5 Things Every Woman Should Know about Induction of Labour

It is important to remember that birth is as safe as everything else in life. That is to say - nothing in life is 100% risk free. Driving in our car or walking down the street or going on a plane all carry a level of risk. All be it very small. And birth is no different.

When we consider an induction, it is usually from a place of fear and to do with risk - and the biggest risk of all being stillbirth. In Scotland last year the % of stillbirth babies born was 0.4%. That means that 99.6% of babies were born safely. If you are being offered an induction due to a risk factor - find out how high that risk is - and remember induction itself carries its own risks.

1. You have a choice.

It really is that simple. If doctors are recommending an induction for you, it is YOUR choice whether you accept that or not. There is no law or rule that means you have to have one. Just because you have a risk factor indicating an induction may be best - it is STILL your choice.

Just because they are recommending an induction does not mean that it is an emergency and your baby needs to be born right away - or when they reach 38, 39, 40, 41 or 42 weeks. If it did - they wouldn't be recommending an induction they would be recommending a c-section.

Ultimately, whether you have an induction or not is your choice. The best question to ask is 'What happens if we wait [another day/week/for labour to start naturally]?' This will help you gauge how serious your situation is. If they are happy to wait another week or more then it is clearly not that serious.

You also have a choice at every step - doctors and midwives need your consent for every intervention. From vaginal exams to the use of CTG monitoring. You can say no. However many would say it is a package deal - you can refuse vaginal exams, for example, as is your right. But without knowing how far along you are or if your waters have broken - midwives can't give you the drip.

2. Expect to wait

Just because you are scheduled for an induction at 4pm on Saturday, does not mean it will start at 4pm on Saturday. It is not uncommon for inductions to be rescheduled to another day if midwives are exceptionally busy. If you are taken at 4pm, it is likely things won't 'kick off' until closer to 6/7pm. You will be shown to a bay in a 4 bed ward, your dinner will be ordered and you will be monitored with CTG before anything even begins. After your dinner, your cervix will be checked and this will determine the method of induction you will be started on.

If your cervix is found to be 'unfavourable' you will be offered a pessary to begin with. This is given 24hours to soften the cervix. A gel is then used and this repeated after 6hours. Priming your cervix can take up to 2-3days. This is prior to a drip being offered. A drip can take 3-24 hours but 6hours is a good average. Some women do not respond to the drip, in this case a c-section is recommended.

3. Induction of labour is more uncomfortable than natural labour.

With a natural labour, your labour starts with your own natural hormones - crucially oxytocin AND ENDORPHINS. Don't underestimate the role these play. Oxytocin starts your contractions and progresses your labour, whilst your endorphins are your natural pain killers which are said to be 500x stronger than opiates during birth. These can also leave you feeling 'high' and create a feeling of euphoria after birth.

When you have an induction, you are given a synthetic version of the hormone oxytocin - called syntocinon - which starts you labour and keeps it progressing. Without endorphins, this can feel far more uncomfortable and painful than a natural birth.

In addition, wires from the drip and monitoring can restrict your movement, again adding to discomfort if you cannot labour is a position that is comfortable for you.

Wires also mean that water is not a comfort measure that is available. Whilst many report a bath, shower or water birth can really relieve discomfort from contractions, this isn't possible if you are connected to electrical devices.

4. Induction of labour is not like natural labour.

Contractions can come 'thick and fast' more than they would naturally and this process can cause distress to the baby. The synthetic hormone is POWERFUL. It comes with its own risks so you need to weigh up the risks of the induction process vs the reason for the induction.

For this reason, when having an induction, it is recommended that you are monitored continuously using CTG monitoring. These are two belts that are placed over your stomach, one to measure contractions and one to measure the baby's heart rate. Not only can this feel uncomfortable, it can also restrict your movement as you are continuously hooked up to a machine with wires. With a natural birth you would simply be monitored by a hand held doppler intermittently.

Due to the wires, a water birth is not recommended, and you will be asked to birth in the delivery suite rather than a midwifery unit so you can be monitored more closely by doctors. This can mean the environment is less homely.

You will also be asked to have more vaginal exams to check progress than in a natural birth where this only occurs every 4 hours. These examinations can feel invasive and very uncomfortable during contractions.

5. There can be a cascade of interventions.

This means that one intervention, such as the drip can lead to others. For example, by having a drip it is recommended you have CTG monitoring. The wires from this and from the drip can make movement awkward. This can lead to many women labouring in bed and moving less. For this reason many request an epidural. This can lead to a closer need to monitor the baby through a foetal scalp electrode. An epidural can also increase the likelihood of having an assisted birth via forceps or vacuum or an emergency c-section.

Final Thought?

If you are offered induction of labour, you need to weigh up lots of things in order to determine which path is right for you. I wholeheartedly support women who want their labour to be induced, and I wholeheartedly support women who don’t. I don't believe it is right that women should be made to feel scared of induction as this is not beneficial to a positive birth experience. If you have chosen an induction, you should be supported to have the best possible induction experience you can and there are definitely way it can be made better. We discuss taking control of your induction experience on my course. Get in touch if you would like to know more about this.