Induction - what you need to know

Induction is an important issue these days - the rate has soared in recent years, 32% of labours now kick off clinically - so it felt good to go through it properly. What we mainly wanted to communicate was a thorough understanding of induction as a process, a pathway and a decision. There can sometimes be good reason to hasten a birth and bring labour on artificially but it is vital that that reason has a super-solid clinical basis (not just, well why not? let's get on with it) and that your own emotions/values/instincts play a vital part in the decision-making process too.
From a legal and ethical perspective, the risk assessment is yours to make - not your caregivers. Which means it is crucial that your choice to be induced is a fully informed one.
Take a look at the NICE guidelines on induction as what should be provided in an end of pregnancy appointment is clearly laid out there. In any appointment where induction is being recommended ( this includes even a sweep being offered at 40 weeks) the following needs to take place:
> . up to date evidence provided on the REASON induction (or sweep) is being recommended
> . the pros and cons of inducing and the pros and cons of not inducing fully discussed in an OBJECTIVE way.
> . other options explored (eg waiting and or a caesarean or even having just a pessary and stopping there)
> . time given for you to reflect and discuss with a partner or significant other
You shouldn't just request all of the above. You should expect it. If a midwife says: 'they won't allow you to go beyond x weeks, or you'll need to be induced by x because your risk doubles...' - generalised statements that quantify nothing, this is remiss and amounts to bad practice. Look at and to find out more.
It is your midwife's duty of care to provide you with a balanced and impartial picture, in a way that involves you properly as opposed to placing you on an arbitrary pathway you feel you have no say in.
It is only with this in place that your decision can be properly informed. If your caregivers don't provide the above, and something should happen that puts you or your baby in danger, the hospital trust is liable. So it is an issue of fairness and responsibility for you AND the trust, that i-s are dotted and t-s are crossed appropriately and proportionately.
As we explained, it is good to do a bit of research well in advance of end of pregnancy, when you have more space for reviewing the facts with a clear head. It's helpful to have birth partners do the same. Then get down on paper a rough plan of your informed choices: on sweeps, how long you are happy to remain pregnant for, what steps you would take should you go beyond this date (eg extra monitoring) whether you want to be induced, or have a caesarean etc. I encourage parents to write it like a contract to themselves and to stick it on the fridge. This might sound a bit much, but end of pregnancy can be emotional and if you find yourself in a fuzzy spin at any point, that contract will serve as a marker on your own actual value judgement of the situation, especially if nothing in your actual health picture has altered.
In order to do that research and arrive at what feels right for you (given what we said about everyone feeling differently about risk), read these articles below:
The two most common reasons for being induced are being post-dates ( technically you are not post-dates until end of pregnancy, which is 42 weeks) and waters breaking in advance of labour. To assess the justification for the first reason, you need to read the articles above and come to a decision as to what feels right for you. As regards waters breaking...only ten per cent of women have their waters break in advance of contractions. Induction will be offered within 24 hours (sometimes 18 hours), with risk of infection cited (usually the actual risk isn't quantified which it needs to be). There is certainly an increased risk of infection once the membranes have ruptured - at 48 hours it rises to between one and one and a half per cent. But this risk, which can be also managed by taking your temperature and pulse, needs balancing with the fact that 90% of women are in active labour within 48 hours.
I think we explored the issues of sweeps. There is no evidence to show they bring any significant benefits to a labour's outcome. But more importantly, do not see them as a trade for induction - a way of bringing things on and therefore avoiding induction. A sweep is an induction in the sense that its aim to get things going by agitating the cervix/uterus and thus bypasses spontaneous onset of labour and it's benefits. A sweep can therefore be the first step on the intervention pathway.
We didn't get round to talking about natural methods of induction. Acupuncture and reflexology can also usher in issues as though natural, they are still an eviction notice. However, sometimes, induction or a medical decision does need moving on and in such a situation, these kind of techniques can be helpful.
I know we went through the induction process itself in some detail. But one thing we didn't talk about is if you did get induced, and a drip was put up, it is really worth getting as far as you can without medical pain relief as the mobility and freedom in your pelvis, not to mention just participating full stop, will really help with the birth and also your experience over all. The problem with a drip is not that it is by default more painful. It is that it is mostly too strong for too long. This won't matter if dilation happens quickly, which very occassionally it can. So it is certainly worth having a go without having pain meds from the get-go.
Full feeling can be a huge benefit if things happen to unfold with ease. As a rough guide, most people can manage three or fours hours if they have lots of good soothing techniques to hand- a leaning forward or lying position (so not feeling tethered as Jeni said), deep slow breathing/vocalising, hot water bottles, ice, lavender, frankincense, ice cold flannel...all the things you would have been using anyway. Pressure on the back is usually a huge help too. So you get as far as you can, and then an epidural will allow you to rest from there on. Once an epidural IS in place, make sure to use it wisely, roll onto your side, put on and in eye mask and earplugs and doze (see picture) .
Last of all, as we said, should induction not feel to be working in simple way, it would always be your right and choice to call a halt to it. You simply discontinue consent.