10 things women should know about induction
If you read my labour and delivery blog post you will know that I fought very hard for my right not to be induced. Induction of labour has become extremely commonplace with about one-third of all Australian births being induced. Although there are a few more natural ways to induce labour, most hospitals perform induction in a highly monitored setting most commonly using artificial oxytocin or prostaglandin gels (artificial hormones that induce labour)
Induction is generally administered because it is assumed that it is safer for the baby to be outside of the body than inside the body for various reasons including the baby being overdue, premature rupture of membranes (waters break early), weight of baby, gestational diabetes, high blood pressure or preeclampsia or other medical conditions as well as issues with the placenta and a few other reasons. It is also administered electively by women who choose to have it once they have reached term.
Most women would agree that the risks of NOT being induced are very strongly communicated, but what is hardly ever discussed is the actual risk associated with induction for both mother and baby.
A recent review of 10 separate studies done in 2018 concluded that the majority of women that had undergone an induction felt uninformed about the side effects following induction and had they known more they may have chosen differently. The review highlighted that: “Women did not feel involved in decision-making regarding induction of labour and women were unprepared for many aspects of the induction process”
Most women are aware that induction of labour is a lot more painful than natural spontaneous labour and are also aware that the need for an epidural during induction is much higher. Beyond that, very few women know what else they can expect with induction.
Here are a few things most women should know:
- Induction has a relatively high failure rate. 25% of women do not take to induction and will often have a c-section if induction fails.
- Induction is associated with increased rates of jaundice in the baby
- Common side effects of oxytocin in the mother include headaches, nausea, and vomiting.
- Severe side effects of oxytocin in the mother include a rise in blood pressure, seizures, and bleeding, slurred speech, extreme muscle weakness, memory loss, and confusion. (Induction will likely be stopped prior to this point leading to c-section)
- Seizures can also occur in the fetus and induction has led to fetal death.
- Induction increases the risk of postpartum hemorrhage.
- Side effects of prostaglandin gel include vaginal pain, increased bleeding of the uterus, nausea, vomiting, diarrhea, difficulty breathing, coughing and wheezing and blue lips.
- Although the risks are very low excessive use of induction agents has been linked to an increased likelihood of uterine rupture even in women with no prior c section. (When the uterus ruptures and the baby or other organs are dispelled into the abdomen) Women with previous cesarian sections are at greater risk and are part of the reason VBACS are considered high-risk
- oxytocin or prostaglandin has been known to cause abnormal or excessive contractions, which can diminish the baby’s oxygen supply and lower the baby’s heart rate. It is also associated with other heart arrhythmias and termed fetal distress which is considered an emergency and leads to a cesarean section.
- Due to the potential side effects mentioned above Increased monitoring is required with an induction which means less mobility for the mother during labour and an increased chance of needing epidural anesthesia. Many women feel unprepared for the intense monitoring during an induction birth.
As with all pharmaceutical drugs the severity of side effects are always downplayed and so it is likely that women will be convinced that the risk of these side effects occurring is very low. On the contrary, the risks of not being induced are often greatly exaggerated (as with my labour where I only carried a 1-2% chance of infection for my waters breaking early) but women are generally not informed of the statistics at all. I do not want to scare anyone away from induction, it is true that complications following induction are rare and severe complications are unlikely. This may be because of increased monitorisation during an induction where medical staff will intervene (often with a c-section) if any of these side effects occur.
Personally, I fought very hard not to be induced because I know that my body cannot tolerate the medication. I react very violently to most medications, including many natural supplements. I know without a doubt that my induction would have resulted in seizures (I’ve reacted with seizures to artificial hormones before) and a c-section. I also believe that for the most part, our bodies are much better at determining the best time for the birth. Of course, there are times when intervention is absolutely necessary. However, there is a lot of controversy over what “necessary” actually is even within the medical industry itself. Due to the current nature of medical practice women are made to believe that they have no choice but to be induced. There is always a choice. Unfortunately, the choice not to be induced comes at the cost of being shamed by medical staff as well as family and friends. I know many women are happy with their induction experience and so I am glad that this option exists for women that choose it or really need it. However more commonly women are left feeling disempowered and violated by the way their both were handled. Of my personal friends that have undergone an induction, all have regretted it.
During my labour when my waters broke early, I told one of the midwives “I just don’t want them to force me to be induced ” she looked at me and told me “no one is allowed to force you to be induced, it is illegal and considered an act of abuse” although the pressure from the doctors didn’t stop, it did give me courage that my choice would ultimately be respected and it was.
I’ve added the reference to the study review I mentioned above as well as links to a couple of articles written by Sarah Wickham, a midwife and best-selling author. These articles were highly beneficial for me so I hope they can help you too.
Coates R, Cupples G, Scamell A and McCourt C (2018). Women’s experiences of induction of labour: a qualitative systematic review and thematic synthesis. Midwifery DOI: https://doi.org/10.1016/j.midw.2018.10.013
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Ten things I wish every woman knew about induction of labour: the article