What if someone is offered induction?
- The choice is yours - you may accept or decline induction
- Relax. Birth won't begin or progress well with stress and anxiety
- If anyone chooses an epidural they haven't 'failed' (that goes for anyone btw, induced or not). Induction is a medical intervention that frequently requires medical pain relief (even if you're the best hypnobirther in the world!) 80% of my induced hypnobirthers choose an epidural (vs 10% non-induced)
- Hypnobirthing can help you stay as calm, relaxed and focused as possible, no matter what!
"Epidural was not where I saw myself going but I was exhausted having had no sleep for days, and it gave me the rest I needed"
20% of births are induced in the UK, why?
Induction is offered if there's any chance that it might be safer for the baby to be born. Reasons can include a poorly parent or baby, but the most common reasons are based on aiming to reduce a very small possible risk of pregnancy continuing beyond 41+ weeks, or the waters having released for 24hrs+ without contractions beginning.
I'm healthy, low-risk and 41+ weeks - should I accept induction?
It's up to you. If one awaits spontaneous birth after 41+ weeks the risk of a baby dying during pregnancy, birth or shortly afterwards is thought to be around 0.16% (between 1-2 in 1000). With inducing birth at 41+ weeks the risk may be reduced to 0.07% (up to 1 in 1000) (if you are over 40 years of age the risks may be at a similar level at 40 weeks). This NHS leaflet provides a clear and simple presentation of recent research. For a more comprehensive overview read this chapter by Dr Sarah J Buckley.
However, as usual for childbirth research, the science is far from clear-cut, especially if you've given birth before. Pregnancy dating may be inaccurate anyway, and the simple answer to all of this is that we just don't know! After considering all the available information, your choice will be the best choice for you.
What about the waters breaking at full term?
For nearly 1 in 10 people, waters release before their contractions start. They usually commence naturally within a day or two and unless there are any further concerns (such as a higher likelihood of infection, or being 36 weeks or less), the offer of induction could be delayed for up to 24 hours. Induction is offered because the chance of a baby being born with an infection might be slightly increased (+0.5%)
What if I decline induction?
The UK national clinical guidelines state:
"If a [person] chooses not to have induction of labour, [their] decision should be respected. Healthcare professionals should discuss the [person's] care with [them] from then on." 'Expectant management' means awaiting spontaneous birth. Increased monitoring is offered including ultrasound scans and CTG monitoring a few times a week.
What does induction involve?
The aim is to encourage the natural physiological birth process as much as possible...
1. Pre-induction: a cervical sweep is typically offered at the routine 41 week appointment. If the cervix has shortened and is stretchy enough, the care provider can insert two gloved fingers into the vagina, up through the opening of the cervix and sweep their fingers around in a circular motion, to separate the bag of waters from the neck of the womb.
Benefits = for 1 in 7 it might reduce the chance of further induction methods
Risks = invasive, discomfort, bleeding, irregular contractions, disappointment
Alternatives = awaiting spontaneous birth
2. Prostaglandin drug: whilst admitted to the antenatal ward at hospital. If the cervix is closed and hasn't thinned much, a dose of artificial prostaglandin (a tablet, gel or plastic tampon) will be inserted high up in the vagina. The aim is to 'ripen' the cervix to trigger natural contractions to start, or at least enough so that the bag of waters can be broken the following day (amniotomy). Parents are encouraged to leave the ward and go for a walk, or in some areas may be able to go home and return later. Prostaglandin treatment can take up to a couple of days.
Benefits = around 30% give birth naturally without further intervention
Risks = vaginal / cervical soreness, hypertonic uterus, contractions commencing suddenly and painfully, fetal distress syndrome, abnormal labour affecting the baby, or on the other hand if it doesn't work:- disappointment, boredom, lack of sleep, birth partner sent home at night
Alternatives = await spontaneous birth, ask about balloon catheter dilation or caesarean
3. Amniotomy / breaking the waters: On delivery ward, if the cervix has thinned and opened enough, a long crochet hook-like device is passed through the vagina and cervix to rupture the amniotic sac. This is done to encourage prostaglandin release / physiological birth to begin, or before the commencement of artificial oxytocin infusion to trigger contractions.
Benefits = Some research suggests quicker progress with less intervention following amniotomy
Risks = scratching the baby, maternal discomfort, introducing infection, small risk of cord prolapse or accidentally puncturing a major blood vessel
Alternatives = await spontaneous birth, ask about more prostaglandin ripening / balloon catheter dilation or caesarean
"Although nothing seemed to have gone to plan I remained very calm throughout the whole experience and what was 3 days seemed like 1 with the most important thing in the end a healthy & happy baby!"
4. Intravenous artificial oxytocin drip: On delivery ward, a synthetic hormone (Pitocin / Syntocinon) is infused to initiate and strengthen contractions to dilate the cervix and aid the baby's passage through the pelvis. Continuous monitoring is required to observe the rate of contractions and the baby's heartrate.
Benefits = can dilate the cervix and birth the baby without the need for caesarean
Risks = Common: abnormal pain requiring epidural, uterine hyperstimulation with fetal distress, headache, nausea, vomiting, slow, fast or irregular heartbeat (parent), failed induction leading to caesarean. Other potential things to note include reduced mobility, and CTG may also increase the risk of caesarean. Epidural also increases the chance of having an assisted delivery (forceps / ventouse)
Alternatives = await spontaneous birth, or ask for a caesarean
"My contractions escalated extremely fast and I only managed to use breathing techniques for about one hour till the pain got unbearable and I asked for an epidural at 5 cm dilated. The relief was instant!"
Read more of our hypnobirthing induction stories