Why might you be offered an induction and how should you decide?
Induction of labour is a medical intervention that aims to start or accelerate the process of childbirth when it doesn’t begin naturally. As a midwife in the UK, I often encounter mothers who have questions and concerns about the reasons behind induction.
As with all interventions, it’s important to emphasise that it’s entirely your choice as to whether you embrace or decline an induction of labour. It’s your body, your birth, your baby! In this article, I’ll explore some common reasons for induction and offer some ‘food for thought’ for mums and parents-to-be navigating this aspect of childbirth. But first, there are a few things you can do to be ready for any discussion about inductions.
Be informed: Knowledge is power. Always understand the reasons behind you being offered an induction by discussing them thoroughly with your midwife or healthcare provider.
Open communication: Maintain open and honest communication with your healthcare team throughout your pregnancy. In the event of discussion of labour, share any concerns or questions you may have about the process.
Birth plan flexibility: While it’s essential to have your birth preferences laid out, be open to adjustments. Labour and childbirth can be unpredictable and flexibility can contribute to a positive experience.
Emotional Support: Seek emotional support from your partner, family, or friends. The induction process can be emotionally challenging for some, and having a support system in place is crucial.
Reasons for induction of labour (IOL)
Medical reasons
Various medical conditions may lead to you being advised to consider an induction of labour. These include gestational diabetes, preeclampsia or intrauterine growth restriction. As a midwife, I advise you to engage in open communication with healthcare providers to fully understand the specific medical reasons for induction in your unique situation. Always ask and use the BRAIN acronym. What are the benefits, risks, and alternatives. What is your instinct and what would happen if you do nothing.
Prolonged Pregnancy
Post-term pregnancies, where a pregnancy extends beyond 41 - 42 weeks is one of the most common reasons to be offered an induction The NICE guidelines recommend offering an induction to ‘low risk’ women at 41- 42 weeks so that the baby is born by 42 weeks. The evidence for this is much debated and if you would like to learn more about the evidence, midwife Sarah Wickham offers some great analysis of the data.
Your waters have broken
If the amniotic sac ruptures (ie your waters break) and labour has not begun spontaneously, you may be advised to induce labour to avoid infections and ensure the well-being of both you and the baby. Typically this is offered after 24 hours but sometimes your caregivers will stretch the window to 48 hours.
Parents should be aware of the signs of premature rupture of membranes and you should seek prompt medical attention if you think your waters have ‘gone’ prematurely. Always pick up the phone and get advice from your caregivers if you aren’t sure. Again, the BRAIN acronym comes in really handy here. Discuss all the information relevant to your situation to make an informed decision as to whether you would like to embrace or decline an induction in this situation.
Infection
In cases of infection within the amniotic fluid and membranes, known as chorioamnionitis, induction may be necessary to prevent the spread of infection to the baby. Parents should be vigilant about any signs of infection, such as fever, and report them promptly to their healthcare providers.
‘Big’ baby
Some babies are said to be ‘large for gestational age’. We have more information on how babies are measured and what we mean by a big baby over on our blog. If you are being offered an induction due to a suspected big baby and your pregnancy is otherwise deemed ‘low risk’, take particular care in gathering information about your situation. The NICE guidelines suggest that a large baby alone should not be the reason for an induction to be offered, however, in your situation, you may feel it is the best course of action.
Maternal age and IVF pregnancy
In the UK, women over 40 are offered an induction at around 39/40 weeks. The reason for this is that some of the research points to an increased risk of stillbirth if you are 40+ and go beyond 39/40 weeks. You can find the supporting evidence here. Many women having IVF are also offered an induction of labour for specific reasons related to hte individual pregnancy.
The key thing, if you are being offered a prolonged pregnancy induction, is that your care providers should inform you about the potential benefits and risks and allow you to make an informed decision. Talk through what a possible induction could look like for you personally if you were to go down that route. Specific areas to talk about are:
Your risk of stillbirth (not just national averages)
Wait times on the wards
Impact of induction on other areas of your birth plan
Ways in which your birth plan could be accommodated or adapted for an induction
Your risk of other intervention such as caesarean section or instrumental birth
Once you have all the details you need for your own situation, use your BRAIN. What are the benefits, risks and alternatives? What does your instinct tell you and what would happen if you did nothing? Take some time to decide. Whilst you might be in an urgent situation, inductions are not an emergency procedure, so there is time, even if it’s just over a quick cup of tea, talk it through with your birth partner so you make the decision that is best for you and your baby.
Looking for more information on inductions?
Our on-demand induction masterclass covers everything you need to know and is just £7.50!
What's covered?
- Common situations in which inductions are offered
- Your birth, your body, your baby
- The induction process
- What you can try before having an induction
- The questions to ask if you're offered an induction
- How to decline an induction, or discussion of an induction