Induction of Labour: Clinically necessary or routine intervention?

Trigger Warning: Induction, birth trauma, stillbirth

We are increasingly concerned by the number of maternity service users reporting feeling coerced and bullied into induction of labour.

There seems to be a particular correlation between this and people aged over 35.

Many maternity service users tell us they have been told they must be induced because if they don’t they are putting their babies lives at risk. If pregnant people ask for more details they are told the risk of stillbirth is higher if you are over 40, or even over 35. Sometimes comments are made about a placenta not functioning properly after 40 weeks. These statements are made to instill fear and compliance. Rarely, are there opportunities for open discussion and comparative risks. Occasionally women are told it’s because of the “latest research”. Recently this “restack” is named as “The ARRIVE study”.

Pregnant people aged under 20 experience the highest rate of stillbirth. The difference in the rate between women who are 20-24 and women who are 40-45 is 0.02.

We understand and respect the need to ensure stillbirths are prevented wherever possible. We understand the devastation that a stillbirth can cause a family, a pregnant person and a Health Care Provider.

However, it is really important to stress that no treatment, procedure or test should be carried out without the person’s informed consent. That means you should be given all the information you need to make an informed decision on induction, or anything else for that matter. Your decision will be an informed consent or an informed refusal. People must be given the opportunity to give either an informed consent or an informed refusal. Anything else strays into the territory of being uninformed, or much worse of being coerced or bullied.

Induction is not without risk.

People need to weigh up those risks and make the right choice for themselves and their baby. Everyone’s choice is entitled to be different because people perceive risks differently.

Some questions you can ask to get the information you need to make a decision based on informed consent or informed refusal:

• What is the benefit of induction for me and for my baby at this moment in time?

The answer to this question is found by discussing the benefit of induction Vs the benefit of waiting with your care giver in a non-coercive setting.

• What is the risk of induction for me and for my baby?

This discussion needs to cover the risk of medically managed birth, interventions, maternal morbidities, birth trauma, baby becoming distressed, instrumental delivery, emergency Cesarean birth, effects on breastfeeding and bonding and perinatal mental health.

• What are the alternatives to medical induction?

This discussion needs to include Expectant Management, measuring baby’s and maternal wellness, biophysical profiling, elective Cesarean birth and other methods that might help bring labour on eg stretch and sweep.

• Is the situation urgent?

This discussion should evaluate how urgent the need for an induction is based on clinical maternal and fetal indicators. It may be that indicators are inaccurate, or will not change over the next few days.

Then make an informed decision on what is right for you and your baby.

Useful links:

Induction of labour – Is it right for you?

Did You Know: a healthy full-term pregnancy is measured between 37 – 42 weeks?

“May I break your waters?” Information on Artificial Rupture of Membranes

Informed Decision Making: “No Thank You” – A Guide to Informed Decison Making

https://www.aims.org.uk/journal/item/ten-things

The ARRIVE Trial: another perspective

Review shows that “evidence is lacking” to induce labour before 42 weeks of pregnancy

https://www.lamaze.org/Connecting-the-Dots/parsing-the-arrive-trial-should-first-time-parents-be-routinely-induced-at-39-weeks

https://www.nice.org.uk/guidance/cg70

https://evidencebasedbirth.com/arrive/