Mother Nature’s Clock
Many of you will remember the classic children’s book, The Very Hungry Caterpillar by Eric Carle.
The little caterpillar grew and grew and grew (a bit like our growing bellies in pregnancy!) then the caterpillar became a chrysalis and eventually a beautiful butterfly. Nature determined this process and it all happened in its own time. No clocks timed or rated the little caterpillar’s progress.
If we tried to prise open that little chrysalis before it was ready to turn into a butterfly, it simply would not have happened. And so often the same can be said about labour induction. Unless the baby is ready to come and the mother’s body is ready for labour, no amount of prodding and poking is going to get that process going.
What many women don’t realise is that induction of labour is a medical procedure that once started, cannot be reversed. If labour progress is not made within a strict time limit, the methods to get that labour going will become increasingly more invasive, leading to more intervention that carries with it higher levels of risk, which can ultimately lead to an unplanned or even emergency caesarean section.
According to the recent Listening to Mothers III survey conducted by Childbirth Connection, a landmark study that polls American women about their maternity experiences, one in four women’s labours are induced. Of that 25%, it is estimated that 19% are performed for no medical reason whatsoever.
Australia’s induction rates are very similar to the United States, and a recent study conducted by Associate Professor Jane Ford from the University of Sydney found that as the rates of induction had gone up, so had the rate of caesareans. Between 2001 and 2007, fewer than half of the women who had their labour induced went on to have a natural birth, with a third of inductions resulting in caesareans.
“Induction seems to be increasing and that doesn’t seem to be improving the outcomes for babies,” said Dr Ford.
While there are reasons to induce a labour, such as certain obstetric conditions that put the mother’s health at risk, or if the baby is not doing well in utero, a very high percentage of inductions being performed are not being done based on evidence-based research.
Some of the most common reasons women are being induced include;
If a woman gets to the end of 41 weeks of pregnancy and has not gone into spontaneous labour, she will most likely be pressured by her healthcare provider to be induced. What’s important to remember is that a normal, healthy pregnancy is anywhere from 38-42 weeks. The due date is simply the arbitrary date in the middle of that period. Sometimes due dates are incorrectly dated. Sometimes babies just come in their own good time. The bottom line is that if there are no other complicating factors (i.e. mother’s and baby’s health are good), there is no reason to induce before the end of 42 weeks.
Lamaze International, widely-considered to be the ‘gold standard’ in childbirth education worldwide, has developed The 6 Healthy Birth Practices, which are all based on the most up-to-date, evidence-based research. The first Healthy Birth Practice is, “Let Labour Begin on its Own”. Click here to watch a brief video to learn more.
Fear of “Big Baby”
A “big baby” (also known as Macrosomia) is when it is estimated that your baby’s birth weight will be in excess of 4kg. Many women are pressured into having an induction (even before their due date) because of the concern that the baby will simply be too large to birth vaginally.
There are many problems with this theory. First and foremost, there is NO evidence to support this theory. Secondly, it is extremely hard to accurately estimate a baby’s birth weight – before they are born! Ultrasound in late pregnancy is extremely inaccurate and can be up to 0.5kg out either way.
Last, but not least, even if a mum does give birth to a larger than average baby, there is no evidence to suggest that there is any significant increased risk to the baby’s health outcomes. The fear of the baby getting stuck (shoulder dystocia) is a comparatively rare condition and can often be well-managed with experienced practitioners.
If you are faced with a possible induction because of “big baby”, I would highly encourage you to read this excellent article by Rebecca Dekker PhD, RN, APRN founder of Evidence Based Birth.
Gestational Diabetes (or “GD”) is another reason why many women find themselves facing induction. While one of the possible side-effects associated with GD is a larger-than-average baby, the fact is that mothers who have well-controlled GD and are not insulin dependent during their pregnancy are generally at no higher risk than a normal, healthy low-risk woman. Once again, the Evidence Based Birth website is a treasure-trove of excellent information for pregnant women and their partners. If you have GD and are concerned about induction, or even possible planned Caesarean-section, then please check out this excellent resource.
Less often, it is the mother’s decision to induce the labour. There are a number of reasons why she might want to choose to. For example, her partner might work interstate or overseas and she wants to ensure that he or she will be present at the birth. Or perhaps she has other children at home, and she needs to be as organised as possible in order to manage her family when she goes into hospital to have the baby.
While it is perfectly understandable in some situations that a woman would want to try and control the labour timing to some degree, in many ways she is opening herself up to a whole range of unknown variables by agreeing to a non-medically required induction of labour.
One of the best ways a woman can ensure a smooth and uncomplicated labour is to allow her labour to start spontaneously. This will trigger the perfect cocktail of labour hormones, such as Oxytocin, Beta-Endorphins and Relaxin which all play a vital role in the unfolding story of labour.
Many of the methods used to induce labour, including the use of synthetic hormones, inhibit the natural release of hormones, often making the labour longer, more painful and more difficult to manage.
If a woman’s health care provider is pushing induction without a clear medical indication, she should feel confident about asking questions that will enable her to make an informed, evidence-based decision. And remember – saying “no” is your right and a perfectly valid option.
Your womb is that perfect chrysalis and you are growing that perfect little butterfly. He or she will emerge at exactly the right moment and you’ll be so glad you waited!
This article first appeared in the Ripe and Ready issue of Empowering Birth Magazine.
Tanya Strusberg is a Lamaze Certified Childbirth Educator (LCCE) and founder of birthwell birthright, an independent childbirth education practice based in Melbourne. In 2015, Tanya was inducted as an FACCE (Fellow of the Academy of Certified Childbirth Educators) in recognition of her significant contribution to childbirth education. Through her internationally-accredited Lamaze Educator Training program, she is very excited to be training a new generation of Australian Lamaze educators.
Last, but absolutely not least, she is also the mum of two beautiful children, her son Liev and daughter Amalia.