Understanding Induction of Labour
Induction refers to any action that is designed to initiate the start of labour, this may include at home remedies such as nipple stimulation, sexual intercourse, or castor oil, acupuncture and homeopathy, membrane sweep, balloon catheter, prostaglandins, artificial rupture of membranes or IV Oxytocin.
Understanding the different methods and their effectiveness:
Sexual intercourse- limited evidence to support its use for induction, however, in low risk singleton pregnancies sexual intercourse should not be limited.
Acupuncture and Homeopathy – some benefits in improving cervical maturity to aid in the onset of labour, however is often regarded as more beneficial to optimise the environment so the body is in its optimal state when the baby is ready to be born.
Membrane sweep- Involves the insertion of one or two fingers into the cervix and using a circular sweeping motion detaches the membranes, aids in the release of prostaglandins to encourage thinning and stretching of the cervix and dilatation potentially promoting labour.
Balloon Catheter – balloon is inflated with saline solution and rubs against the side of the cervix, once dilated to 3cm the balloon will fall out, may be effective in inducing labour. Has been associated with increased rates of oxytocin use for induction.
Prostaglandins – A tablet is placed inside your vagina that slowly releases prostaglandins over the following 24 hours, oral prostaglandins may also be given. Most women do not go into labour with prostaglandins and additional methods are used.
Artificial Rupture of Membranes- The amniotic sac is broken and releases the waters, “breaking the water”. It is used to speed up labour and assess amniotic fluid, carries the risk of umbilical cord prolapse and its effectiveness is inconclusive.
IV Oxytocin – Often used after a balloon catheter, prostaglandin or artificial rupture of membranes has been tried, patients are unable to have a waterbirth after receiving IV oxytocin and movement is limited due to IV and continuous fetal monitoring.
Rising Rates of Induction of Labour
One of the main reasons women have induction of labour is becasue they are told that this will lower the chance of stillbirth. However this is not always the case as it depends on the reason for induction. When the reason for induction matches research findings of lowering the chance of stillbirth, the difference in rates of stillbrith for those induced compared to those not is minimal.
And unfortunately induction causes more medium and long term side effects to both the mother and the baby.
In 2020 35.5 % of labours in Australia were induced. The proportion of first time mothers who were induced has increased form 26% in 2004 to 46% in 2020.
The two most common reasons for induction are a suspected larger baby or post term. Other reasons include- age, race, body mass, preeclampsia, chronic high blood pressure, low amniotic fluid, fetal growth restriction, pre labour rupture of membranes or medical conditions of the mother or baby.
Large Baby
A big baby is classed as weighing over 4kg at birth, only 1% of babies in Australia are over 4.5kg at birth. Inaccuracy of estimated fetal birth weight is more than 10% outside the actual birth weight in one quarter of the population and it is estimated that over 30% of women are told their babies are quite large, however only 1 in 5 of these women actually delivere infants over 4kg.
Unfortunately often in private obstetric practice “seeding” of the notion of a big baby will occur throughout prenatal appointments, increasing fear in mothers that there baby is “too big”.
Post Term
Post term refers to a pregnancy that has extended beyond 42 weeks gestation. Often an induction is encouraged at 39 weeks gestation, not 42.
Induction prior to post term (42 weeks) was associated with few beneficial outcomes and severe adverse outcomes. Rates of long standing illnesses at 5 years old increases, as well as increased likelihood of special needs education, metabolic syndrome and diabetes mellitus in offspring.
Impacts of Induction
A 2020 study found:
72% of women induced had hoped to have a spontaneous labour.
19% did not feel they had a choice about induction of labour.
26% did not feel adequately informed about induction of labour or were uncertain if they were informed.
17% had not been given any other alternative options.
30% did not receive any written information on the induction.
A Finnish study of over 95,000 births also found that:
Labour induction produces a more negative childbirth experience for the birthing person.
Women who had induced labour had also decreased likelihood to achieve vaginal delivery.
The highest risk for a poor experience is when labour induction results in an operative delivery.
Some advantages of waiting include:
Avoids the risk of being born too early – the baby is born when the baby is ready.
The hormonal orchestra that aids the physiological birth occurs- potentially increasing fetal and maternal outcomes associated with this.
Improved breastfeeding rates.
Better psychological outcomes for mothers.
Improved long term health and cognitive function of babies.
If you choose to decline induction of labour:
Pregnant persons can choose to decline or postpone induction of labour.
Recommend maternal and fetal assessment instead.
Consider monitoring from 41+0 weeks and offer twice weekly.
Cardiotocography and Ultrasound for fetal wellbeing.
Provide verbal and written information on fetal movement.
Contact your health care provider if you are concerned.
This blog post is intended to be informative only, please talk to your health care provider before making any health care decisions. We encourage everyone to do lots of research, ask your care providers lots of questions and trust yourself and your body.
As always feel free to reach out to us if you have any questions at info@tugunosteoptahy.com or
Disclaimer
The content provided in this blog post is for informational purposes only and should not be considered a substitute for professional medical advice. Induction of labor is a medical procedure that should be discussed and decided upon in consultation with a qualified healthcare provider. The information presented here is not intended to diagnose, treat, cure, or prevent any medical condition. Every individual's situation is unique, and outcomes may vary. Always seek the guidance of a licensed healthcare professional regarding any questions or concerns you may have regarding induction of labor or any other medical condition. The author and publisher of this blog post are not liable for any consequences arising from the use of the information provided herein.