Induction

Here's a very clear summary of the findings of the Cochrane Review into induction of labour:

www.cochrane.org/CD004945/PREG_induction-labour-women-normal-pregnancies-or-beyond-37-weeks

Tbh I considered myself no more qualified to decide what was medically necessary or advisable during my births than I would when having an operation etc. I wasn't even particularly keen on making a birth plan, because I wanted to let the medical professionals do whatever they thought was best. I'm not sure how I would have known whether I was being given the best advice or not tbh.

I was induced both times due to being overdue and having increasing hypertension. Both births were pretty difficult, first one was back-to-back delivery. I certainly wouldn't have wanted to be anywhere but in hospital. The idea of home birth gave me the heebie jeebies tbh.

I've had both the most medicalised birth and the most unmedicalised. I've had twins and a singleton. They re teens now and I used to frequent many many pregnancy and baby forums. I've seen women post all of the views expressed here many times over.

We do nerd to stop pitching 'natural' v 'medicalised' here. I really feel we are fighting the wrong battle. The truth is that maternity care is severely lacking in many ways. And though it doesn't directly influence outcomes and can be sidelined, the attitude and respect for women and their views/capacity to have valid views on their own care is woeful in the extreme. The fact that we still haven't worked out a way for a woman to have proper continuity of care is a scandal. Most women understand that a medicalised birth is sometimes necessary, of course they do.

This is something we can all agree is needed desperately, not least because it is clearly helpful to avoid unnecessary interventions.

I won't go into my own complicated story but I can tell you the scariest bits were when I didn't know what was happening.

In general there seems to be this wanting to divide childbirth into good vaginal deliveries and bad cesareans when talking to women antenatally and the real picture is far more nuanced than that with a lot of people having poor experiences of vaginal births that no one seems to want to talk about

I fully agree Dragon.

I remember in my VBAC meeting, it was absolutely geared towards persuading me to have a VBAC - every stat she gave me was to persuade me against a pre-planned c-section (which from re-reading my notes was far more appropriate), yet she didn't mention any stats with similar stats that didn't - ie. it was a snow job, I wasn't fully informed at all. It generally all felt very production line, rather than looking at the woman in front of them and actually thinking what would be best in her case.

I'm not entirely sure what the answer is. Others on this thread may think that if 199 women managed to avoid an induction that resulted in a very difficult birth, then we should accept the one birth that had a terrible outcome.

I don't think it's as simple as inducing vs not inducing. It's also about the pathway that follows induction of labour, and the likely outcomes after labour is induced.

Once you piece it together, the percentage of induced labours that end in ventouse/forceps delivery or EMCS for first-time mums is really high. (I'll try to find some stats, but this figure isn't usually published directly.) However, that's not presented in a clear way to women when they are asked to consent to induction. Instead it's implied that their labour will progress in the same way as if they had gone into labour spontaneously, which isn't really true.

I think if presented with the statistics that (say) there was a 75% chance of a forceps delivery or EMCS after induction, lots of women would choose to have the caesarean then and there rather than after hours of exhausting labour and a failed forceps delivery. (Note - 75% isn't the actual figure - I'm looking for stats now)

To mousey I am so sorry to read about what happened. I hope you and your son are getting all the help you need and are well supported xx

I can see where the OP is coming from but I do think that birth is such a crapshoot that it is a little naïve to dismiss medical interventions on the basis of little more than an untested idea that if we have more "natural" labours somehow the outcomes for mother and baby will be better (also better how?)

I was similarly privileged to have the time, resources and wherewithal to read lots, plan my positive birth, hire a doula, kit out my living room for a lovely home birth, for similar motivations. I feared a cascade of interventions, I wanted a nice "experience" and I was frankly arrogant. I believed I knew better than the entire medical profession after attending a hypnobirthing course and reading some Gaskin, that birth was medicalised unnecessarily. On paper I looked low risk and so was supported in my decisions.

On the day, I was one of those 9 in 1000 where it goes horrendously wrong and we both had a 999 transfer due to a very rare complication no one saw coming and the obstetric team had only read about. We both ended up in ICU, both facing a risk of very severe, catastrophically disabling neurological damage. Somehow, miraculously, we are both fine, but I didn't see my son for two days until I regained consciousness and he had months of follow up appointments to screen for neurological damage. It was only because one of the obstetricians recognised this condition on the day that we are both still alive and well.

You can read as much Milli Hill, Gaskin and Odent as you like, but you never know with birth. You can never tell if you will end up with a positive experience, or you will end up in a life threatening situation. And the outcome is largely down to factors beyond your control. I put my baby and myself at risk because I thought I knew better than the doctors, and I wanted a nice, positive birth experience. They were the ones saved our lives though.

There is a trend to dismiss medicalisation in birth, and to an extent I can agree, but as others have said, do not underestimate having a healthy baby and mother at the end of it. For me and any further pregnancies, if that means having a cascade of interventions and a shitty stay in hospital for a few days, so be it.

I've had a baby in Canada, and a baby in the UK. Both ended in EMCS, I was induced (2 attempts!) in Canada, but not in the UK

Both were national healthcare systems which didn't cost a penny (at point of delivery)

In Canada I was listened to, talked to, treated like a grown adult able to understand options and make choices. The surgeons actually introduced themselves, and checked me afterwards. I was given pain relief, I was headed for a home birth before going to 41 weeks, and in one of the scans due to that, discovering low amniotic fluid (hence the induction). Food was delivered to me at my bed, there was a large shower etc.

In the UK I was kept in the dark, nothing was ever communicated, even as I went overdue again (except occasionally in an attempt to scare me into doing what they want) I was persuaded to VBAC (and the offered pre-arranged one evaporated when someone forgot to confirm it after I went overdue again), I was left without pain relief despite having been having regular contractions (as in 20 mins apart) for days (and so being exhausted). The midwife tried to make me stay on my back in the bed (the most painful position for me), no food ever came, I was left bleeding and sweating in a bed that was straight from call the midwife, and had to manouver my still swollen belly and catheter bag into an 80x80 shower, through the 40cm sliding door, a good 6-8 inches off the ground, after major abdominal surgery, and out of visiting hours, so that was having pushed the baby in the fishbowl into the communal toilet so I could wash the worst of the blood off. I was sent home with no pain relief, and a box of injectable blood thinners, which no-one had told me how to use.

So yes. It can and should be better. My Canadian experience, as a first timer, with everything going much more wrong than my second, I have nothing but positive feelings about. The NHS one still makes me angry when I think about it.

My point is I was told the risks. They seemed small and very unlikely. And yet, here I am.

My heart goes out to you. And I think you're a good illustration of why this is so difficult. People will often tell you that the risks (eg of avoiding induction and going two weeks overdue) are very small. But when you have 650,000 women giving birth a year, a very small percentage of babies being injured or dying translates into quite a large number. So a risk of, say, one in 100 or one in 200, may feel quite small. But when you have 200 women going well over their due date, that means that one of them is going to end up with a baby who didn't live. (These numbers are made up - they're just to illustrate the point.)

I'm not entirely sure what the answer is. Others on this thread may think that if 199 women managed to avoid an induction that resulted in a very difficult birth, then we should accept the one birth that had a terrible outcome.

Obviously women should be given the opportunity to make a properly informed choice, with the risks explained to them. But making an informed choice is hard - because the guilt attached to making the "wrong" choice will be huge.

[quote RaeRaeMama]@Hoping4second

Exactly

Of course our children are important, but a woman's experience when she gives birth MATTERS

I also think people do forget birth is experienced by a woman but also her baby

Why are we always so quick to jump to medicalised intervention that can actually cause more harm then good?

The stories I've heard make my blood run cold and I can't understand why everyone isn't trying to do more. I hate that women are being treated like this whilst we are doing one of the most important jobs in the world [/quote]
I have had 2 babies. Both pregnancies were fine, but both deliveries were traumatic. In my experience, it was because of the care I received from my midwives that both my children and I survived. You have said you had a good experience because you paid for a private midwife. That’s great - so why are you saying that interventions are so awful?

[quote RaeRaeMama]@CovidCorvid

I would argue that the interventions cause more harm than good

I read yesterday that in the past 16 years induction and interventions have increased but still birth rates have not fallen [/quote]
Where did you read this, as it is incorrect with regards to stillbirths. The link shows an ongoing decrease in stillbirths, and a fairly level rate of neonatal deaths. Stillbirths are counted when a baby is delivered dead from the 24th week.

Your post replying to @YourSexNotGenderIsOnFire sounds a little strange. If a woman’s waters break, but she doesn’t eventually go into Labour naturally, what would you suggest happens? Sit and wait? Do nothing?

I was wondering what had happened to what were women's support groups and campaigns for better and more choice when giving birth.

they seem to have faded away and the two well known campaigns turn out to be more about returning to work (Maternity Action and Pregnant then Screwed).

But Birthrights seem to be carrying on the lonely struggle (haven't read their material so may be a let down) www.birthrights.org.uk/ and there is a relatively new group campaigning for better care of Black Women in maternity services www.fivexmore.com/ who are currently running a survey on Black Women's experiences (although they do also refer to birthing people?).

@BlueBrush

Thanks for compiling what’s been said, thinking about the posts on this thread it seems interesting that hospitals at the moment are caught in an odd place of pushing natural birth in a way that restricts pain relief eg. In some cases making it difficult for people to access anything other than gas and air. But at the same time recommending inductions that may be unnecessary.

I guess these two things combined mean that the women who have the inductions find it harder to access the pain relief they want, at the stage that they want it. When in fact an induced labour is often quite different to a spontaneous one and so the women experiencing them have different medical needs.

Like we’re at a weird halfway house of maternity care that doesn’t really fit with what either party “natural” or medicalised necessarily want.

@Heyha I think part of the process not being fully explained relates back to women being infantilised during pregnancy the whole language of ‘we’ll just pop this in’

@BlueBrush I would wholeheartedly support that, I wish I'd read your post before putting my garbled one up 😂

Induction is a great tool for improving outcomes in my opinion but the information around it really needs some work. I advocate for them now where appropriate despite having an unpleasant, complicated one and hoping to avoid another, but the balance definitely isn't out there in the public domain at present I feel.

The PP that had a friend induced at 39 weeks 'just cos' I suspect you weren't told the full picture by your friend as I know I was a massive drain on NHS resources sat there waiting, taking up a bed for nearly a week, and then being medicated to the eyeballs. I can't believe for a second there wasn't at least something that gave a nagging doubt about allowing the lady to at least get to term if she truly had no underlying worry.

If there's going to be a push for more inductions then there needs to be a hell of a lot more effort to improve the experience for the women undergoing them. It needs to take place with the woman's comfort and dignity in mind and not just be all about getting a healthy baby at whatever cost to the woman.

@pinkplantcase I can totally identify with that about not being told the whole process. It was very much, oh we'll pop in a pessary, maybe need another one, then you'll be off. No discussion about the various different pathways it might go down (hyperstimulation on the first one that they almost got to point of reversing it, then it didn't work well, what the drip means in terms of extras like catheters, what the drip itself can do, and so on. And I'd considered myself well- prepared and also had lots of time to read while I was waiting for pessary to do whatever).

So perhaps it's not that induction itself is bad, but that the 'marketing' for want of a better word isn't very well done. I think anyone talking about C-section gets a lot more input and information on all aspects than a woman being induced does- obviously it's got the surgery aspect that an induction doesn't have but perhaps if as much effort went into the prep and discussion of induction patients might not feel so strongly about them both before and after?

I've been thinking about what everyone has said so far, and trying to come up with a list of how things should be, or what should be improved. What does everyone think of this? (I’m not a medical professional, and I’m not suggesting that there aren’t protocols in place to this effect already. I guess this is my own personal wish list.)

• There is a place for both medicalised and “natural” births.

• Women should receive comprehensive and accurate information about the different options available to them. This information should be open about the risks involved, but also open about the likely experience of that route e.g. levels of pain.

• Women’s decision-making shouldn’t be at risk of being heavily influenced by the individual view of any one HCP.

• Women should be free to make informed choices, but should not feel like they have to carry the psychological burden of having the full responsibility of making that choice.

• When doctors and midwives advise women, risks should be carefully balanced. Although we all want to avoid the ultimate risk of serious illness to the mother or child, this should be very carefully balanced against other less-serious but perhaps(?) more likely outcomes of a traumatic experience of birth that can affect a woman’s post-natal recovery or mental health. (Hope that one makes sense. I’m not suggesting those risks aren’t balanced at the moment, but I don’t know that the balance is right.)

• Women undergoing induction should be given honest information about the likely experience at each stage, and should have a plan in place for adequate pain management, the treatment of side effects, and the involvement of a birth partner.

• Women shouldn’t feel, or be made to feel, that they are in some way weak for wanting to avoid pain or other discomfort during childbirth.

• Women shouldn’t be made to feel guilt or shame for going down a more medicalised route.

I'm not sure. I did think I needed a CS at one point because the baby was 'stressed' but the team carried on with the induction because he wasn't 'distressed.'
I was really really scared of a CS which did factor in our decision, as we were trying to avoid, 'cascade of intervention'.
We don't know exactly when baby had the stroke. Quite possibly when we were left for hours on end he became distressed and it could have not been picked up. He was born with a really good apgar score, so he must have stabilised. It does just go to show that hospitals absolutely need more staff and money and that you can't rely on *if something goes wrong someone will press the red button".

Great post Hoping