of a gentle slow movement into labor, rather than forced and help in a state of agony, with an outcome only known by Doctors…
I sit here and cry and want so much for my fear of birthing to dissipate. I wish someone had of just told me that I could of waited up to 3/4 days at home and trusted myself as a woman to birth the way I was meant to Birth, in my power!….x Thanks for this site…x Em.x
I love that you went into detail on all of this stuff ranging from induction of labor and the how it works to the risks of it. Particularly helpful was the risk of infant death. I had an awful experience with my midwife during my last pregnancy continuously encouraging me to go in for an induction because I was 42 weeks. I had three fetal stress tests taken and had high scores for all of them. I felt physically great, besides wanting to get the baby out. lol The baby was still very active and I felt sure that God wouldn’t allow someone to be pregnant forever. Surely. That was my hope. It was a really scary situation I had my midwife telling me that my baby was in danger and the doctor at the hospital telling me he would die after 42 weeks.
In the end, I went with my gut and I also found this study by Gulmezoglu Am and held onto that for dear life. It wasn’t that comforting though since I was under immense pressure from my healthcare providers and everyone that I knew to induce. I successfully went into labor on my own when Peter was ready to be born at 42 1/2 weeks.
Thank you so much for making this information available to moms! I wish that more healthcare providers knew it too.
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The best time for induction is 41 weeks of gestation.
I think the best way of induction is Misoprostol. Here what is required is approach on how to insert to posterior vaginal fornix.
I am currently 40 weeks and 2 days pregnant with my first child. I am 38 years old. I live in California, just for further info. My baby is healthy and the pregnancy has been fine with zero complications. My OB/GYN started to talk about induction at the 38 week mark. I’m not exactly sure why. At 40 weeks she said to come in for a Non-Stress Test and was really pushing the idea of induction. (In fact she said it is far more likely that I’ll have to be induced than not be induced- her reasoning- I am effacing but not yet dilating) The NST test was this morning. The baby looks great, the heartbeat is strong. The placenta is healthy and working efficiently, the baby is moving and kicking just fine, amniotic fluid check- fine, etc…. So they want to give me another NST next week. Fine. I myself was 2 weeks late back in the 70’s. I’m in no hurry and it seems the baby wants to cook a little longer. I will resist induction as long as I can and am comfortable with. But when she uses phrases like “fetal death” it feels like she’s using guilt to get me to have an induction. Why does she care if I wait longer? This person barely knows me. The whole thing makes me want to hide out at home and deliver my own baby in my bedroom with my doula. (I won’t. Sadly I can’t afford to have a midwife/home birth even though I desperately want to) My baby is healthy! Why is she tormenting me!? This is such a stress-filled way to end what has been a beautiful pregnancy.
Thank you for your article. I don’t feel so isolated now.
Your obs is a bully and I am sorry that you are not being given evidence based information or being supported by her. I cannot believe that even an obs would suggest a stress test at 40 week… more like a stress inducing test. I really hope you can stay strong and do what feels right of you and your baby. Please let us know what happens. You are the expert on your body and baby – not your obs.
Hi, this blog is an amazing find – thank you! I am almost 35 weeks pregnant, and planning a home birth. I have been advised by my midwife that because of my age (42), I “won’t be allowed” to go over 41 + 4 for fear of my baby’s placenta not working properly after this gestation. I have been unable to find any info about this online but was recommended your blog……..I really want to avoid induction unless my baby’s life is at risk. Can you advise at all?
I can’t offer advice… only that nothing can be done to you without your consent ie. it is not a case of ‘allowing’ you to do anything. I would be worried about your midwife’s understanding of the physiology of the placenta. You can do whatever you want. Risk is a fact of birth which ever option you choose. You need to decide what type of risk you want to take 🙂
Hi again and thanks for replying. I have a good awareness of the risks of induction but it’s the risks involved in not inducing in particular at age 42 that I don’t know and am finding decent info hard to come by.
Rachel – the risk is an statistically increased chance that your baby will die while waiting for your labour to start or that complications will arise during labour. However, you are not a statistic and it will be difficult to identify your personal risk. Humans are more complex than stats. For example, is the statistical increased risk because of the interventions women who go postdates are subjected too?
If I was caring for a woman who went past 42 weeks the kinds of questions we would be working through include ‘why’ has she gone post dates… is this normal for her or is there something else going on (emotional, physical). What has her pregnancy been like. Is she really post dates – how was the due date worked out. Has the baby grown well, is he/she moving well. What does the women feel – what does she know. There is the option of a biophysical profile where they assess placental blood flow and fetal well being – for some women this is reassuring, for others it increases stress and prolongs the pregnancy further.
As for your age. This again is totally subjective. An individual 20 year old may be less healthy than an individual 45 year old. You are not a number and to be honest your age should not be an issue in itself. You really need to connect to yourself and your baby and allow your intuition and embodied knowledge to direct your regarding what is right for you. You will never find concrete answers outside yourself 🙂
Thanks for this question and your replies. It’s really helpful for my situation. I hadn’t heard about biophysical profiling, so will definitely make sure I raise that with the consultant at my next appointment. I would much rather be monitored than induced!
Reblogged this on Mommy Baby Spot and commented:
This is a must-read if you’re considering induction due to your due date having come and gone. She’s also included some really great links for more information. Don’t succumb to the medical pressure to schedule your baby. Trust your body.
Thank you midwifethinking for a great article!
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I am currently 38 weeks pregnant, I’ve had 3 children but my 1st was 2 weeks overdue and induced and then ended up delivering by emergency c-section. My two subsequent children were natural births but each time I had my waters broken and not good experiences. As I am now 40 and have had a previous section, (16 years ago), I have been told that I can go over due up to 10 days but need to decide whether I would prefer to be induced at the end of that time if need be or opt for an elected c-section. The reason has been presented as far as I understand mainly on the basis of possible rupture of the uterus due to more intense contractions resulting from induction. Also my age has been raised as cause for caution. I’m now confused and anxious as to what would be best (apart from obviously hoping and praying that I go into labour naturally before a decision needs to be made!). To elect for major surgery and all the possible risks that presents seems crazy, but the thought of risking rupture of the uterus and all the other undesirables that can potentially arise from induction is also really worrying me. Chances are I could quite likely end up with an emergency c-section anyway! Any advice??
Hi Janet – I don’t give individual advice. Some issues to consider: If you haven’t already read: http://midwifethinking.com/2010/09/16/induction-of-labour-balancing-risks/; induction will increase your risk of uterine rupture, however the risk is still small and lots of women have inductions with c-section scars… and elective c-section also has risks; you have done and can birth a baby vaginally; age is individual – some 20 year olds are less healthy than some 40 year olds; You can go as far as you like past your ‘guess’ date – no one can do anything to you without your consent.
So, you basically have 3 choices:
1. Wait until your body and baby are ready to birth – regardless of what the guess date is.
2. Opt for an induction which involves: http://midwifethinking.com/2011/07/17/induction-a-step-by-step-guide/
3. Have a planned elective c-section
All of these options hold risks and very small risks ie. we are talking less than 1%. You need to do what feels right for you. Let me/us know what happens 🙂
I wish I had found this back when it was posted (funnily enough my daughters EDD). I was induced at 42 weeks for her and it ended in a c-section, which I think was more about the length of time that I had been in labour for than anything else since she wasn’t distressed and they came in to discuss surgery within 30 minutes of my epidural…
Now I find I’m fighting an uphill battle to be “allowed” to have a vbac. The hospital are fine with it in principle, but want to place restrictions on me that aren’t exactly conducive to achieving a vbac, and I’m worried the stress of arguing with my healthcare providers is going to up my adrenaline and prevent labour from coming on
I hope you can find a way of de-stressing the situation because it is counter-productive. It is such a shame that the hospital creates such unnecessary stress around a simple birth.
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Thanks for this article and the birth stories. All three acurrately summarise my current situation of having a ‘post-term’ pregnancy. While I am convinced that my EDD is (and we already know this is only an estimate), pressure began from 39 weeks (according to their calculations) to begin the induction process.
Both the baby and I are fine, it seems everytime I come into contact with a medical professional (and now that I have passed their 42 week mark this has become a daily occurrence), there is yet another reason given to me, ‘objectively’ of course, as to why I’m putting my baby and myeyself at risk. For example, last week after being given the all clear from a scan of the placenta, fluids, etc, I was then told the baby was at an oblique lie and that he was ‘too humongous’ to move. He was of course deemed ‘humongous’ based on the estimated fetal weight which clearly states is an estimate, is less accurate after 36, and without taking into account previous scan data (at 34 weeks he measured above average and from both the scan palpatation it is obvious that he is very long). So, I was then told that if I went into labour naturally his shoulder and cord would arrive first and he would asphyxiate. Super. Way to frighten a poor stunned woman who only minutes before was given the all clear. I was then told that I would be kept over the weekend and scheduled for an emergency c-section on Monday AM (clearly it was not urgent enough to ask a consultant to perform this over the weekend). I tried to insist that the baby would move as he is still quite active and had been disturbed by all of the poking and prodding, which was of course ignored.
Once in hospital I felt wrongly imprisoned, as I knew nothing was wrong. And sure enough, while being monitored later that evening that I asked for the position of the baby to be checked and he was in the correct position. Once that issue was resolved they began making more of an issue about his weight and shoulder dystocia. I was also told that I wouldn’t go into labour after 42weeks bc I hadn’t and other women
Apologies, I didn’t complete my previous post.
So, as I was saying, I was told women don’t tend to go onto labour after 42 weeks (nevermind the fact that women are generally induced before this point so there is no supporting evidence for this). I wad also then told that they wanted to check for gestational diabetes as this would explain the baby’s size (and warrant the unnecessary c-section now planned for Monday). This suggestion completely threw me! This was being suggested to a woman with none of the associated risk factors, with an extremly healthy diet, had walked, swam as well as practiced yoga 3 times per week up til 40 weeks and has only put on 11kgs. Nevermind, that not a single one of my routine urine tests had showed any positive signs for glucose. Thankfully only after very brief consideration did we decide to refuse the test, to continue with my original plan and to be discharged. They agreed, but this means both the baby and I are subjected to daily monitoring for 30 mins and today I have to see ‘my consultant’ the one who I saw for 3 mins and inaccurately ordered a ceasarian. It is obvious she is very pro-intervention, so I am trying to regain my slightly shattered confidence to go into battle. I can’t emphasise enough how stressful this is and how disempowering it feels to have someone making blanketed decisions about me and my baby without considering our case individually.
But, this article has given me back some of my confidence and I am ready to ask for the evidence, to be informed of induction risks and to have my due date re-estimated. So, many, many thank yous for this!
I have had 4 babies. back then they didn’t do the scans they do now-Thank God! My first was due on Fri, the doc “rimmed the cervix” on monday and said he would see me in hospital in a couple of days. Jason was born 2 weeks later-healthy and 5 hrs from start to finish. I have no clue about the timing of my next, since there was a possibility I had lost a baby. She was either exactly 4 weeks late or right on time-which would be right on time in any case. My third baby was “due” 18 of Nov. and was born 18 of Dec. My 4th was due 3 wks after the “due” date. All my babies were healthy. I was healthy. I am a birh doula and have witnessed obs tell outright fabrications(lies) to get their clients to do what they want according to their schedules. Growing up I had a great deal of respect for the work and dedication I thought obs represented. It is very hard to mesh what I thought with what I have witnessed. I guess that is what happens when you put any person or profession on a pedastal. This post is a wonderful tool to get women to think and help them to know what questions to ask, and hopefully learn to respect themselves, their babies and their bodies. We were not made less that any other mammal on the planet. Our bodies are more than capable of carrying, delivering, and nurturing our babies. On the occasional time we need help, I thank God that we do have the proffessional people there to help, but we need to recognize that they are only people, with lives of their own.
I would love some advice from you regarding my delivery! Your post was very helpful, however, I’m still having a difficult time deciding what I need/should do. My “due date” is tomorrow. I have been at 2 cm dilated for several weeks and I started to thin about 2 weeks ago. I lost my mucus plug almost a month ago. I am considered high risk because I have a thyroid disease. My doctor has been pretty great about meeting my desires and not pushing an early induction. Last week, he suggested that if I had not gone into labor by my next appointment (coming Tuesday) that we would schedule an induction for the following week. He does not want me to carry over 1.5 weeks but he will let me go 13 days. I haven’t argued with him because I don’t know what I feel most comfortable with. Do you have any suggestions?
Hi Brittin
I don’t give advice only information – you need to make your own decision about your own body/baby. I have a number of concerns about your comment…
Firstly how on earth do you know what your cervix is doing and why? I am hoping that you are not seeing a care provider who is undertaking the outdated and invasive practice of vaginal examinations in pregnancy. This practice is pointless as it does not indicate when you will go into labour and it can result in complications… possibly why you lost your mucous plug in the first place. A woman who has previously had a baby can walk about with her cervix opened for most of her pregnancy. This is normal and nothing to do with labour.
“My doctor has been pretty great” – because he has not bullied you into an early induction?? But will schedule an induction if his ‘guess date’ is more than a week wrong (did he discuss the evidence or your thoughts on this?)… “he will let me” NO – this is your body/baby. He does not ‘let you’ do anything. YOU let him do things to you ie. give consent for procedures. He does not need to give consent for you to not have a procedure.
The only suggestion I have for you is to take responsibility for your body/baby/choices/birth and do what feels right for you… and that may be an induction. You are the one who has to experience your choice – no one else should make them for you.
I am sorry, I don’t mean to be harsh with you. I am just deeply amazed and saddened at how disempowered women are within the maternity system.
Not quite the reply I was hoping for, beings this is my first pregnancy and it’s all so new to me. All of the women in my family that I’ve spoken to are pro-induction and pro-epidural, so it’s hard enough just feeling like I’m going against the ‘norm’. I have tried to research as much as possible during this pregnancy and I never read any warnings or had anyone tell me that having my doctor check my cervix would be a bad thing or should be avoided. The way you say it makes me feel as if I’m stupid for allowing this. I was just uninformed, like most women in America. It is hard to find any reliable sources online that are pro-natural births and list warnings of hospital procedures since it’s so common highly promoted. Just recently, 3 of my friends were induced. Each was between 36-38 weeks. When I asked why they chose to be induced, they said it was because their doctor recommended it. They didn’t question it at all. I feel like I’ve done pretty well this far since I made it very clear from day 1 that an induction would be a last resort for me and I will absolutely not have an epidural. I feel a bit deflated after your response.
One of my friends that I reach out to more than anyone had a home birth and her midwife performed several vaginal examines and swept her membranes 4 different times (she is even strep b positive). I did see a lot of research where that was not suggested. I, too, am positive for strep b, so I haven’t asked him if it was something to consider. By saying my doctor was been pretty great, I mean that he has listened to my concerns and allowed me to make my own decisions so far. He has not pressured me to feel a certain way or even to schedule a induction. He made the comment that we would go ahead and schedule it so it’s on the books and we could go from there. He, like most doctors, is concerned with letting me go over 42 weeks. Like I mentioned, since I am a high risk patient, he would like me to only go to 41 1/2 weeks, but has said he will “let” me (if I still “look great” – blood pressure, etc) go up to the 25th of this month, which is 13 days past my EDD. He is a doctor for a reason and while I trust my judgement, I also take his opinion into consideration since he is aware of my medical history.
Thank you for your response, I guess, but I will seek information from other, more understanding and less harsh resources!!
I am sorry you have taken my comments as a personal attack. If you note I state that women are disempowered within the maternity system ie. you are not given access to the information and care providers take a paternal approach to their client relationship. You are not stupid. You are searching for the right answer. My point is that you will find external experts who advocate induction and ones who advocate never inducing. I don’t advocate either. I want you to access the information and make your own decision. I have taken lots of time and effort to put the information out there for women to access. It speaks volumes that you have been unable to explore your options and thoughts with your care provider.
I am aware that homebirth midwives also do dangerous/pointless practices such as vaginal examinations in pregnancy (and worse). This is why I use the term ‘care provider’ to talk about those who do things to women.
You asked me to give you advice. I do not know your medical history – your doctor does and is in a position to discuss with you your options and the risk and benefits of each option specifically related to your individual case. To ask me or anyone outside of this relationship for advice is putting them in a difficult situation. You may be able to find some more understanding and less harsh resources on the internet but I hope you don’t find anyone willing to give you advice about what to do in your situation (for their sake and yours).
Again I apologise if you feel that my response is an attack on you. It is not. It is a comment on the state of maternity care and how it works to prevent women from being informed and from taking responsibility for their birth journey.
Also be careful about stating you will absolutely not have an epidural. Induction is not a physiological process and many women require an epidural to manage the pain. You have not failed if you choose an induction or an epidural. It is important that you do what is right for you not other people.
If you are not too annoyed by my honesty I’d love for you to come back and let us know how your birth went 🙂
Wow, do you have the same autonomy of your legal issues wrt your attorney? Do you tell your builder contractor how you want him to construct the framework? Do you have that same autonomy in choosing the chemotherapy for a relative who may have cancer? Sounds like if this woman wanted an epidural and wanted an induction, you would take that autonomy aware from her because you want to impress your ideals upon her. POT meet kettle.
Have you actually read the reply and the post and other posts on here? Try: http://midwifethinking.com/2011/04/09/judging-birth/
If a woman wants an epidural and an induction I support her choice… I have cared for many women who chose this option… and elective c-section. It is her birth, not mine – she needs to gather information and make HER choices. I’d like to see where I suggest taking autonomy away. That’s the opposite of what I am suggesting in this thread which is about taking responsibility for ones body/baby/choices rather than expecting others to.
From your comments re. autonomy and building/medical treatment/law – you clearly don’t understand the concept of bodily autonomy or law regarding adequate information for consent.
Hello Rachel,
I am a doula in Ottawa, Canada. I really enojoy your blog. Thank you for writing!
In your opinion, if an induction was necessary for medical reasons at 37 weeks with the first baby. Because of all the advirse effects on the induction drugs to the baby and because it could 3 times more likely turn into an emergency Cesarean, wouldn’t it be a better choice to have one planned?What are your thoughts on this?
Yes – I think that an elective c-section should be offered as a choice in this situation. The mother needs to make the decision as what she feels is the best option for her weighing up the risks and benefits of induction vs c-section.
This is exactly what I needed to read at 42 weeks 4 days. Thank you!
I am still feeling great, my daughter is doing well. My doctor has been great about following what I want, not that he has a choice, until my last appt (42 week). He still made sure I knew it was my choice to make, but made it very clear that he feels I’m putting my daughter’s life at risk. He even asked what exactly my issue is with induction. I explained that once one intervention is introduced that it often causes a domino effect that I’m not comfortable with. He had me start doing NST and she is passing those without issue. I am thinking of asking for a biophysical profile at my next visit as he has mentioned he isn’t comfortable with me remaining pregnant after that date. He said by then he wants me to make a decision. Obviously he’s trying to pressure me into the induction, but back tracked to make sure I knew he couldn’t make me do anything. Thankfully when he tried to play the ‘dead baby card’, to scare my husband I believe, he underestimated my support system. Thankfully my daughters birth will more than likely be attended by a midwife.
Do you have opinion on biophysical profiles?
Hi Penny
Biophysical profiles when done correctly can provide helpful information ie. if they show that all is well. However, they can promote anxiety and stress for some women which is not helpful. Remember this is your body/baby and therefore your choice. Your doctor is not responsible for your choices – only for the care and information he provides. Maybe he needs reminding of this? Good luck, let us know what happens 🙂
I went into labor/water broke (the day after I left my comment) on my birthday September 11 at 8 am. I was to 7cm at 10am and my daughter was born at 1:24pm. She was OP and didn’t turn until I was pushing. She weighed 8lbs 11oz 20 inches long.
The head nurse that I had met during a NST (very chatty) informed me that it was in my chart that had I made it to my OB appt that day my OB had planned on talking me into an induction. I explained to her that I wouldn’t have consented and she said “Good! Your baby is doing well.”.
The hospital I gave birth in was much better than I thought it would be. After my last birth I was fearful of hospital policies vs my birth plan. I had one nurse for the entire time I labored. I was her only patient so she stayed in the room and helped my husband comfort me. Suggested a bath, different positions to try to get my daughter to turn, and held the monitor to me so I could continue to move around. She also was our day postpartum nurse while we were there. My daughter was breastfeeding so well when she was put on my chest that they left us alone to cuddle for two hours. They were all wonderful supporters of breastfeeding. All of the nurses followed my birth/baby plan without complaint. Even my requests for no eye ointment and no bath. After the last hospital I was ready for a fight and was so relieved to not have to.
The on call OB was less than pleasant. I had Norovirus and while the nurse explained this the OB looked at me and said “So you took castor oil.”. She was also very angry that I was refusing *routine* pitocin and made a few rude comments about to the nurses in front of me. She was so rude it was actually funny. The nurses kept looking at me in horror. Even they were shocked.
Over all I am very happy with the experience. Thank you for easing my fears. The information you share here is so important.
Thank you so much for coming back and sharing your experience. Congratulations! 🙂
I was induced at 41 weeks (EDD based on dating scan) with my first baby in February year. LNP put me at 40+3 but my cycle had been anywhere between 28-38 days in the year prior to getting pregnant. Due to Wednesday 8th February being lucky in the Chinese culture (I live in Melbourne!) I was unable to be induced at 40+10 as all the induction spots at the hospital had been booked! I had the option of waiting until 40+12 or else 40+7 (which I chose). I liked the fact that you clearly outlined the risks associated with induction however I did not face the issues of confinement and limited movement that you suggested. I was given cervidel at 4pm and attached to a wireless CTG that allowed me to move freely around the birth suite. After 90 minutes of monitoring, in which I had already begun contracting, I was allowed to walk down to the hospital restaurant to get food (provided I was back in 30minutes for more monitoring). At 7.30pm my membranes spontaneously ruptured and active labour really began. The wireless CTG allowed me to assume any position I liked and I spent most of the time walking/squatting/standing etc.I had an IV catheter inserted (incase further intervention may be needed) but was not hooked up to an IV line/bag so this did not limit my movement either. I was determined to move as much as possible during labour to really get the endorphins working. After my membranes ruptured I was able to use the shower for pain relief as desired as well. At 10.50pm an internal examination was done suggesting that i was 5-6cm dilated and fully effaced. At this point i decided i wanted an epidural however i had a very good midwife who convinved me to wait it out a little longer (she knew i wanted to keep as active as possible for as long as possible). At 11.25pm I asked for pethidine however again my midwife convinced me to wait 15 minutes to see how I was going. At 11.30pm I felt the need to push and at 11.45pm my son was born on the 5th February. My obstetrician didn’t make the birth (he assumed after the internal examination I’d be at least a few more hours) and I managed to birth my son without any pain relief at all. I guess I wanted to tell my story as everyone told me beforehand ‘that I didn’t want to be induced’/’that I wanted to avoid being induced at all costs if I could’ etc but for me being induced was no-where near as terrible as everyone made it out to be. I am sure it can be awful (as some of the above stories attest) however if a future pregnancy required me to be induced I would definitely do it again. I am sure some genetics were involved (my mum had me spontaneously and naturally in 6 hours and my younger brother in 3 hours and my grandma had my mum in 5 hours and her younger sister in 2 hours) however I am also thankful for my obstetrician, midwife and hospital for allowing me to support my birth plan despite being induced by being able to move around as much as possible and holding me off from pethidine/epidural while in transition when your mind tells you ‘that I don’t want to do this anymore!’. So while there are many risks involved I definitely think that the mindset you take into induction can help you with your induction experience.
Thank you for sharing your experience. Induction can be a positive experience. It seems your body was ready to respond and you managed to avoid the artificial oxytocin IV which is often the source of problems during induction. 🙂
Just wanted to say I’ve had 4 children all were past their EDD, one was 17 days past and I was threatened with and Induction but baby decided it was time, I had no calcification of the placenta only thing that was noticeable was he seemed to shed a layer of skin over the first couple of days otherwise perfectly health and he’s 25 now!!!!
Thank you for your article. We have two daughters: one was induced at 38 weeks while the other arrived of her own accord at 40. The oldest was induced and is now 31 months and the younger is 14 months. we have compared how often both girls get sick and found that the daughter who was induced is more prone to catch colds, viruses etc. This trend tends to repeat within our family between children that have been induced and those that have not.
I wish our obstetrician mentioned that there may be potential consequences to our baby’s health later in life. I now appreciate that nature knows what it is doing and we need to listen more to her and where possible we should not try to change the natural process.
Did the daughter that was induced receive antibiotics in the hospital, during the labor or afterwards? That could have an effect on the health of the child throughout her life. I also have a friend with 3 children, and the one that was induced (the youngest) has the most allergies of the three and seems to get sick more often.
As you say, research depends upon who is interpreting it. In regards to the increased LSCS rate in first time mothers who were induced; Was it is the induction process or the pathology behind the cause for induction which led to this increase in caesareans?
Yes, it is difficult to make clear cause and effect assertions from quantitative research. Both studies cited in my post attempted to control for co-founding variables. The Selo-Ojeme et al. study only looked at induction for post-term pregnancy. In both studies the researchers concluded that induction of labour independent of other factors increased the risk of c-section for primiparous women. That is their interpretation. The same problems crop up with research into post-term pregnancy which demonstrate increased risks for the baby… they don’t provide the ‘why’ ie. are these babies already at higher risk for reasons other than length of gestation. Anyhow, in terms of induction and c-section the findings fit with ‘common knowledge’. In my years of working in a large regional hospital we would have to inform the anaesthetist and theatre staff when putting a primip on syntocinon… because it was likely we would end up in theatre and need them. Either way, I think this evidence should be shared with women to assist in their decision making re. induction. 🙂
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Thank you for your posts and sharing your knowledge and research! It has been wonderful learning from you! I truly appreciate the time and effort you put into writing about such important issues.
Thanks 🙂
Thanks for your brilliant blogs. As a London based Hypnobirthing teacher and clinical hypnotherapist, I’m frequently having to help women ‘fight off’ unnecessary inductions. It’s so often not an ‘offer’ but pressure and bullying. When questioned on risk, many midwives simply don’t know the facts. I work with many women for the first time during their second pregnancy following a difficult or traumatic first birth. I am often de-traumatising before anything else is possible. I think there is an argument to say that an (unnecessary) induction can cause PTSD. Do you know of any research on this? Thanks again.
It is great that women are finding healing after traumatic births and that there are practitioners like yourself to support them in this. Wouldn’t it be great if women had empowering first births instead?
There is a fair bit of research on interventions and a negative birth experience. In summary – the less control the woman perceived she had over the events, the more likely she is to be traumatised. So it is not the intervention, but the way it is administered that matters. I don’t know anything specific to induction – but if a woman did not feel informed and was pushed into an induction with full information… and then endured the associated interventions and complications she may be traumatised. In contrast, if she chose an medically unnecessary induction and was fully informed of the risk, she may feel empowered that she was in control of the events in her birth. 🙂
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I loved it
A very interesting blog. I am one of the women who does not necessarily mind intervention. Whilst I would prefer not to have any kind of assisted delivery (especially a c-section), if its needed then so be it. I had an epidural with my first child and it was the best thing I ever did, I couldn’t move and was on a drip but this did not bother me, In fact I was glad of the chance to rest and sleep. My labour lasted 12 hours (which I believe is the lower end of average for first time mothers) and I had absolutely no problems. I am currently overdue by 2 days with my second child and would and will do it all again. My baby is also in a occiput posterior position and as I have been led to understand that this can lead to a much more painful labour, I request that they have an epidural ready and waiting! I am not ashamed of this, I am no hero and no one will be awarding me any medals for doing it au naturele! I am happy for women who insist on only natural births and yes I do agree this is the optimal way (for most), but for me, I don’t tolerate pain well, and i don’t want to be pregnant past 42 weeks and if that means intervention then so be it! I am no medical professional, and like you said, any medical intervention for anything poses risk, but I would take an educated guess that the progression of medical technology regarding pregnancy labour and birth, since even 50 years ago, results in fewer maternal and perinatal deaths. Whether or not that means intervention and an inability to move, if that’s means that my baby and me will be ok in a situation that otherwise might’ve meant extreme complications or death in a time when these interventions did not exist, I’d take interventions any day of the week.
This is just my personal opinion of course, but like was stated, as a woman, MY choice would be for the labour and birth choice that is most comfortable for me. But I respect that women should be informed of the risks of all possibilities of birth, but not made to feel any less of a woman if they choose to have pain releif such as the epi, or feel like a failure if they end up with a c-section.
Interesting blog, thank you for sharing a midwifes perspective.
Midwife thinking – you are a star. It’s so refreshing to read your information. I’m not going to ask you anything as I have read a similar story to mine in your blog (42 years old and doc wants to induce me) I’m so relieved. I’m fit and healthy, had a fantastic pregnancy so far and the only thing worrying me was induction. Thankfully just for a week, since I’ve found your site I am no longer stressed and will go back to my doc confident about the questions I want to ask. Thank you so much x
Thank you and enjoy your new baby 🙂
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Hello! i found your blog through a link on Twitter. This is a well written, informative and empowering post. I do wonder if the photo of caster oil was a good idea though – particularly for those who simply skim read posts, and as a result might think you were advocating the use of caster oil as an ‘alternative to waiting’. I’m so happy to have discovered your blog and will be back to read more 🙂
Am 40week+3 pregnant and am going to be induced next week thursday ur blog as been so informative. I will keep u post on how my induction goes, but I still pray I go into natural labour before then
Good luck 🙂
Great article thanks! I’d love to hear your comments/experience with women in my situation. I have a ‘double’ uterus, ie. a completely separate second uterus with a second vagina (not really sure of the correct term as it seems there are all different degrees of the same thing). I have no kidney on my left side, and my left vagina is the ‘path less travelled’ so to speak, hence I have no chance of conception in that side. I had been told, and was kind of expecting, trouble actually conceiving, as I can only really conceive when ovulating from the right ovary, I was also 36 when I decided to go off the pill after half of my life on it. Surprisingly I was pregnant within a couple of months. I was treated as high risk in the early months because doc wasn’t sure how well my right uterus would expand, and how much room was there. I ended up having an amazing pregnancy, worked hard to stay super healthy and fit, gained only 3kg as I was overweight to begin with. At 40+3 my bp shot up and doc advised induction. I was scared as everyone I know who was induced ended up having emergency cs. But I trusted my doc as she was super supportive of all of my plans, and was highly recommended by (and complimentary of) my doula. She always said ‘women’s bodies know what to do and baby knows where to go, in an ideal birth I’ll only be there to sign the papers’. This attitude is amazing where I live (I’m an Aussie living in Dubai) as birth here is a purely medical process, must happen in hospital with an obstetrician and is full of interventions, most of which seem to me to be for the benefit of the doctor/hospital schedule. I went into hospital the next day and had 3 inductions over the next 3 days, I begged for a 4th in a last attempt to avoid cs, but I just didn’t dilate at all. I also had my acupuncturist come, my doula was with me doing hypnobirthing techniques, acupressure etc, but despite everything I ended up having a cs. I had the most amazing baby boy who I still think of as my little miracle at 19 months old. After his birth my doc said the left useless uterus was pulling so hard on the right one that my right cervix had dislocated and there was no way it could dilate. So I realise I was never going to have had a vaginal birth that time, which is somewhat reassuring as I don’t need to beat myself up over choices made. But I have heard of women with the same physiological setup birthing vaginally. In your experience, would this likely be an issue second time round? Would this be permanent cervical damage, or can the cervix repair itself and function as nature intended next time? I’d love to try for a vbac if I get pregnant again, but I don’t know if there’s any chance at all. I will be ecstatic just to have another healthy happy baby, however they come into the world!
Hi Hannah
I have known women with similar anatomy ie. double uterus have a vaginal birth. As I don’t have your notes, and have not been involved in your care it is difficult for me to comment. However, some questions that jump out = did you have ‘raised bp’ or pre-eclampsia (PE)? Raised bp does not mean you have PE – and blood tests + urine tests are required to make this diagnosis ie. raised bp alone is not an indication for induction. Your cervix is not separate to your uterus, it is just the opening… it is all part of the same structure. The uterus pulls up or ‘absorbs’ the tissue that is called the ‘cervix’ during labour… I am not sure what is meant by dislocate or how that could possibly happen…
Even if you have 2 uteri and 2 cervixes, the hormonal changes during physiological labour would soften them and allow stretch… but then again I don’t know the particulars… just thinking out loud.
Enjoy your beautiful baby boy and I can’t see any reason for you not to be able to birth a baby out of your vagina in the future.
Pretty nice post. I just stumbled upon your blog and wanted to say that I’ve truly enjoyed surfing around your blog posts. After all I’ll be subscribing to your feed and I hope you write again soon!
This may help provide some clarity
Great blog! I was just wondering after reading the comments what are the precise stats of having a still birth after going over 42 weeks and refusing an induction. 1 in 200 or 1 in 1000?
Also, if you choose expectant management then surely the risk must be very low if you’re being monitored every few days? Thanks!
Unfortunately you will never get precise stats for individual women ie. your particular pregnancy/baby/situation. Waiting beyond 41 weeks and declining induction = 30 in 10’000 chance of your baby dying. Being monitored (if that involves a full biophysical profile) can provide an indication of how well the baby is at the time of the assessment… and may indicate a decline in the condition of the baby ie. reduced placental flow. But not necessarily. There are no risk free options. You must choose the risk you want to take.
Do you have any information regarding twins. Specifically, being “full term” at 38 weeks? Actually I have read some sources that say 37-38 weeks is considered full term by most OBs. I have heard that they develop faster (lung maturity, ability to suckle). How could that be? Why is it twins are born so early compared to singletons? Is it because there is so much intervention prenatally, or is it really a physiological reason? Of course I realize there are many twin mothers who have gone 40 + weeks, but that does not seem to be the norm..
Most women birth earlier with twins. Perhaps because of the size of the uterus = triggers labour (spontaneously). Also probably due to the fact that most women are induced or have a c-section ‘early’ with twins due to policies like your OB has. Therefore, not many women get to 40 weeks or over.
I am 40 weeks plus 11 days..due to the fact with my previous pregnancy, the dr in the hospital scared me into an induction, even though I really didn’t want to. She brought up all these legal issues etc. And then the labour was so intense, I knew that a natural labour wouldn’t have felt like that. So with this pregnancy I actually told them a period date of 2 days later than my actual, as post dates run in my family, and was quite sure this pregnancy will most probably go over as well. And I was worried into getting ”bullied’ into an induction. and sure enough they tried getting me to come in today but thank God the midwife was supportive of my decision and coerced the dr into giving me up till Sunday night. And really I would be 40 weeks and 15 days by then. My last assessment showed that everything was going great. Can you give me any information, tips or advice for my situation…
Thank you
Only to trust yourself to know what is right for you and your baby. Let us know when he/she is here.
at 38weeks i had hbp i was told id need 2 b induced and i refused they wrote it in my chart. they told me it could cause health problems for me and my baby if i didnt go ahead with it,so i did.i will never 4get da pain i cant even sleep at times thinking of it.my 4th baby and i ended up getting an epidural im still upset after it.my little man is now 6 months so cross colic and has a floppy lyarnx.he is still waking every 3 hrs for a bottle im sorry i didnt stick with my own choice but i was afraid.i felt like i had no choice and wasnt given much information.i really think that they just wanted people out of there for xmas??????
I am sorry that you had an induction without consent. You should complain to the hospital. You should have been clear about their recommendations and the risks involved before the induction started.
That’s not “no consent”. Turning up for induction implies consent. I’m very sorry this lady didn’t have the birth she wanted and felt that the induction process/ reasons required were not explained well enough, but it’s certainly not “no consent”. Sometimes birth just doesn’t go to plan, that doesn’t mean it’s the Dr’s/ hospitals fault.
Unfortunately you are incorrect – this post explains the law relating to consent and to negligence of information giving: http://midwifethinking.com/2010/09/15/information-giving-and-the-law/
Thank you for the link, but I am fully aware of informed consent. I have worked in the hospital system for 20yrs and my post grad studies also included studying ethics. Again, I maintain that this lady did give consent, and again I’m sorry that her hypertension meant she couldn’t wait until term to go into natural labour. Do you explain every single risk to your home birth clients eg a baby that becomes distressed with a low fhr will be far more likely to die or suffer brain damage than it would if immediate access to a c/s was available???????
My frustration with your statements comes from my work with parents in the pediatric setting. Unfortunately you seem to foster a fear of medical professionals in hospitals. It is very difficult when faced with a sick baby you are trying to help and parents are opposing interventions etc due to mistrust of hospital staff and information they have read online. Unfortunately this is often to the detriment of the baby/ child.
Why, oh why can it not be acknowledged that not everyone can have a natural labour. Things crop in some people that make that an unsafe option. Let’s acknowledge that and say ” that’s ok”. Surely that would prevent some women from feeling so upset and let down when a c/s or induction is required?
“Do you explain every single risk to your home birth clients eg a baby that becomes distressed with a low fhr will be far more likely to die or suffer brain damage than it would if immediate access to a c/s was available???????”
Yes I do actually. It is vital women are aware of the risks associated with their decisions.
“Unfortunately you seem to foster a fear of medical professionals in hospitals.”
A significant proportion of my readers and those that I work with as an educator are medical professionals – I worked in hospitals myself for many years. I foster critical thinking, evidence based practice, informed decision making, safe practice and legal/ethical practice. Perhaps if other medical professions don’t they should be feared.
“Why, oh why can it not be acknowledged that not everyone can have a natural labour. Things crop in some people that make that an unsafe option. Let’s acknowledge that and say ” that’s ok”. Surely that would prevent some women from feeling so upset and let down when a c/s or induction is required?”
I totally agree. I’m assuming you are not entirely familiar with my work otherwise you would know this. I think you are projecting your preconceived ideas onto me. Perhaps take some time to read the interviews with me (which includes my perspective on ‘natural’ birth) – there is a link in ‘about’, or my post ‘judging birth’… or ask me what my thoughts are rather than telling me.
My response to the original commenter did not make any judgement about the necessity of her induction, only issues of consent and inadequate information giving… clearly her experience was traumatic which is not OK.
i didnt turn up for induction i was been kept in and felt pressured after i refused induction at first.i just felt afraid after they telling me it could cause problems later on if i didnt go ahead with it.i just wanted 2 b home xmas day with the rest of my kids and feel foolish for not asking what the real risks would be if i didnt go ahead with it.my first 2 kids{girls} were easy enough labours my 3rd a boy of course was induction as i was told he was a huge baby 7/10 but at least that was a day b4 my edd it was hard enough but it was the complications after and then 4 them 2 loose my files?????its just the pain of my 4th and last, no doubt….that really gives me nightmares.i wish i had been brave enough to ask questions.
Trish – this is not acceptable practice and I am sorry that you had this experience. This is not your fault and it is awful that you feel foolish, or that you should have been ‘brave’ and asked questions. The onus is on the practitioner undertaking the procedure/intervention/treatment to provide adequate information and ensure that they gain consent without coersion.
It is worrying that ‘Concerned’ works in a medical setting and thinks that ‘implied consent’ is enough for a medical procedure such as induction. This is one of the problems, many practitioners are unaware of the legal and ethical issues surrounding practice and violate women’s rights without even knowing they do it.
Could you write to the hospital involved and highlight your concerns? It might make them review the way they do things in the future.
I’m sorry you had such a hard time. But again I don’t believe this was a case of no consent. Your initial refusal was respected, so why would they suddenly force things upon you? Telling you the risks of not getting bub out is not pressure, it’s giving you the info you need to make an informed decision. Yes, the risks of induction should have also been explained. Again I’m sorry that you didn’t find labour a great experience, and I don’t mean to trivialize your feelings by saying this, but wouldn’t you also be traumatized if your baby had suffered problems due to not being born at that time.
Hi there I found you blog as I was trying to find the dangers of being induced 3 weeks early. My sister in in hospital now and has been since Tuesday. The induced her and pumped her with steroids as baby was too small. She started going into early labor but then it stopped so I don’t know why they keep giving her stuff to induce the labor. The have induced her 4 times using different methods and they have stopped the labor twice due to the babies heart rate being too fast. I am in South Africa and my sister is in the UK. I am really worried that they are endangering my sister and her baby. They want to break her water now to speed things up but I am really worried as she stop dilating and only now after they used the drip this time to bring on her labor has she started dilating again and is now just over 3cm’s. She has had a hard pregnancy and this is her 4th child. Please can you tell me if my sister or her baby is in any danger as the Dr’s and nurses are not saying anything other than this is how they do things.
Hi Amy
I really can’t comment on your sister’s case. I would imagine (hope) there is a very good reason for inducing her at 37 weeks i.e. a serious medical condition. The dangers of being induced 3 weeks early are the same as any induction plus addition risks… that the woman is less likely to be ready to labour therefore more difficult to get into labour, and the baby is less resilient to induced contractions therefore more likely to become distressed. Also after birth the baby is more likely to require resus and admission to special care nursery for respiratory problems. I hope you sister is fully informed about what is going on and why they are suggesting induction in her case.
I was induced with cervidil at 42 weeks with my first. Then my second was also overdue about five day, and I decided to get induced, and my third was right on the forty week dot and I went in for an inducement and I can’t tell you how much I regret it. They all had a hard time nursing, and all of them have a hard time gaining weight….I will forever grieve about it.
Firstly, thank you for another excellent blog entry. I am a Lamaze Certified Childbirth Educator working in Melbourne. One of the materials I pass on to all my clients is your blog on delayed cord clamping which I love! So I have a question: in addition to being “post term”, the other most common reasons I come across all the time for so-called justifiable inductions are oligohydramnios and macrosomia. I’d love to read your thoughts about this. Thanks!
Thanks Tanya… they could be entire posts in themselves – and might be. Here is a brief response. Firstly estimating oligohyramnios and macrosomia using ultrasound is very inaccurate. Amniotic fluid reduces around term anyway – so it is normal to have less fluid at this point. True oligohyramnios i.e. not just the normal reduction is not good and indicates poor placental function. It is commonly found in small growth restricted babies and usually evident before term – via palpation and in some cases you can see the baby’s limbs via the abdomen. Not good. Macrosomia – you would need to do 3695 inductions in non diabetic women with a baby estimated at 4.5kg to prevent one brachial plexus injury (ie. nerve damage due to shoulder dystocia) – Rouse et al. 1996. Not sure that an induction based on an inaccurate estimation of weight + the lack of evidence supporting induction for large babies would = justifiable. I guess that is up to the woman to decide 🙂
Thanks for your reply! And please – I would love if you had time to get around to writing blog posts on these comments some time! Keep up the fantastic work!
Thank you so much for this information! It amazes me that I can’t get this information from my healthcare provider. I have a feeling I will go past my due date and that I will be pressured into inducing, but I will definitely come prepared with this information! I expect to see “deer-in-the-headlights.” I hope this is a new age of women who take charge and make informed CHOICES about their birthing options!
Hi Rachel. I too want to thank you for your blog, very informatim and reassuing indeed. I have a question which I am hoping you can answer.
I went into labour with my first child naturally. Upon my arrival to the hospital the doctors announced I was not contracting “good enough” and had to be stimulated with syntocin. I’d planned to have my birth as natural and drug-free as possible, needless to say it all went pear shape. I’d been coping with my pains for several hours and thought I was doing fine. After they’d stimulated my contractions, the pains became simply exhausting, I knew I wouldn’t be able to go on like that for long and asked for an epidural. Then all as you describe – prolonged second stage, more synto, more epidural, in the end I was asking for c-section or forceps or anything to get the baby out because I simply had run out of energy. I actually managed to avoid both, miraculously, and my girl was fine, got very good apgars 9 and 10, no concerns. But I was so heavily drugged I can hardly remember them putting her on my stomach or how she looked… which still really saddens me, because well, this is the best part, isn’t it? To sum up, I did not enjoy it, and feel like I failed as a woman, in a way.. Oh well.
My question to you is this: should I have insisted on carrying on on my own? It is so hard to argue with medics, especially when you’re in labour. I started feeling contractions on monday morning, at 4am on Tuesday (some 18hours later) I was at the hospital, 3cm dilated. Would you say I could have still had the chance to improve my “performance” naturally or is it the kind of time frame when one should get on with it? I know it is hard to answer such questions, I am merely wondering what was all the hurry about. It was a healthy pregnancy, with no complications…
The reason for my asking is that I am 5 months into my second pregnancy and having been down the induction road, I do not want to go there again. I have so far expressed my concerns about the EDD (I belive I will be two weeks late) and the response from my MW was that the guidelines are to induce at 40wk+10. I said “There is absolutely no way I am doing that, you can put in my records now “objects to induction”. For a moment she was speechless, but then said that thechoice was mine. Gosh, I felt like I’d won a little war there 🙂 More to come!
Sorry it was such a long message. Thank you very much for your time, I will continue reading your website with pleasure. Kind regards. Maria
Hi Maria
It sounds like you were having a ‘long’ early labour – which is very normal. It is impossible to say what would have happened if you’d been able to follow your body’s labour pattern. The problems is that in hospital they cannot accommodate women spending many hours on their labour ward – they will either send you home or speed things up. This is one of the many reasons I am a homebirth midwife now. First time mothers require a lot of patience, and when they are in their own home they can rest and await established labour and the midwife can check in (ie. is mother and baby well) and leave them to it… however long it takes. Because you have previously birthed, this time is likely to be quicker ie. a shorter early labour. And I don’t think you failed as a woman. I think the system fails women over and over again.
Here are couple of posts you may find helpful.
http://midwifethinking.com/2012/09/22/early-labour-and-mixed-messages/
http://midwifethinking.com/2010/08/18/the-effective-labour-contraction/
Dear Rachel, thank you very much for your response, I have read the suggested posts and wish I’d read them sooner. Everything you mentioned is exactly how it was with me. I can only say it saddens me to see how artificial the clinical environment seems to be in that regard and how easy it is for the medics to make us, uninformed womenfolk, feel we’re not doing things right, the very things we were designed to do. As for me, I have realised that a hospital birth is not for me and for that reason I am not doing it this time (unless it’s an emergency). I am currently choosing between a home birth and a midwife-led unit. Once again, thank you so much for the work you’re doing, I am growing more confident with every page I read, and believe it will be a totally different experience this time! Kind regards, Maria.
Just remember that you are the expert 🙂 Come back and let us know how your next birth goes.
Absolutely! I have spoken to my midwife and she seems in favour. The only things she’s concerned about is that last time I had a retained placenta, not sure whether that means it is likely to reoccur or what.. I am just reading your post “An actively managed placental birth..” and trying to enlighten myself in that field a little. Thank You!
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My 6th baby certainly knew it was time to be born and even how fast she came (precipitous birth) played a factor in her overall wellness at birth. I began experiencing contractions that were neither regular or strong around 5pm on her EDD. After experiencing weeks of pre-labour with my first 5 babies, I discounted these contractions as ‘only the beginning’ and continued cooking dinner, feeding the family and getting my other 5 children into bed. By 7pm the contractions were close(between 1 and 5 minutes apart) but still not regular and still comfortable. Being well aware of my history though, of a rapid second stage (after being at 2cm for days or weeks with mild, close contractions I would dilate to 10cm in 1 HUGE contraction and about 5 contractions only 1 minute apart later a baby would be born) I decided that I would take a shower and if things didn’t settle down then I would go to the hospital. Within minutes of entering the shower, that huge contraction came, my membranes ruptured (meconium stained) and I knew baby was about to be born. I called for my husband and told him the baby was about to be born and to call for an ambulance. He grabbed the cordless while I got out of the shower and felt the overwhelming urge to go to my knees during the next contraction. I managed to crawl into the hallway before the next contraction hit me and I managed to breathe through it even though I could feel the head was in the birth canal. I screamed at my husband this baby was coming when I heard him tell the operator that he couldn’t see a head, seconds before a huge pushing contraction expelled my daughter, head, shoulders, body all in one at which point I was grateful for my husband’s quick reflexes as he took the catch of the century. At this point contractions ceased and I managed to get back into a seated position, attach baby to breast and thought about how to clamp the cord. All that was available were some hair ties, my older daughter had left laying around so we tied these around the cord. 10 minutes later the ambo’s arrived, had no injection to give to help me deliver the placenta, so put some cord clamps on and took me to hospital to complete the third stage. Once at hospital, a syntocin drip helped get contractions going again and I was able to deliver the placenta. It was at this point I suddenly realised that there was a lot of interest being paid to my placenta, rather than my tiny, meconium stained baby who was still happily feeding. They quickly asked me if I needed to keep my placenta because they would really like to have it as a teaching tool for med students…..I was a bit confused until they showed me the ultra long umbilical cord that had 2 true knots, one on top of the other and a partially calcified placenta. They told me that many babies with true knots(let alone 2 on top of each other) do not survive gestation let alone delivery as these knots tend to pull tighter with each contraction. Had I have had the long pre-labour of my other babies then there is a fair chance that she would not have survived. These knots also finally answered the question as to why my baby had slowed in growth after 26 weeks, especially compared to my other 5 babies who were all between 9 and 10.5 pounds. Only my private obstetrician seemed concerned at the time about this as my baby was measuring at the 15th percentile. Public medico’s fobbed it off as not being IUGR as she was still at the 15th percentile, regardless of the fact that my 5 previous babies were all at the 90th percentile and above. My baby girl knew she needed out, and just how to do it as an induced labour may have resulted in a stillbirth due to the hyper stimulation of the uterus and prolonged first stage, causing a tightening of the knots and insufficient blood flow to baby.
Thank you so very much for this blog. I’ve been unable to stop reading the comments and posts which followed. I am 30 y/o and now nearly 42 weeks (in 2 days) and have had no doctor/obstetric consultations so far; first baby. Only the community midwives have seen me and since the pregnancy has been uncomplicated and I’m pretty healthy, I’ve not been urged to go to hospital. I have been told though, that an appointment will be made for me to go to hospital on the day of the 42nd week (Saturday – today is Thursday). I am dreadfully fearful of an induced labour. I think the psychological impact of the impending 42nd week is making me anxious and depressed. I’ve tried to explain this to the midwife and she has looked at me rather sadly and has not given away judgement one way or another, which is probably the right thing to do. I was asked at the last appointment whether I was still ‘wanting to avoid an induction’… I didn’t know where to begin.
I wanted to thank you in particular for the way you have handled the, rather emotive criticism if I can put it that way, that you have received from two posters on this thread – Nicholas and ‘Concerned’. My only message to them is this – as a solicitor and someone who considers myself to be a bright, sensible woman, I have never felt so patronised by the medical community as I have since I was pregnant. By this I am referring to exactly the type of sentiment they have both expressed, which minimises my very active part in this impending labour and emphasises in hysterical tones that “not all labours can be ‘natural”. Surely a more accurate way of putting it would be that ‘in all but a minority of cases, labour can be natural’? And surely, women should be encouraged, where possible, to labour naturally, as a basic starting point? Anything else stinks of medical pomposity and a critical lack of cognisance that labour is NOT a medical process, it is a normal and natural process, unless something goes wrong?
Nicholas states that it is ‘nonscientific magical thinking nonsense’ to state that the baby knows when it is time to come. And yet, all current research indicates that it is indeed, the baby, that triggers the natural process of labour. Of course, there will be instances where this does not happen due to the baby being unable to instigate it. My problem is with the offensive language which assumes that any woman focussed on a natural birth, who believes in her ability to birth naturally, is a nutter. I’m not a nutter, but I am terrified of being induced in a hospital for a number of reasons. If doctors and obstetricians spent more time speaking to women about their fears and concerns, instead of tutting and shaking their heads at women who question why they are being advised to be induced, fewer women would come away from the experience of induction traumatised.
Because of people like them, I fear being in hospital more than ever. Thanks to the majority of balanced views displayed on this thread and of course, the original post, I have more faith than ever in midwives and in myself.
Thanks Kate
Issues around birth and women’s autonomy are always emotive. I find it helps to understand where people are coming from ie. fear and a lack of ‘alternative’ experiences and lots of experience of complications (most resulting from intervention). I am lucky to have enough experience of ‘post guess date’ births to trust women and their ability to birth. It would be great if you came back and let us know how your birth went 🙂
Thank you very much for this Rachel, it is a huge source of support to have a forum like this to explain anxieties.
Dear Kate, I feel for you. I was augmented with my first baby and it was hell. I am 34 weeks with the second but have a feeling that my edd is way off and I’ll probably go over 41 weeks. I’ve asked my midwife why this whole edd thing is such a big deal for them and she said “Because two overterm mothers (in the area) have lost their babies”. I was like, hmmm, ok what sort of period are we talking about, 6 months, 10 years? Any specific details? She didn’t know, two babies have died, that was it. In other words, something may have happened in the past (it may have been a long time ago), but it was obviously no good for their statistics so they had to introduce strict guidelines and now because of that every woman will have to be induced. Some may find it convincing, I didn’t quite.
One thing is for certain though and that is they have to have your consent, they can’t tie you up. If you strongly disagree, they won’t be able to do anything but check regularly that you and the baby are both fine. Good luck with your appointment, hope all goes well!
Thank you Maria – I’ll post when I have news!
well said “if we were advised as why we were been induced we might come away less traumatised”
Hospitals and Doctors practise Evidence Based Care, sometimes referred to as Best Practise. Studies, research etc are analyzed and then policies are developed in accordance with what the research has shown. When you go against what a hospital or Dr is recommending, you are going against current research and practise that has been analyzed by experts with years of training. That’s fine if you choose to do so and accept the risks in doing so. My concern comes when people read opinions etc online and feel that that constitutes “having done their research”. Does online research by someone with no medical or research qualifications out weigh recommendations by those that have and have made recommendations?????? This isn’t a criticism of those that read online, I just think it’s important to acknowledge this when weighing up options etc.
I have been involved in the development of guidelines and policies for hospitals (as a practitioner and an academic). Recently on the working party for the Queensland Health ‘normal birth’ guidelines. The reality of how guidelines are created is very different from your ideals. Guidelines are influenced by the needs of the institution and cultural norms as much as the available research. One example is the use of partograms… a Cochrane Review concludes that they should not be used for normal labour and yet the partogram is used in most hospitals. I could go on with lists of examples of guidelines contradicting research findings… and attempt to explain why and how they do… but don’t have the time or energy right now. Archie Cochrane (the father of evidence based medicine) awarded the ‘wooden spoon’ to obstetrics as the least evidence-based ‘medical’ speciality in 1979. I don’t think much has changed.
I do agree with you that people should not just take opinions as fact… including my opinions. I provide links to research in my posts and encourage people to access the research and evaluate it themselves. Don’t assume that my words, or anyone else’s including a hospital policy or staff member are evidence-based.
Thanks for the reply. I should have mentioned in my post that my concern was not directed at this blog, but in general. Most people( through no fault of their own) would not have the skills to critically analyze research and studies. Anyway, just thought it was worth noting so others can take it into consideration when looking at options.
Critical thinking skills are essential and critical thinking needs to be applied to the concepts you believe and those you don’t. Check out all sides of every story. Evaluating research however can be more difficult but there are organisations such as the Cochrane Database that do this for the ‘lay person’ and provide an easy to understand summary and recommendations. For most topics there will be a peer reviewed literature review available in a journal.
However everyone is biased and every organisation is biased, and how research is conducted and interpreted in biased. This is why it is important to acknowledge bias and not assume that a doctor, or a policy, or a midwife, etc. is providing the best information or recommendations for ‘you’ as an individual. Women must take responsibility for their own choices. Ultimately they have to live with the outcome of their decisions.
That’s where it’s important to have the skills to look for randomized or blinded studies, rather than just “reading a study”. Also when making a decision re birth/ labour do you base that on a health providers experience, or a health providers evidence based practice. Again no right or wrong, but something to be mindful of when making a choice.
The origins of ‘evidence-based practice’ are from ‘evidence-based medicine’ which advocated to decide the best treatment for a patient involved combining 1. patient’s wishes 2. practioner’s experience 3. research evidence. And RCTs only answer particular questions and provide very general answers. I wrote an entire chapter on evidence-based practice for my thesis… which didn’t end up in it. Might turn it into a blog post when I get some time 🙂
People tend to decide first – then find evidence to support their preference anyhow. Humans are complex.
That hasn’t been my experience. I work in the clinical setting and am involved in writing policies. We have to review studies etc when writing them and updating them. Obviously clinical judgement may mean at times you deviate from the policy, but generally I think they promote safe practise for both hospital staff and patients. I haven’t experienced them being “influenced” by Dr’s/ hospitals preferences etc.
So your hospital does not use a partogram to assess the progess of labour for ‘low risk’ women? Supports water birth? Keeps the umbilical cord intact during resus? Does not carry out routine clinical assessments at set time frames during normal labour? I’m sure there are lots of midwives who would like to work there! 🙂 I don’t think this is the norm. Even the Queensland Health state guidelines were heavily influenced by the preferences of those on the working party.
I have some great data in my research of midwives altering their practice depending on the preferences of the obstetrician on shift (in a public hospital). Performing unnecessary assessments and interventions to keep them happy. Practice is never objective – it is best to be honest and examine the influences on how we interact with women and their birth experiences.
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Greetings ~ Thank you so much for what you do. I admit I have not read all of the comments and your responses so perhaps you have already addressed this question elsewhere. I am curious to learn if there is any research, or if you have any insight into whether or not herbally-induced labor with a midwife due to post term pregnancy can be associated with long labor and failure to progress. I was 42.5 weeks along with my first baby and felt very much pushed into a corner due to other people’s schedules (midwife, visiting parents). I felt very pulled in different directions – on the one hand feeling that I didn’t want to get the midwife in trouble for going any longer, also hoping my parents would get to meet the baby, and on top of that feeling impatient myself to meet my baby. Instinctively though, I did and do feel that letting the labor arrive on its own would have made the most sense. Eventually I caved in and induced with herbs and castor oil. I wasn’t prepared for the horrible diarrhea and burning pain that I experienced from the castor oil, all before even going into labor! I won’t go into all the details of the birth, except to say that part of me wonders whether inducing before the body was ready may have led to less forceful contractions. I realize you can’t comment on my particular birth, but since I did end up getting transferred to the hospital, with another 12 hours of pitocin and epidural before the c-section, I will admit that I feel I let myself get more or less cornered by the needs of others. Also, the predictable segmenting of the birth is a little eerie in retrospect – leaving me with the feeling that the birth ended as it did because my time was up on all fronts: the late term, then the 24 hour threshold of the midwives, then the 12 hour threshold of the obstetrician. All that to just ask how you feel about herbal inductions as they pertain to being “post-term” and how that using castor oil and herbs may or may not get in the way of a more favored outcome if the body is not really ready. I guess I am not convinced that a castor oil induction was as effective or powerful as my body’s natural urge would have been. All hypotheticals, I realize. But we need to recognize that herbal inductions are inductions too. And maybe they have risks as well that aren’t being recognized.
Hi Marya
Thanks for sharing your experience. I am not aware of any research in this area but anecdotally ‘your’ story is common. An induction is an induction whether it is done with herbs or medicine. If the body is not ready to respond you can end up with irregular contractions that do not open the cervix. That is why I have not provided a ‘how to’ induce ‘naturally’ in the post. Another concern is that at least with a medical induction the baby is monitored to detect distress and further intervention is close by. At home with herbs this is not the case. Having said that… if women are teetering on the edge of labour any type of induction is likely to be successful.
Thank you. Given that my cycle was fairly irregular the months prior to conceiving, I can’t say we really know when we conceived and therefore the idea of me being “late” was all just conjecture. Our son’s heartrate was monitored closely by the midwives after herbal induction, but my contractions were never very strong and eventually became more and more spaced apart. Anyhow, i did find a little bit of info indicating that there might be a higher risk of c-section with herbal induction, tho not a very robust study: http://www.instituteofmidwifery.org/MSFinalProj.nsf/a9ee58d7a82396768525684f0056be8d/e28ea481990d98da85257708004c24b6?OpenDocument. Many studies are highlighted here, you have to scroll down to Study#1 in the Literature Review.
Thanks 🙂
Thank you for such an informative blog. I am U.K based, 3rd pregnancy at 41 wks + 1 day and considered overdue. Today I had my last MW appt. where induction was arranged at 42.0wks, after much debate with hospital who wanted me to come in at 41 + 4. Having had first 2 babies at 42 wks (induced and horrifically painful) and second 41 + 6 (just made it naturally before induction due next day), I have been keen to avoid another induction. Although I am still nervous about the risks of induction at 42, rather than 41 wks I feel much more confident after reading your blog. Kind regards Rebecca
I’m afraid I had an experience rather similar to Marya above. Health warning: this is a trauma story. I finally went into labour on Friday night of 27th (42.0 date was 28th) with baby born at 8am right on 42 weeks on Saturday morning. I don’t know if it was anxiety related to the impending ‘due date’ but I went in to labour very fast and couldn’t catch my breath properly between the contractions when they started. I also had a bleed after the fourth or fifth contraction. We called the triage, to ask for the midwife to attend (as I was supposed to have a homebirth) but due to the bleed, they told us to make our way to the hospital. When I arrived, the midwives did everything they could to keep me calm, but once I realised that I was going to labour whilst strapped to the fetal heart monitor on a trolley in labour ward, I was despondent. I continued having fast contractions with 3-4 minutes between for the next few hours and eventually accepted morphine after about 5 hours. The baby had somehow slipped into posterior position which was causing my back to ache terribly. I recall crying out that ‘I just wanted to float in water’ but was told that was not possible due to the heart monitor.
I was urged to push (I would call it ‘directed pushing’) and managed to do so for another 3 hours until the baby’s heart rate began to fall. The whole team at the hospital demanded that I have a forceps delivery. I stated again and again that I could not consent as I didn’t want the baby to be pulled out using forceps, I didn’t want the spinal injection and I wanted to be able to feel my legs and I wanted to feel the baby. Eventually I was persuaded when one of the doctors said ‘if you don’t have a forceps delivery, your baby will die’.
Since then, I have felt terribly guilty about avoiding the forceps and the spinal. I feel as though I put her life at risk unnecessarily. I don’t recall much about the whole thing and I think I was overcome by the pain and the morphine and tiredness. It was a real shame, because I felt as though there was no effort made to try and turn the baby from back-to-back position, which would have made the whole labour easier and quicker. I was essentially forced to give birth from lateral position, which I wanted to avoid. The whole thing was fast and difficult. I’m grateful for my daughter, but wonder what could have been done to make it easier. I think less anxiety near the term date might have helped.
I’m sorry you didn’t get the birth you wanted, but I’m glad that your baby is ok. Unfortunately birth doesn’t always pan out how you want it to. I really hope that this is recognized more often, so people aren’t disappointed when things don’t go as planned. I was relieved to hear you consented to forceps delivery. With a low heart rate it sounds like she really needed out.
Hi Kate
I’m sorry your birth was like that. I don’t think it had anything to do with your anxiety. I am guessing that there was some concern about the bleed you had which is why you were ‘offered’ monitoring? Directed pushing is known to result in fetal distress (see my post on pushing and literature review). Your baby did well to cope with 3 hours of this… most get distressed within 30mins. Once a baby is showing signs of stress from directed pushing there are 2 options. Stop pushing and allow baby to recover or ‘deliver’ the baby quickly. In your case it seem the later decision was made. What happened is not your fault it is a reflection of normal hospital management of birth. Thank you for sharing your experience and be gentle on yourself 🙂
I lost my baby during inducement in 41st week. It’s devastating!
I am sorry that you lost your beautiful baby. x
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If the baby is the controller of the labour “on switch,” why is there the implication that it is anxious mothers who are responsible for their longer than average pregnancies??
I was induced for the birth of my first child at 41+6 because I had a sudden increase in blood pressure and was diagnosed with preeclampsia. I am currently 41 weeks pregnant and doing my best to calmly wait for baby to be ready. I don’t have any symptoms of preeclampsia. Last time at this stage I had severe edema. I don’t intend to have an induction this time unless I have a genuine medical reason to. I feel as though I’m doing a good job of just being calm and patient, but reading that maternal anxiety is a factor in longer than average pregnancies makes me worry;)…..
Hi Paula
It is thought that the baby and placenta signal to the mother’s that baby is mature and ready to birth. The mother’s body responds – part of that response is release of oxytocin… oxytocin is inhibited by anxiety. However, this will not hold labour off forever… otherwise a lot of babies would not have been born. It is normal to feel some anxiety as birth is imminent (http://midwifethinking.com/2013/03/27/feel-the-fear-and-birth-anyway/). Be OK with feeling a little anxious and find moments to relax – sleeping, massage, spending time with people who make you feel happy. Your baby will come 🙂
Hi, I’m really glad I found this blog, and I’m hoping to get some help to be able to make a more informed decision. I’m 40+2 today, and even though I was initially completely against any form of induction, following an appointment with my midwife I have agreed to a sweep at 41+1. If that doesn’t work I’ll have to see whether I’ll go for a medical induction, and if so when – I’m definitely not going for it before 42 weeks but then I’m not sure how much I should push it. If after 42 weeks you keep getting monitored every other day isn’t that safe enough for the baby?
I also have some reasons that make me think that the baby might simply not be ready yet. These are: 1) I was born late myself, after my mum’s labour had been induced, 2) I always had irregular periods, ranging from 28 to 45 days, so the EDD is probably even less accurate than usual, 3) I was a late developer – I had my first period at 17 1/2, maybe this doesn’t mean anything but I’m thinking my body (and maybe the baby) is just slower than the average, and 4) later scans showed different dates, the one from week 25 gave me an EDD of 9 days later than the initial one. Yes later scans are supposedly not as accurate as the first ones, but I’d think it’s something to take into consideration. Having said that, at the 12 week scan the EDD by dates and by scan were the same. Would you say these reasons have any standing? Thanks
Hi Chris – your reasons do have standing and there is evidence to support 1 and 3. Unfortunately this is your decision and there is no ‘right’ way – only what works best for you. And getting monitored every other day… what is your definition of ‘safe enough’? Safe is such a personal/individual concept. Some women might feel that an elective c-section at 38 week is ‘safe’… others might feel that no pregnancy care and an freebirth is ‘safe’. No one external to you should define what is ‘safe’ for you. Good luck – let us know what happens 🙂
Thank you for your reply. I’m being told that after 42 weeks I’d be putting my baby’s life at risk because the placenta starts to degenerate, so by safe enough I mean that I’m not risking my baby’s life. If the placenta does stop working as they suggest, would that happen from one minute to the next? Or would it be a gradual process so that by the next check-up they’d know its condition was declining and have time to act accordingly? And then would baby’s life be at risk straightaway or does it have some kind of reserves to survive for at least a while in case the placenta does stop working? When I asked these things they told me it’s something they don’t know, which is why they strongly advise not to risk it. But from what I understand the reason for the degeneration is calcification, is that right? So I’m assuming it’s something that wouldn’t occur within minutes or hours and they would be able to diagnose a degenerating placenta before it completely stops working?
Hi Chris – there is no evidence to support the idea that the placenta ages (see the article linked in my post). This a cultural understanding of how placentas function. Some placentas do deteriorate but this can happen at any time in pregnancy – so being pregnant is putting a baby at risk of this complication. Placental insufficiency is more likely with poor nutrition, substance abuse or pre-eclampsia than it is with being past your prescribed birth date. Even with real placental insufficiency it is usually a gradual process, and an umbilical artery doppler assessment is the most accurate way (scientifically) to assess placental blood flow to baby. If baby is having problems with oxygenation he/she will generally slow their movements to conserve energy. However, unexpected intra-uterine death can also occur at any gestation without any warning… again another risk of pregnancy and not necessarily anything to do with the placenta. The longer you are pregnant the greater this risk… if you drive a car every day for a month you are more likely to crash than if you drive a care every day for only a week – because you have spent longer in the car. There is no risk free option here – that is what the post is about. You need to consider the information and do what is right for you. Hospitals are very policy driven – policies are based on ‘professional (cultural) consensus’ at best… one obstetrician’s ideas at worst. In the post I have tried to lay out all the research and information so that women can gain further information to assist with making their own choices – whether they are in alignment with hospital policy or not. No one can/should tell you what to do.
Thanks again for the reply, I need to make my mind up now so that at least I can stop thinking and stressing over this. I’ll let you know what happens.
I gave birth last Sunday, at 41+4 weeks, without having the sweep or the induction, but I did have some amateur reflexology done by my husband and mum which might have helped! It all went well, waters broke at night and 6 hours later our little girl was delivered in the water – all healthy and lovely! We couldn’t be happier, thank you so much for the advice, it really helped me make the right decisions!
Congratulations Chris! And thanks so much for coming back to give us the news. Enjoy your baby girl 🙂
Hi Chris. Just a thought. I too often described my body as “slow”, like you I was a late developer and had periods up to 45 days. My due dates varied significantly. I declined induction and my baby came on 41+3 which I thought was still quite normal.
The only thing that I had not foreseen was the duration of labour and this is where my body did prove it to be a slow one. Started at home, 48 hours later I was hardly contracting with the baby’s head so low I could touch it, very frustrating. Everybody thought it was a matter of minutes but nothing was happening. Having tried everything my midwife decided it was safer to transfer me to the hospital for “a little sniff of pitocin”. In the end I had my baby in the ambulance.
Like I said, just a thought. If your body is slow the way mine is, bear in mind it can also labour slowly. I think I panicked a little and I wish I had not! If somebody had said to me “Relax it’s just your slow body doing it in its own manner” I would have probably had my baby at home, the way I wanted.
I would like to hear how it went for you. x
Thanks Maria for the input, I hadn’t considered this so it’s good to be prepared in case I’m in a similar situation. I’ll let you know how it goes.
Well done Chris and congratulations on your new baby girl 🙂
I just wanted to leave a quick comment on my last babe, who came in her 43rd week. I think it’s really important for women to hear stories of normal “late” pregnancies; My little one came out on Mother’s Day night, weighing a very average 7 lbs 10 oz. She was covered in vernix, and showed no signs whatever of post-maturity. Obviously, 43+ weeks was just the right amount of time for her. 🙂
P.S….oh, I almost forgot. The placenta! Big, thick, and glorious-looking. Certainly no deterioration going on. When my pregnancy went post-term, I remember reading that French women have 41 week pregnancies on average….so who’s to say what length of pregnancy is “correct”?
Thank you for the Wonderful posts, which I regularly use to support my London Hypnobirthing clients. My client this evening is having first baby at 43 and has been offered a home birth or water birth in midwife led unit. However, if she gets to 40 weeks the consultant has said that because of her age it is safer to be induced. blah blah blah – really? I’d like to provide my client with some facts so that she can make her own choice. Any thoughts appreciated.
This seems to be a trend at the moment. It is probably related to this research: http://www.ajog.org/article/S0002-9378(13)00534-6/abstract
Statistically women over 35 are at increased risk of stillbirth post dates… but as you can see the actual risk is still very small. The risk of stillbirth at 40 weeks for a woman over 35 is 10 in 10’000 compared to 6.8 in 10’000 for under 35yrs. At 41wks 15.4 in 10’000 vs 8.5 in 10’000. At 42wks 32.5 in 10’000 vs 28.2 in 10’000. Interesting the rates of infant death are lower for women over 35.
The system has little tolerance for any risk. It is up to the mother what she considers to be ‘risky’ for herself.
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This is a pretty good summary, acknowledging that neither option is entirely risk-free, but I think no survey could be complete without citing the recent review by Mandruzatto ( http://www.pqcnc.org/documents/sivbdoc/sivbeb/16MgmtofposttermpregnancyguidelinesJournalofPerinatalMedicine2010.pdf ) on the subject of post-term. It concludes, I quote: ‘It is not possible to give a specific GA at which an otherwise uncomplicated pregnancy should be induced.’
Following that and other research, the risk of waiting in the absence of any pathology is likely even lower than you quote. It is enough to make to me a good case against ordering induction for post-dates alone.
k_over_hbarc at yahoo dot com
Hi Andrew. I have added that review in the blog post – thanks for drawing my attention to it. 🙂
Thank you for this article. I was informed by my provider that they ‘don’t let women go past 41 weeks and will induce at that point. I went home and told my husband, ‘I’m not inducing at 41 weeks, what are they going to do, drag me to the hospital?’. I have since done a lot of research on this topic and have my mind fixed to do all I can to avoid an induction. I won’t say that I absolutely will not have one, because there are situations and risks which to me are greater than the risk of induction. That said, I am a nurse (not OB) and while doing OB clinicals during nursing school, the most difficult and prolonged labors were the induced ones. At this point in my pregnancy (22 weeks) I have had no complications and feel great. And I am prepared to fight my battle should my little one decide her timer isn’t up when the Dr. Deems it should be. Thank you for giving me a little more empowering amunition!
An interesting number of points have been raised
– I think ultimately it is a case of balancing a calculated risk (however inaccurate or difficult that may be) – against what that risk means to you.
I think whichever way it is sliced or diced
statistically speaking – a still birth can’t occur if a baby is out of the uterus.
Looking at implementations to avoid medically ‘unnecessary’ early term inductions
A recent study showed that the counterpart to reducing early inductions was a non significant increase in still births (14 per 10000, down from 10 per 10000). The sample of women in the analysis was about 20,000 – so the numbers look believable.
http://www.nature.com/jp/journal/v34/n3/full/jp2013166a.html
I think that early induction (looking at still birth rate + perinatal mortality associated with induction) still leads to a net decrease in overall baby loss. The more the risks that the mother has – ie obesity, smoking, sga, hypertension, age – the more the benefit vs risk for early induction.
However, as an OB/GYN – it is what these risks (and it is exceedingly hard to try and customize a risk to a patient) mean to you which count. – My wife and I was still happy to go T+13 in the first pregnancy (she was an undiagnosied extended breech so emlscs at t+14).; and T+12 in the second pregnancy whilst awaiting spontaneous labour. (obstructed labour, em LSCS for FTP). Granted, she was fit and healthy.
One thing to mention – most of the RCT’s looking at IOL for post dates women – excluded women with LSCS (including the Hannah trial – from where the policy of IOL from T+7) came from.
It is even harder to advise VBAC candidates with for example risk factors for the benefit/risk of waiting vs IOL.
http://www.nature.com/jp/journal/v34/n3/full/jp2013166a.html
I agree JK. Risk is a very complex concept. All we can do as practitioners is provide as much information as we can, both generalised and individualised. Women will attach significance to information that is meaningful to them and make their own decisions… often not the decisions that we would make ourselves.
Yes, stillbirth can’t occur if the baby is born, but the baby can still die and there are other ways it might be harmed by being born early or by induction itself that I can’t believe we have fully quantified. If it were the only factor we would deliver all women as early as possible, as early induction (with fetal monitoring) will almost always reduce stillbirths. The latest study I could find, http://link.springer.com/article/10.1007/s00404-013-2957-y/fulltext.html , shows the lowest rates yet; in particular the stillbirth rate not increasing until 42 weeks, only mildly at 42-43, and large after 43; but the increase itself may be misleading as those may well involve undiagnosed or ignored risk factors, especially the latter because of German policy that all pregnancies be delivered non-electively before 43 weeks, and the low total number. The argument based on stillbirths is therefore very weak; the difference in the Nature article you cited was not significant as stated there (if each sample were 20,000 we’d be talking about 28 vs. 21 stillbirths, which is well within likely random variation.)
It is quite true and should not be disputed that every individual case is different risk factors; but that makes it hard to justify a policy that all women be induced non-electively by a certain date. Letting them believe that they are gravely endangering their baby by not doing so, as many do in fact believe, is only a deceptive scare tactic. It is not true that women avoiding induction are just taking an unnecessary risk as your first paragraph seems to imply.
k_over_hbarc at yahoo dot com
I love your blog!! Thank you for posting objetive and empowering information in such a clear way.
I had a c-section because I went past 41 weeks… Now that I have more information than I had back then I realize the c-section was unnecessary and, given that there were no signs that anything was wrong, I shouldn’t have let my ob bully me into a c-section.
I’m thinking about a VBAC and wondering what sort of tests should be performed once you go past 41 weeks, If the placenta is not calcified are there any real risks in waiting?
You could opt for a biophysical profile which assesses a number of factors. The least useful assessment is a standard u/s. To assess placental flow/oxygenation you need to do an umbilical artery doppler assessment. You need to consider the potential stress involved in this testing and the mother’s knowledge of wellbeing (fetal movements, etc.). The risks of waiting or not can be read in the post. There is not a risk free option.
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Interesting read! I was induced 22 days after my ‘due date’, my waters were broken and 7 hours later was put on the synoxytocin drip. My baby was born 6 hours later without complication or too much pain. The main reason I was induced was pressure from consultants that I was putting my baby at risk. After I went 14 days over my due date I visited the hospital for daily monitoring & there were no signs that my baby was in distress. I was reminded each visit that my placenta could stop working at any time, hence the risk. I think the consultants were also quite nervous because they’d not come across anyone who had declined induction after the standard 14 days over due date. Most women, actually, ALL women I have spoken to had no idea there was a choice. A common response was “do they ‘let’ you wait that long”. I had done my research and was all for a natural birth so I knew all the options and risks. Whilst I don’t regret being induced or anything about my labour, I will always wonder when she would have arrived had we not intervened. Interestingly, there were no signs of post maturity in the placenta (it was my 1st question after it was delivered!)
I would like to see a more positive side of labour being championed instead of the expectation of horrendous pain and that intervening is the best way forward. Somewhere along the way I think we’ve forgotten just how amazing our bodies really are and if we have the right information, reduce the fear, relax and work with our bodies, giving birth could, & should, be dare I say, an enjoyable experience. I am hoping for a home birth next time round (which I had originally planned for the first!)
I thought this was a really well written article. But I would have liked to see some numbers for the adverse consequences of induction similar to how you presented them for post dates (ie a discussion of the relative and absolute risks of induction) . I have to say though, I am a health care provider and I was completely disappointed by the idea of ‘informed consent’ demonstrated at my antenatal appointment yesterday. They really glossed over the risks vs benefits discussion and no discussion of alternatives at all.
Thanks Sarah – do you mean the list of adverse consequences of the medications? These are as reported by the pharmaceutical companies ie. from notifications from users. Where there is research I have used it and if you click on the links there will be more detailed stats in the journal articles. Unfortunately there have been no large Cochrane (or otherwise) reviews of the adverse effects of induction = no relative and absolute risks available overall… unless I do the review and work out the numbers – which isn’t going to happen as that is certainly not my area of expertise 🙂
The recent case in the UK may provide practitioners with some food for thought regarding information giving: http://www.bmj.com/content/350/bmj.h1481. And there is no such thing as ‘informed consent’ – only ‘consent’ and one of the elements of valid consent = adequate information giving. Invalid consent = assault and battery in law. There are a lot of women being assaulted and battered in the maternity system!
I most certainly agree with the court’s decision there, though I have some doubt that case really required C-section, given an ideal system. What you are calling ‘valid consent’ is really the same thing as ‘informed consent’; I don’t see an issue with the name, but fully support you on the concept. This is an ideal case supporting my contention that C-section should be given as an alternative option when induction is discussed.
That article, which is paywalled anyway, does not mention induction, but the court judgement ( http://www.supremecourt.uk/decided-cases/docs/UKSC_2013_0136_Judgment.pdf ) makes clear it was used (and in a particularly troubling manner) – therefore it plays directly into Sarah’s concern of not having information to give informed consent for induction. She could not give that, not only without knowing risks, but without mentioning the options of scheduled C-section or waiting for natural birth (at least possible as there was no immediate need). The harm here could most definitely have been caused by the induction.
I also know of no reliable medical source isolating the adverse effects of induction. Controlled trials are really not definitive because of lack of blinding and the fact that many of the possible effects are very rare. One of the sources I do have – http://www.rima.org/web/medline_pdf/MaternalMorbidityCesareanDelivery.pdf – finds evidence that planned induction may be more dangerous than planned C-section; while not definitive, it at least raises some doubt.
k_over_hbarc at yahoo dot com
UK hospital episode statistics classify by mode of onset of labour (although a few of those inductions will be because of IUD)
So unbelievably grateful to come across your blog. The way you have written the piece and provided links to references/further research is invaluable.
I was due to be induced on Monday (due date was 10th June) however I am convinced my due date is incorrect. Plus the date I gave for my last period was wrong by 5 days – unplanned pregancy meant I was a bit all over place. I am almost completely certain I know the date of conception and this current date of induction would put me at barely 37 weeks. I had such a strong gut feeling that the 22nd was to soon I have cancelled this induction and I am going to speak to a midwife instead.
I am low risk, baby has been fine all the way through so an induction just seems crazy. My mother went from 11 Jan – 11 Oct with me and I have feeling my baby is not ready yet. I am so go with the flow most of the time that I had to question this induction. I only have a leaflet and the research I have done since I got date on 15th.
I feel like I should trust and listen to my body! I have always been quite good at listening to it!
Thanks again
I’m pleased you found the information helpful. Yes – trust and listen to your body and baby! Please come back and let us know when/how your baby arrives 🙂
My baby arrived safely 25th June by C-section… Overall it wasn’t a pleasant experience for me.
I refused to be induced on the Monday wanting to give my girl just a little more time. I was told I would need to go into hospital on Tuesday to see a consultant and sign something about risk. On the Tuesday in the early morning I had started to have very minor contractions. I went to the hospital and they monitored my baby, who was completely fine, noting the natural contractions which had increased in pain, although bearable, and came about every 10/15 minutes but also then seemed to disappear.
The consultant basically made me feel like baby had to come out asap (due date had been 10th). With what was happening naturally already I reluctantly agreed to be induced (had thing they insert and went home and then the hormone after by drip in hospital).
In hindsight I should have waited until the Wednesday to be induced but I felt unsure in my situation and was frightened by the mentioning of stillbirth risk. Even though I am sure she would have been completely fine for one more day. Plus I live 5 minutes away from the hospital.
After 36 hours of intense labour I was advised I was still only 2cm dilated and by this point completely exhausted, I broke down and gave into an epidural. This did not work it numbed me from my feet to my knees (which would be great if labour pains felt like getting kicked in the shins!). So c-section had to be done. Very far away from the natural water birth I has envisioned! However we are both fine, she is a very healthy little girl (scored 9/10) and I have recovered well.
I am now frightened of having to have a csection again if I do decide to have another. I feel disappointed it happened to way it did but have tried not to dwell as unhealthy. Just grateful we both got through it safe!
Thank you for returning and providing an update. It is OK to be feel love and be grateful for your baby and be disappointed about your birth experience. Be gentle with yourself x
Your website is the most amazing thing I have read in a very long time! Thank you so much for creating this. I am a mother of three and a labor and delivery nurse in New Mexico, US x 11 years. I have travelled to many hospitals, rural and urban, and have learned so much about the importance of empowering women during the labor process… even in the most disrespectful and terrifying moments.Reading your articles and blogs feels like home.
I started working in labor and delivery after having a traumatic first delivery in a university hospital in Switzerland, enema, shave, Pitocin, epidural, forceps, third degree laceration repaired by a student and my baby put in a nursery. Fortunately, I birthed my two following children in warm, soothing water, surrounded by loving practitioners as well as family, and had a totally different experience. This dramatic shift showed me what a difference a caring, respectful environment can make in the life of a family.
Just today, I found myself despairing at the amount of inductions we offer to and carry out on women. It seems like anything can be done “in order to protect the mom and baby from harm”. Many women are made to believe that inductions are necessary to be a good parent. When I advocate for the patient ( which is in my job description, in case anyone criticizes me for causing trouble), I am always very saddened by the look of total surprise on women’s faces when I tell them the risks involved with being induced. This two faced game played by many health care providers, claiming to care only for the safety of the patient but making most decisions for convenience and self preservation is almost more than I can handle. Is this really what we went into health care for? No amount of EBP, followed guidelines, increased productivity or “patient satisfaction” can replace an authentic one on one caring and respectful healing interaction. This is where true healing happens.
Reading your work, people’s responses, seeing how strong and sharp your arguments are and feeling your passion in helping women ignite their power really inspire me to carry on. Thank you again, sincerely, Nathalie
Thank you Nat. And thank you for the being there for women. I also came to midwifery through comparing my own birth experiences too – one disempowering, the other empowering. It is very frustrating working in ‘the system’ – I did it for many years. However, you can make a huge different to the individual women you care for. Sometimes just asking a woman what she wants to do is enough to make her realise that this is her birth/body/baby and she should make the decisions. They often don’t even know they have a choice or are ‘allowed’ to decide. All you can do is keep doing your job ie. sharing honest information and reinforcing the woman as the decision maker. You can’t own her decisions – or the out come of her decisions. Women make decisions based on their world view, beliefs and experiences i.e. often from a place of believing that medicine and men are the experts. You can’t change this – it is embedded – but you can make sure she has all the information about her options. You can also push for political, cultural and social change in maternity services – but in most cases you have little power to change anything alone from the inside.
Keep up the good work. Knowing that there are care providers out there being ‘with woman’ inspires me 🙂
Thank you for creating this resource. I read the comments and it seems like there is not data about the risks of induction, although I will look at the links. You mention in your post that the experience of first time mothers vs. women who have already given birth is different. What about the risks for women who have already given birth? I see from your article that the first time mothers will have a highly increased risk of c-section–what about women who have already given birth?
To be honest, both of my children’s births were traumatic for me, even though one was natural etc. and one was with the epidural. But I am now 9 days past my due date with my third. It has been a stressful pregnancy–not an unhealthy one, and I am afraid of not inducing because of the risk of stillbirth. I had an early ultrasound and the baby seems to be growing on course with the estimated times, so this is my latest baby, it isn’t an off estimate of the baby’s due date. I feel like if the baby comes out at least there is no risk of stillbirth, but I did want to try to compare the risks of induction vs. waiting and don’t really find any numbers to compare. I think they will induce me in two days. I don’t understand what the risks of induction are. I am not happy with either option–I wish labor would come on its own, but if it doesn’t I feel afraid to wait.
I don’t think my birth experience will be positive either way. Induction will probably be worse, but honestly even though I am sure that you are right and obstetrics is not evidence-based etc., part of the problem seems to me that the whole system is so hard to manage. For example at the hospital where I will give birth they do have a birthing pool. I had a midwife when my son was born and requested the pool. She called ahead to the hospital and asked them to fill it. When we arrived no one had turned the water on and by the time it was full I was pushing and the last thing I would have wanted was to try to get into the pool. This time I switched from the midwifery practice because I found that they were not communicating my test results to me and since they are not allowed to give diagnoses by my health care group, no one was looking at tests like ultrasounds for weeks. They would order a follow up, I would have it, and when I came back for my appointment no one would have looked at my follow up. So since only the midwives can supervise the pool labors, I can’t use the pool this time either.
Your care providers should be discussing the evidence with you in order to support your decision making. Every woman will have a different perception of risk and of what is important to her… this needs to be explored.
I am a little confused about what information you are seeking regarding risks… the blog post includes discussion of and links to the research – including a Cochrane Review (that reviewed all of the research) and comparative stats for induction vs waiting. This evidence is all general to a degree and that is why your care provider should discuss it in relation to your individual circumstances and preferences.
Again in general – for women who have previously given birth vaginally there is not an increased risk of c-section. However, the risks of prostin and syntocinon are increased – often care providers will avoid these medications or use them very carefully. You can read the risks of these medications here: http://midwifethinking.com/2011/07/17/induction-a-step-by-step-guide/. The reality is that most women who have previously given birth vaginally respond well to induction – with careful monitoring – and birth without complications. The experience of birth is different ie. it is not physiological, is usually more painful and will involve interventions such as continuous fetal heart rate monitoring, IVs, etc. For some women this is important. For example, it is not appropriate to have a waterbirth if you are being induced – because of the need for continuous fetal monitoring and the risk that if the baby is compromised by the induction process if is best not to be born under water.
The important thing to know is that the decision to have an induction is yours. No one can induce you without your consent. You need to make the decision that feels right for you. Your care providers job is to discuss evidence based information with you and help you work through your questions and concerns… then support your decision.
Good luck 🙂
My partner is quite anxious about my decision at 42+1 to delay induction. We went to hospital and had agreed to do induction today but I feel like I need more time and baby will come in the next few days. We had planned homebirth. My check up showed some small calcification of uterus, 1cm of fluid and baby is predicted to be around 6.11 pounds. From that basis consultant wants induction. I’m keen to go for the next few days and see how I feel. I was having cramps yesterday but seems to have stopped this morning. My partner is quite anxious and I’m not as worried. Baby is moving fine and I feel fine. In my mind if everything is OK by check ups and she’s not here by 43 weeks then I’ll do it. Is there anything else I can do?
That is all you can do… listen to recommendations and information and make your own decisions based on what you feel is right for you and your baby. Good luck 🙂
Really informative and an Eye-opener. I wish I had seen this before. Here in India C-Sec is on the rise for the past few years.(Statistically unconfirmed but heard from friends, relatives or acquatainces). This happens mainly in hospitals as more and more people are opting for hospitals over home. The hospitals do make easy money as the bills are 2-3x that of normal delivery. Moreover many expecting moms of new age opt for a C-Sec to have it quickly without having to go through natural labour pain. My wife(first time mom) has just reached 40weeks. The hospital suggested admission (and probably Induction soon after) asap. The reason given was:
1) Reduced Liquor – 2cm
2) 1 portion out of the 3 from the cord is around baby’s neck.
The doctor pointed out that the liquid has reduced sharply. As per her this should be 10cm.
How important is the Liquor mentioned here? What can lead to its reduction? What are the risks? How big is the risk? I observed that the readings of this Doppler test were not consistent with earlier USG so much that the EDD moved 3 weeks later. Could it be possible to have wrong decisions made solely based on Doppler readings. I am planning to show the report to 2-3 other hospitals and if required, have the Doppler redone by someone else. Any guidance would be appreciated as I have only 24 hours to take the decision whether to go for induction or wait for the Natural term. As far as possible, we want to have a safe and healthy mom and baby naturally if possible.
First of all lets get the cord around the neck issue out of the way. A third of babies have the cord around their neck at birth – this is normal and not a complication. See this post for more information: http://midwifethinking.com/2010/07/29/nuchal-cords/
Secondly – the reduced liquor is only a problem if it is caused by a poorly functioning placenta, more info here: http://midwifethinking.com/2013/08/14/amniotic-fluid-volume-too-much-too-little-or-who-knows/ 2cm is still within normal for 40 weeks.
It is very sad to see the exportation of the medicated birth an the impact it is having in other countries. I hope your wife is given the support to do what she feels is best for herself and her baby. Good luck – it would be lovely if you could come back and give us an update once your baby arrives 🙂
i am only just 5 years on discovering the risks of induction! sadly! i wish i knew then what i am learning now! i believe both myself and my son are amazingly fortunate to be alive. I was 39 years old, first child, alone and so much went wrong! i had an unexplained bleed at both 14 weeks and 27 weeks and at 40 weeks it happened again a day later they attempted to break my waters, absolutely no discussion about the whole process of induction just the factual explanation of the sweep, they tried 2 times to no avail, the next morning they said “induction” was probably best and that was it! i trusted them, i had a detailed birth plan and had researched so much with the exception of induction, it just never occurred to me! i was put on the drip of oxytocin at 9am, an hour later the contractions started they continued throughout the day and heart rates were monitored, however it all started going wrong early evening when the midwife had gone off shift, the pain became immense, g&a helped along with hypnosis but a couple of hours later everything changed, i was left alone for 4 hours by this stage i was climbing the ceilings literally with the pain! i truly thought i was going to die! eventually a crash team arrived! the doctor was going to do a scan started it up but then stopped! they tried getting me to push as i had gone finally from being 3cm dilated all day to 9cm, there was too much pain and baby’s heart rate was dropping so they decided there was no alternative but to do a c section, however not before attempting birth after the epidural through vaccum cup and forceps. This failed and by this stage my body had almost given up and everything became urgent. I lost 2 litres of blood and the placenta had separated. Early hours of the next morning i was lucky enough to meet my beautiful son. The only thing they would discuss with me surrounding the whole birth was my son was born with the cord around my neck and he was stuck in the birth canal, i felt that they were avoiding me! My after care was appalling, a day after he was born i knew there was something wrong with him, the ward refused to accept that i believed he had Jaundice! hours later the community midwife arrived and got him rushed to neo natal! another lucky miss he had seriously high levels for a week! i kept asking during this week to see the doctor to have an explanation of the birth and what had happened, this never happened. My son had sever colic at 3 months but appears to be a healthy and active 5 year old now! i only stumbled across the whole oxytocin after reading an article recently, i had absolutely no idea! and to this day my body has never felt the same! i was a fit and healthy 39 year old (and i believe it was this that kept me alive!) i was serving in the forces at the time. My body has never been the same since, I am still very active but have never been able to lose the birth weight despite having done baby fit classes and all other things! I always believed i had just experience a horrific birth but now i believe most of what happened could have been avoided had i not been induced and looking back we were the bleed had stopped and we were fine so i am not even sure why they took that decision! I had an operation a year ago to lift my uterus as was badly incontinent! its a comedy of errors! i am considering requesting my records out of interest.
I am so sorry that you were not informed enough to give consent for all that was done to you and your baby. It might be helpful to get your notes and go through what happened with someone independent to the hospital/staff involved.
I was induced for my 3rd child. We induced because I have large babies. With my 2nd went into labor on my own at 41weeks3days he was 9.9lbs and I hemorrhaged, so it was I was in ultrasound to keep track of how big my 3rd was getting at 39 weeks he was 8.11lbs .I was induced at 40weeks1day. The induction was horrible. My son was pushing the back of his head out first..I had to do the hands and knees thing and didn’t work!then my cervix was not opening properly onside was stuck after 12 hours I couldn’t take the pain anymore and recieved epidural. He was born 3 hrs and 8mins latter. The whole experience was bad and I’m thankful to God that we are both here and ok. My husband said when our sons head started coming the doctor grab his head and spun him? My husband said that he feared the doctor had broken his son neck. We are OK but is that a typical thing doctors do?
I am sorry that you had such an awful birth experience. It sounds like your baby was in a ‘posterior’ position – http://midwifethinking.com/2010/08/13/in-celebration-of-the-op-baby/
Unfortunately it is common for care providers to pull and man-handle babies as they are being born. They are taught to do this in training despite the lack of evidence supporting the approach… or the experience for the baby: http://midwifethinking.com/2010/08/07/birth-from-the-babys-perspective/
I am pregnant for the first time with twin boys (after 7 IVF tries). I’m currently 27 weeks and everything looks fantastic. They are healthy and so am I. And, they are almost always head down (raring to go, maybe?). I am on lovenox, though, and will end up switching to heparin as the EDD nears. I am 36 years old and in Florida.
My OB has told me that he will not allow me to go past 38 weeks. I’m assuming this is because of my age and possible placenta deterioration? But, I’m not sure. I was surprised. I had hoped as long as we were all healthy I could carry on until I could have a natural birth. But, I’m assuming I’ll have to be induced at 38 weeks. I’m anxious about this because I know it increases my risk for a c-section and I want a vaginal birth.
Do you have any insight to share on induction of twins? Can it be done with good outcomes? Would you induce at 38 weeks? Or try to wait?
I had so wanted a water birth with my favourite midwife, but because of twins, that is no longer an option. At least not here in Florida. I am trying to make the best of what I have to work with, though.
I can’t give you recommendations or advice. However, your OB can not make you do anything. There is no such this a ‘allow’ – you are an adult human with legal rights. No one can do anything to your body without your consent. Your OB can recommend or suggest a course of action – but it is not up to him to ‘allow’ you, or ‘let’ you do anything.
In making decisions about what you would like to do, you need to consider your individual (twin) situation. Find out why your OB recommends early induction… discuss your wishes for a vaginal birth. Bear in mind that twins do come with additional birth risks and that your OB may be unfamiliar and inexperienced in natural vaginal twin birth (because it is rare due to routine intervention). Ask him what his experience/rates are. Do you have a doula or support person who can help you get the information you need and the support for whatever you choose to do?
Good luck! 🙂
Thanks for this article. In our book [proactive support of labor] we too show that there are more C-sections.
However, your book also advocates lots of intervention to ensure that a woman’s labour pattern meets prescribed timeframes (that are not evidence based). There is more to physiological birth than a baby arriving out of a vagina. Women are beginning to question these medicalised notions of birth that are not evidence based but culturally based. Do you advocate that care providers give adequate information about these interventions to gain legal consent? https://midwifethinking.com/2010/09/15/information-giving-and-the-law/
https://midwifethinking.com/2011/09/14/the-assessment-of-progress/
https://midwifethinking.com/2015/05/02/vaginal-examinations-a-symptom-of-a-cervix-centric-birth-culture/
Yes. But it is very difficult. As you know of course. Actually, I am a midwife and I see in practice that the psol timeframe is very interesting for women. I see too many women telling me the first appointment that their mom/sister/friend suffered for hours and that they don’t want that. And since we introduced psol in our practice our homebirth rate increased the first year with almost 15%. That was mainly because of 121 support from diagnosis in labor. But it meant that we stay with women from 1 cm. And when they are 7 then within 2 hours many asked if they could have the baby at home.
When you say ‘interesting’ what do you mean? If a woman is told ‘we can ensure your labour is shorter’ I’m sure they are interested. However, they also need to be given information about physiology and that’long’ is not necessarily worse. They also need to understand the risks of the proposed interventions, VEs, ARM, etc. As you note the homebirth rate increased mainly because of 121 support from early labour – why can this only be provided with psol? Seems you are doing lots of VE’s despite no evidence to support this intervention in normal labour. Do you share the cochrane reviews re. VEs and partograms with women so they can make an informed decision about whether they consent to psol?
We do what we can, but in our socially deprived neighborhood and the lack of time we have here in the Netherlands this is something that is very difficult. People here don’t read magazines. don’t have money for prenatal classes etc. They are busy surviving and giving birth is just something rotten that they don’t expect to be positive at all. Quite often we hear: o’ I’ll have an epidural that is easy. I work here now for more than 30 years. I developed the website keepingbirthnormal.com especially for women in my neighborhood.
And as for the number of VE’s Women who deliver according to psol have on average less VE’s than the rest of them. 3.7 vs more than 5. And we have lots of women who have only 1 or max 2 VE’s. We don’t do from as a routine, we don’t press for VE’s when some one doesn’t want it. But then again, the women I work with have very little perception. Asked about a birth plan they will say: O, I don’t know. I suppose it hurts like hell.
About options like delayed cord clamping and no active management of 3rd stage: o, the dr will know what is best. It is really very challenging. And in that challenge we find psol very useful.
I understand you have constraints, but I cringe at the idea that women from socially deprived backgrounds and who do not have good information literacy do not deserve the same standard of care as other women. I also worked in a very deprived area of the UK for years – so I do understand the challenges. However, the legal requirements for consent are the same for all women. I would be really interested in your response to this post: https://midwifethinking.com/2016/06/28/responsibilities-in-the-mother-midwife-relationship/
It is such a shame that midwives are not taking this opportunity to help women reframe their birth and body in a positive way. Birth is a rite of passage – yes it is painful but it can be transformative (see my PhD work). This is also an opportunity to reinforce their rights as women… and their responsibilities in terms of making decisions about their body. I understand your motivation re. your website, I just disagree with the underpinning paradigm. And think it is contradictory to tell women that their bodies are capable of birth, then walk about ‘effective contractions’ and imposing patterns of labour that may not match their body’s unique way of birthing. More worrying are statements such as those about ‘corrective interventions’ eg. ARM which do not also present the risks of these interventions or make it clear that they are NOT evidence based. And statements such as ‘the midwife will clamp the cord’… imply that there is not decision to made by the woman about this.
I am not sure about the legal and professional requirements in your country but I generally midwives are expected by the ICM to: promote physiology; provide evidence-based care; and ensure that the woman is the primary decision maker.
I’m an antenatal teacher in the UK and your opening sentences resonate so much with exactly what I’ve been saying to clients for years; that everything in life carries risk, there is no “risk free” option and that all we can do as individuals is consider which bunch of risks feel more, or less, acceptable to us. I often hear women telling me, “I had to have x intervention because I didn’t want to take any risks” and inside I’m thinking “but you’ve just had an horrendous birth with epidural, forceps, episiotomy, difficulty breastfeeding, etc, etc….” Antenatally, I send clients information about induction – procedures, NICE guidelines (highlighting the “choice” part, the bit that says they shouldn’t be alienated from their health professionals, the bit that says what extra antenatal care they should receive if they decline the “offer” of induction, etc) and I’ll add a link to this blog now as well. Thank you.
Hi,
I enjoy your posts. I especially like your emphasis on leaving the decisions in the hands of the mother.
I had my six sons at home and unassisted. (Partly due to not wanting a midwife telling me what to do.)
My bag of waters started leaking with first baby before his due date. So I took castor oil and that worked. I took castor oil again with my second, but that time I kept having to run to the toilet with diarrhea. I normally go past my due date.
My 3rd baby was induced with chiropractic(pushing on my feet and ankles).
Boy number 4, we used an enema and nipple stimulation(and sex) at 2 weeks past due date. He was 11 lbs. So my last 2 boys I induced closer to their due dates.
It would be great if more people knew about the alternatives to medical induction.
Thanks for answering so many of my birth questions with your posts. Really good stuff!
-Kathleen
There are risks with all induction methods. Induction means you are trying to get the body to do something it is not ready to do. For some alternative methods e.g.. castor oil there is research questioning safety. As a registered midwife I don’t advocate any alternative methods of induction… and would be very reluctant to attend a homebirth if I knew it was an induced labour. Of course, I totally support women’s right to induced their labour if they feel it is right for them 🙂
That link to BellyBelly did not provide ‘alternative’ or ‘natural’ inductions. It had 5 induction methods AROM, sweeping, Pitocin, prostaglandin gel, and a Foley catheter.
Natural induction methods: nipple stimulation, sex (for Orgasm for woman and semen on cervix), castor oil, enema, blue and black cohosh.
I’m sure there are more, but it’s a start. There are safer alternatives to medical induction.
Nipple stimulation / Sex / orgasm will only work if the body is ready to respond to the release of oxytocin i.e. the cervix is ripe and the oxytocin receptors in the uterus are ready. There is not enough prostaglandin in semen to make a difference re. cervical ripening. Blue cohosh can be dangerous. I’d rather undertake an induction of labour in a setting where it can be monitored well… induction is not physiological – it is an intervention and can result in complications regardless of method. There is no such thing as a ‘natural’ induction – nature is not ready to birth yet, otherwise it would be happening without induction.
This article provides a good summary of the research regarding most methods of induction: http://www.ncbi.nlm.nih.gov/pubmed/22032440
This article describes a complication associated with blue cohosh: http://www.ncbi.nlm.nih.gov/pubmed/9544922 (I have also heard of complications from this herb in my circle)
You won’t find information about alternative induction methods on my blog because I have professional/legal obligations re. the information I provide.
Hi Rachel! I was wondering if you can translate the article you referenced for the lay person – https://fn.bmj.com/content/77/3/F171.full – I’m really struggling to follow it and would love to get a good understanding of it.
This is what I wrote in my new book to summarise the evidence re. placentas:
“There is evidence that the structure and biochemistry of the placenta changes as pregnancy develops. Some scientists interpret these changes as the placenta growing and adapting to meet the changing needs of the baby. Others suggest that these changes are due to aging and deterioration of the placenta. However, tests of placental function show no changes in post-dates pregnancies. In addition, babies continue to grow after 40 weeks, suggesting that they continue to receive adequate nutrients and oxygen. The studies that identify an increased perinatal death rate for post-dates pregnancies do not identify the placenta as a problem.
– Why Induction Matters: http://www.pinterandmartin.com/why-induction-matters.html
Thanks so much for that. I want to tell the world about my pregnancy but they would laugh. Finally now people come up to me and ask me and rub my stomach to make sure. I don’t see a dr because in the beginning they all thought I was crazy. I feel my baby move and kick all the time. It’s really a blessing because it’s my 1st.
Holy bananas. After a 2 day build up, and contractions at home for 16 hours, my midwives had to transfer me to hospital. They basically forced an epidural on me, despite not wanting it,then they made me take the induction drug, despite me not wanting it. My placenta wouldn’t come out, and I wouldn’t stop bleeding, so after being half stitched up from being cut, I was re-opened to surgically stop my bleeding (to this day I dont know what was actually done). It took 6 weeks to get my son breast feeding, after snipping his tongue first, but I was determined. He had a few minor issues later, including speech problems, which I’ve read may correlate with the use of fetal monitoring and earlier with ultrasounds. I’m so grateful for my only child, but I wonder if my pregnancy was less medicalized if the outcomes would have been better.
The risk is the drs playing God. They take your last period and the size of your baby to determine your due dates and that’s not always correct. They say that a woman doesn’t see her cycle when pregnant, that’s not true. They say Creptic pregnancy isn’t real, they are so wrong. Why they won’t admit they are is beyond me. Do you think God would let you get pregnant and don’t know when the due date. He only need the Dr, when there is an emergency.
Hi Rachel, do you know what the evidence is on syntocinon infusion rates? I can see that different hospital use different rates and I’d like to know which rate is using evidenced-based medicine. I can’t seem to find any studies
different hospitals have different protocols but generally it is about increasing the rate until there is an established contraction pattern. Usually very high levels require OB review/sign off. I don’t think there is research about rates per se.
Really enjoyed reading this article and it’s links and references. It is well written and easy to understand for women and professionals alike.
My placenta stopped working at around 39 weeks, apparently, my baby had stopped growing, I was induced by a drip method, and I gave birth within 18 hours, Being very stressed I asked for an epidural which on hindside was not necessary as my beautiful baby daughter (my second child) was small and birthed quickly. She was very jaundiced not sure if it was the induction drug or the epidural? which was too much for her liver, She was put in an incubator for 3 days, I write to flag up to other Mums to be, be careful with the epidural you may not need it, great blog thank you, Helena
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