Induction of Labour – Lesley Gilchrist (Independent Midwife)

Kindly copied from the VBAC support group page with permission …

Many of you have asked about induction of labour and some of the statistics that are being quoted are quite out of date. I’ve cut and pasted this article from my blog (didn’t want to fall foul of the the ‘no business advertising’ and this is important). I am a midwife first and foremost, but also a clinical researcher hence the subject and it’s content. Please PM me for more details if you wish.
Thank you, Lesley  Link


First things first… I’m not suggesting for a moment that babies need to be evicted by a certain date, or indeed that by going past a ‘due date’ or ‘best before date’ your placenta will somehow disintegrate (some people do actually claim that your placenta will just ‘stop’ working). Evicting a baby from their comfortable home whatever means you use is still an induction, natural or not. What I’d like to do is talk you through the normal human gestation which should lead nicely to induction of labour.

The Normal Gestation for Humans

When you’re first given you due date, it’s calculated from the first day of your last menstrual period plus 9 months and 1 week. But, would it surprise you to learn that what’s classed as term (the period of pregnancy at which point your baby is expected to be fully matured and able to survive outside with only the support of heat, love and nourishment) is anything from 37 weeks of pregnancy to 42 weeks of pregnancy (World Health Organisation).

This wide variation in gestation makes understanding the ‘due date’ even harder to comprehend; how can it be that with a 5 week window of normal gestation that we can give one date from which to work out when your baby will be ready to be born? Surely, if a baby is naturally mature and ready to be born at 37 weeks then 40 weeks would be 3 weeks ‘too late’, equally, a baby not physically mature until 42 weeks would be 2 weeks ‘early’ if born at 40 weeks. And, more counterintuitive, what of the babies born at 36 weeks, they’re classed as premature at only 1 week before they reach maturity if they were those babies physically mature at only 37 weeks. But, a baby physically mature at 42 or 43 weeks, born at 37 weeks may be classed as ‘term’, how does that work?

My son was born at 37 weeks and weighed 4200g (9lb 6oz), he had beautiful long finger nails and dry skin, a sure sign that he was physically mature, equally I have seen babies born at 41 and 42 weeks still covered in their white, petroleum jelly like substance known as vernix, most usually seen in babies of an earlier gestation.

What I’m trying to say is that each baby is unique and will come when he or she is ready. The problem lies with the ‘estimated due date’ (note the word estimated there) that’s given to you at your first scan. This date is used to calculate everything from your maternity leave to the thorny issue of ‘post term’ induction (beyond 42 weeks).

Induction of Labour for Post Term Babies

There are numerous studies that have examined birth outcomes for babies depending on which point of the pregnancy continuum they were born. A Cochrane review found that fewer babies died if babies were induced at 41 weeks rather than 42 weeks or beyond, however they also acknowledge that ‘such risks (of death) were rare with either policy’.

To put it simply, if we induced every woman’s labour at 41 weeks the risk of a baby dying is 3 in every 10,000 or 0.03% compared with 30 babies in every 10,000 or 0.3% if we left them alone, so you see, extremely small numbers.

Another important point to remember; you do not ‘have’ to have an induction of labour and equally the medical and midwifery profession have no right to ‘allow’ you to go over your dates and wait for natural labour. It’s their duty to ensure that you have all of the information to make the decision about what’s best for you and your baby; only you can decide. If you do decide to wait for natural labour and decline their offer of induction of labour you should be offered monitoring of your baby’s placental function to ensure that he or she are happy and healthy.

‘What’s the Catch?’, I hear you ask

Well, hands up who’s had this chat with a midwife or doctor; the ‘baby dying’ chat? Now, hands up who, during that chat was also informed of the risks of induction? I suspect that not so many of you raised your hands to the second question. So what are the risks of inducing your labour? To be clear, I’m talking purely about post term induction of labour, this post is not about induction of labour for any other reason.

For first time mothers 2 studies found that induction of labour increased the risks of Caesarean section (a Cochrane study in 2013 found the opposite, however that study didn’t exclude those women having subsequent births, which may have skewed the data).

In addition to the increased risk of Caesarean section you also have the following:

Prolonged stay in hospital (increased risk of hospital acquired infection)
Increased reliance on strong pain relief (epidural for example)
Increased risk of forceps or ventouse birth (epidural doubles the risks for first time mothers plus)
Increased risk of forceps or ventouse birth (syntocinon increases the risk of fetal distress hence the need for continuous fetal heart rate monitoring)
Increased risk of Caesarean section (continuous fetal monitoring is extremely unreliable and detects problems in 6 out of 100 women when they aren’t any, hence the increased need for Caesarean section and forceps etc)
Finally, inductions of labour take a long time, especially if this is your first baby. The pessary that’s used to soften your cervix takes around 24 hours to work, that’s 24 hours before a midwife can even break your waters. You will then be advised to walk around to see if breaking your waters alone will start your contractions. If the walking around isn’t successful you will then be started on the hormone drip (syntocinon) which is given through a needle in your hand. Because of the risks of fetal distress with this hormone you’ll also be attached to a monitor recording your baby’s heartbeat for the entirety of your labour.
So you see, nothing is without risk. What’s important is that you are given all of the information need to make an informed choice. Ask the questions about risk of going over your ‘dates’ but equally, ask the questions of risks of induction of labour and their consequent risks

Natural Methods of Induction of Labour

As much as I am a staunch proponent of ‘baby knows best’ with regards to their date of birth I’m also fully aware that the ‘estimated due date’ and the NHS machine is a strong beast to fight against. So it is with a heavy heart that I’m going to give you some tips on how to start your labour naturally.

Acupuncture and reflexology
They will help to prepare you for labour; I believe the most likely reason for our 5 week window of a normal term pregnancy is in part due to our busy lives and constant need for adrenalin to fuel it (see my shrinking cervix blog). If you’re tense and have low levels of adrenalin constantly circulating then the hormones needed for labour don’t stand a chance. It may be that your baby was ready to be born at 38 weeks but your anxiety and stress levels are hindering your body’s ability to start labour off. Acupuncture and reflexology (some theorists believe) help to restore that natural balance of oxytocin and help to reduce adrenalin production. This, theoretically should allow your baby to decide when he’s due to be born but won’t help him come sooner than he’s ready.

Clitoral & Nipple stimulation
Both of these methods (start from around 36 weeks) help you to produce oxytocin, your natural labour hormone. Now, once you’ve produced this hormone, theoretically you should start to feel cramps as your uterus contracts under the action of this hormone. If done frequently enough this gradual contraction of your uterus may help to encourage labour and to soften your cervix and your baby’s membranes.

Raspberry Leaf Tea or Capsules
There’s no evidence that this actually works to start your labour off, however equally there’s no evidence that it doesn’t work and there’s certainly no evidence that it’s harmful, so crack on I say. What raspberry leaf does do though is to help tone your uterus to make your contractions more effective during labour.

Other Methods
Pineapple: you’d need to eat massive amounts of this which just aren’t feasible
Sex: no more effective than clitoral stimulation
Baths, curries, divination: they don’t work I’m afraid, but if you’re partial to any of these they certainly won’t do any harm.

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