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  • Writer's pictureDoula Tracy

INDUCTION of LABOUR

Updated: Mar 2, 2022

In the UK today approximately 25-30% of labours are induced.

There are some very valid reasons for induction, but all too often an induction is offered simply because a pregnant woman goes over her 'due date'.


The new National Institution of Clinical Excellence, (NICE), have just published their new guidelines for induction of labour.

(November 2021)


The guideline is 36 pages long so I have picked out a few key points.


  • You have the right to be involved in discussions and make informed decisions about your care.

  • Your birth PREFERENCES should be confirmed towards the end of your pregnancy, as you may have changed your mind since earlier on in your pregnancy.

  • Induction of labour is a MEDICAL INTERVENTION that will affect your birth options and your birth experience.

  • You will need Vaginal Exams before and during the induction process.

  • You will be restricted to birthing in hospital.

  • You may not be able to use a birth pool.

  • You will have an increased likelihood of needing an instrumental birth, eg, forceps, ventouse or caesarean birth.

  • You will be more likely to have a 3rd or 4th degree tear.

  • Your labour might be longer and more painful.

BE INFORMED


Take time to find out what the risks and benefits are for you and your baby for having your labour induced.

You can go ahead with induction, delay, decline or stop an induction.

Every woman who has had a low risk pregnancy SHOULD be given every opportunity to go into spontaneous labour.


SHALL I WAIT FOR MY LABOUR TO START, EVEN IF I AM OVER 40 WEEKS?


This is entirely YOUR decision. The following facts might help;

  • You will be told that there is an increase risk of stillbirth if you go past 42 weeks. This is the main motivation for being offered an induction. You would need to induce 426 woman around 41-42 weeks to avoid one still birth. That means 425 women are unnecessarily induced. (Middleton P. et .al .2018)

  • Stillbirth beyond 42 weeks is RARE, 2/1000 pregnancies. This compares to 1.5/1000 after 40 weeks.

  • f you are black or Asian, according to the MBRACE UK study, 2022, your risk of stillbirth if you go past 41 weeks is higher than a white woman.( 74/10,000 if you are black. 53/10,000 if you are Asian, compared to 34/10,000 if you are white.) If you chose not to be induced, your decision should be respected.

  • After 42 weeks you can accept increased monitoring of your baby and baby's amniotic fluid.

  • Labour normally starts before 42 weeks, based upon your scan date. (4% of babies are born on their 'due date', 11% before and 84% after.)

  • Induction is not now recommended purely on the basis of race, age or your BMI.

  • A planned caesarean birth as an alternative to induction should be discussed with you.

REMEMBER, A SWEEP IS A FORM of INDUCTION.


A sweep will still be offered at 39/40. You have the right to decline. Your consent should ALWAYS be obtained.


Your cervix should be assessed to see if a sweep is likely to work for you. The Bishop's score is used. (Are you dilated, is your cervix thinning, softening and has it moved forwards? Where is baby's head?)


WOULD YOU LIKE TO KNOW MORE?


Please do get in touch if you have a specific question about induction.

The NICE Guidelines are available on line for everyone.

The book 'The AIMS Guide to Induction of Labour' is a great resource.


Remember, you body, your pregnancy, your baby, your birth.



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