Why do so many women need inducing?

[flameprincess]

Just something I've been pondering recently during my pregnancy insomnia riddled nights! My due date is looming, with DC1 my waters broke but never went into labour, wondering with this one if I will ever experience it.

A lot of the chat on here and other forums women mention being booked in for an induction - why is it so common for a woman to not go into labour? I'm not sure of the percentage but seems a high rate just from reading threads here (though I accept you probably don't get as many people posting 'average' delivery stories).

Before we had the medical know how would women have just been left even longer than 42 weeks and been ok or were there more casualties as a result of this?

I suppose people tend to talk about problems on here more than non-problems. So you're seeing the 100 women who have needed induction but not the 10,000 who don't.

(* very randomly picked numbers)

Mumsnet is notorious for giving a skewed outlook in most subjects for a similar reason.

And yes, a lot more mothers and babies died.

I've just found out that my trust only lets you go overdue by a week. Apparently by doing this, they have reduced the number of still births by 2/year. You can ignore their policy and go to 42 weeks but must go to the hospital for daily monitoring, so I suppose most women by that point are fed up and would rather just have the baby here.

I've not needed an induction for either of my children. However One was booked for DD1- I went into labour before it. It was booked a week before it was needed.

I was told by a labour ward doctor with my first that the dating scan can be a week out either way so I suspect that has quite a bit to do with it.

Older women and more overweight women
www.bbc.co.uk/news/health-45978623

I don't have a complete answer for you, but in the book Why Induction Matters by Rachel Reed, she states:

"In maternity services, the threshold for intervening to reduce a particular risk is very low if the impact of the possible outcome is considered very significant. For example, induction of labour for post-dates pregnancies is based on a less than 0.3% chance of stillbirth if a pregnancy continues beyond 41 weeks. While 0.3% is a small number, the impact of stillbirth is extremely high for the families who experience it. Comparing this one particular risk with the risks of induction can be very complex."

Great book on the subject - definitely worth a read if it's something you're interested in or contending with.

I had OC so there was a risk to DS’s life if they didn’t get him out. I was induced the day I turned 37 weeks as the pros flipped massively over the cons at that point. X

Interesting thread. I would assume that at some point the benefits of induction outweigh the benefits of keeping the baby in, & equally the risks of keeping the baby in become greater than the risks of induction.

In my social group induction is the minority however I know people who claimed reduced movement just to get an induction booked which disappointed me, given the additional strain on the NHS.

Could the increase be due to maternal age? Older mums are often steered towards induction.

Mum's talk more about the challenging births than the uneventful.

There is possibly a more reasons to induce than there use to be, in my nct group induction has been proposed due to large babies and overdue babies - I think the relative proportion of women accepting induction under these reasons has increased. Two of us has inductions books due to our waters breaking before labour - one of had to be induced as she didn't go into active labour before the deadline whereas mine was cancelled as baby arrived before the deadline.

There is better monitoring and testing for things like gestational diabetes and cholitus both of which increase your chance of induction

Interesting that it seems to be penned down to age & weight increases in mothers. My (purely anecdotal) experience has been with average weight and age mums! That being said it probably is the case that there are more complex birth stories shared on here than those that went without a hitch. Probably skewing my view.

It's an absolutely massive topic but to dramatically simplify my answer, we live at a stage in time where we expect our babies to survive childbirth and to be healthy and the medical establishment has a duty of care to facilitate this. This includes good and bad actions/reasoning but that is the ultimate end.

In my circle it's because the mums are older.

I expect there is an increase but also I knew a few women who were booked for induction but went into labour before. And one whose waters broke as she arrived at hospital to be induced (always thought that was a great story!)! Also women like me because technically I was in labour but it was too slow so was put on the drip to speed things up. I guess I'd be considered induced according to stats, although I'm not sure.

Prior to induction and c-section maternal and infant death rates were higher. We now have better diagnostics and a low risk threshold. We know for example that if someone goes too far overdue they are at risk of placenta failure so women are induced at a set cut off point to reduce that risk. Or if protein shows in urine and blood pressure is high that those are signs of pre-eclampsia, we don't want to risk eclampsia because that can be fatal so we induce.

Before we had the medical know how would women have just been left even longer than 42 weeks and been ok or were there more casualties as a result of this?

Yes.

My mother was 4 weeks overdue with my brother and her labour lasted 3 days.

Neither of those things would happen today.

@sashh - curious why you think 3 days labours don't happen anymore? Mine was over three days before I begged to get admitted (because I was too exhausted to cope). They tried to send me home as I was 3 cm.

It was later in the day that my labour was augmented. Baby born after 86 hours of labour. I needed forceps as I was just too tired... baby was getting a bit distressed by that point too.

I was so exhausted a midwife woke me up that night on the ward because I was sleeping through my baby screaming. But I digress...

This was 18 months ago, so not in the dark ages.

All women would go into labour naturally if left long enough... the baby wouldn't just stay in there forever! But women are sometimes induced earlier than they would go into labour naturally for various medical reasons which mean that it may be safer that the baby is out ASAP. Having said that, the high number of inductions is also due to lots of women being offered inductions unnecessarily. I was offered an induction at 37 weeks because of one episode of reduced movements, even though baby was absolutely fine on the monitor. Another example is big babies - the NICE guidelines state that women should not be offered induction just because their baby is suspected to be big (without any other risk factors) but women are induced for this reason all the time. A lot of women will just accept induction the first time it's offered without doing their research or questioning it, when their baby would have been absolutely fine without one.

The 'big baby' reason always baffles me for this especially with how inaccurate the scans seem to be in estimating weight - how many women are told they have huge babies and the baby is born perfectly normal size!

I opted for an induction at 8 days overdue. Baby was big for my size but showing slowed growth during the 2 weeks prior to birth. I know due to growth scans later in my pregnancy. I had a slightly low BMI at the beginning of pregnancy and I was in my early 20s. The consultant was happy to leave it longer but she was very good and listened to my concerns and we decided to induce after a week rather than the standard 2 weeks. I was concerned that the placenta was ageing and thus causing the rapid slowing of growth. It suggested to me that the placenta may have been providing fewer nutrients and less oxygen than baby required, ergo I was concerned about still birth possibilities.

I ended up with an EMCS bit I don’t regret my decision to be induced and I’m glad someone listened to me. FYI my son’s head got stuck in my pelvis. He was born with a head circumference on the 99th percentile and I have narrow hips (my mother is the same stature and struggled with me as an average sized baby). He wasn’t a huge baby (bar head) but was big in comparison to my size.

physicskate

Wow, I take that back, I've not heard anyone being allowed to go on that long, it must have been terrible.

I was induced due to an ivf pregnancy. There’s some research that suggests the placenta is more likely to start to fail post 40 weeks in in ivf pregnancies. Was induced at 40+2 he was born 17hrs later. Very positive experience for me and as PP have said the pros outweighed the cons for me at the end

@physicskate so sorry you had a rough time as I know from your previous posts you’ve not had the easiest road to get there! Hope you are enjoying motherhood now

My waters broke but no labour with my first so was induced (41wks). With my second my waters broke and I did go into labour - a week before due date. So you may be lucky

It's because they see the families as their baby is stillborn, maybe also being the one who has told them a little earlier that their baby has died.

They really don't want to do that, but as Britain's stillbirth rate is not good, most midwives and obstetricians have done exactly that at some point. And therefore support and clinical protocols which reduce it.

Risks increase over 40 weeks, considerably so after a bit longer gestation, and having a dates-based system means that you put everyone on the lower-stillbirth pathway unless they have actively opted out from it. It's the safer way round.