Why is everyone so against inductions?

[Penny2020]

Sorry if this is a stupid question, FTM here so I have lots of them!!!. I’ve been reading up on as many positive birth stories I can find in preparation for the big day and a theme is that nearly everyone says they do everything the can to avoid inductions, sweeps etc. I haven’t seen anything saying inductions are bad so I’m just wondering if I’m missing something. If you had this approach, what about the induction caused concern, is there something I should be asking my midwife should that be suggested to me?
Thanks mumsnet

I was put on a drip to induce labour after my waters broke and nothing happened. I was begging for an epidural after one hour because I couldn't move around and just lying in pain was awful. No one explained anything about it and in fact I asked for it myself because I was worried about why I wasn't going into labour. The midwives were horrible absolutely horrible. They didn't let the epidural wear off in time so I could feel to push and sneered at me when I asked why they hadn't done so . The response was ' well, if you couldn't bear the pain at the beginning, you certainly wouldn't have at the end'.

The midwife was arguing with the anaesthetist over my head .. it was bloody awful. I would never recommend one.

The tip I got was it can take an hour or so for the anaesthetist to become free so I said no to drip before that part was done.

I’ve done a NB which felt more in control and I didn’t want to experience something like waiting in a lot of pain

I had 3 lots of pessary which didn’t work so ended up with drip. I’d had two spontaneous labour & births previously using only gas and air that were both positive experiences. My induced labour was definitely more painful, and whilst I did end up managing with just gas and air and morphine, I found myself wishing I’d insisted on an epidural. I did ask for one, but I was so near to the finish line I never got it.

In short it was more painful yes, but overall I managed and all was well in the end.

I've had three inductions, never gone into labour spontaneously so I have nothing to compare to but I've had the drip twice and although painful it wasn't unbearable and I didn't have an epidural either time. The pain is different to normal pain.

My induction was fine, I didn’t need any drugs as the sweep two days before had worked well. They broke my waters and I gave birth eight or so hours later. I imagine it would have been a lot different if I’d needed drugs to get it going but we didn’t know until I got there

I had the drip after my waters went but I didn't progress enough past 4cm. I must have been naive as I didn't realise I had a choice really! It wasn't so bad really though, as soon as I had the epidural I managed to have a sleep, which the midwife recommend. What was worse was how I felt afterwards, I guess it's beyond our control though that's how I've always thought about it and usually just put my trust in the medical staff. Hoping for an easier birth this time though!

@museumum

My preference was to have a water birth in a MLU and so therefore I didn't want an induction as they don't have them in MLU and you need a cannula inserted in your hand so can't use the pool.

Having read up about inductions and pain, although my plan A was MLU gas and air in the pool. I decided that if it went to plan B with an induction I'd ask for an epidural right away because I think that induced birth is not the same as spontaneous and therefore it doesn't always make sense to have the same pain relief preferences for both.

This isn’t quite true. You can’t have a water birth on the drip, but you can have the pessary / gel / balloon to kick start contractions and once you’re contracting well and if not on the drip you can still have a water birth.

I've read into this quite a lot, I'm a scientist so like to look at the evidence. From what I gather, statistically there is a real and increased risk of stillbirth after 40 weeks, it is still small, but doubles each week from 40 to 42 weeks. Therefore induction is recommended by the NHS. It has a reputation of being faster and more painful than a naturally occurring birth, but I haven't seen any statistics on this to back this up. That is why I personally find the current narrative around inductions worrying - why would you take the risk of a stillbirth to avoid a slightly less painful birth? Yes, it's a small risk, but in the likelihood-severity risk approach, the severity is so high (baby dying) that it's not worth even a small risk in my opinion. A recent Cochrane review (a best in class review that assess all published data) showed that across 22 trials, 16 infants were stillborn in the expectant management group and only 2 in the induction group. That's a big difference even if the numbers are small - I wouldn't want to be one of the 16...

Sweeps I understand have much less clear cut statistics, but still result in "a 24% increase in chance of delivering within 48 hours, a 46% increase in chance of delivering within a week and a 74% reduction in likelihood of going 2 weeks over dates. It is not associated with any increased risk of infection of the mother or baby." From a literature review published in May’s British Journal of Obstetrics & Gynaecology. So my understanding is that they are done to avoid the higher likelihood of an induction if you don't have one.

Personally, based on the above, I will be first of all basing any decisions on my due date by ovulation, not scan, to ensure it's as accurate as possible (appreciate this isn't possible for everyone). Secondly, I will be refusing sweeps or induction until 41 weeks, but then probably would accept a sweep after that and induction at 42 weeks.

On a personal note, my mum has a friend whose baby died after being overdue, I don't know how you'd cope if you knew it was because you'd refused medical advice.

Hi OP.

I was induced at 39 plus 3 due to reduced movement. It would not be my preference to do this again unless there was medical concern and not being induced would put baby/me at risk.

Firstly (slightly trivial)
It's super boring, you have to wait ages and until you're in active labour nobody takes an interest in you, I was in hospital 3 days before they broke my waters.

Secondly - my daughters heart rate massively dropped when they broke my waters which led to emergency buzzer etc

Thirdly - there is no slow build up to contractions, they hit you like a brick within 10mins of waters being broken (I had then epidural, as pain to bad but this increases your chances of needing instrumental assistance, which I did (forceps).

Sorry to sound a bit negative, you'll be fine! But I wouldn't choose an induction again if I had the choice. Hope that helps!

I have 4 DCs and still wonder myself why people are so negative about inductions.
I was a bit apprehensive myself but was also greatly relieved when induction was on the card with my 3rd (my pre eclampsia and SPD).I obviously thought about 'cascade of interventions' but the experience was very positive.My waters were broken,baby born 2 hours later,everything was straightforward and quick.If I will have to do it again,I would not hesitate.

Everyone thank you so much for your replies and sharing your experiences, I am so very grateful for your honesty and openness. It has put a slight taint on my attempt to surround myself with ‘positive’ birth stories but I think the most important thing is to be informed and know what to expect, so you’ve helped me so much!
I have struggled to find any information beyond the standard medical explanations of the types of induction so first hand experience is so valuable.
I’m 32 weeks at the moment, so a little way to go yet, but I will be hoping and praying that a natural start to labour is possible.
Thank you

This is why I'm glad I knew nothing about them and hadn't discovered forums before having DC1! I happily went along with the induction (not much choice due to pre-eclampsia) and due to the need to get him out fast I was straight on the drip. It was absolutely fine, perfectly good actually. Quick labour, under 4 hours at 35 weeks, gas and air only and just a small tear with 1 stitch.

Nothing like what you read about and I'm really not someone who deals well with pain! DC wouldn't have made it if we'd waited any longer (despite a scan the previous day suggesting the blood flow in placenta was good, it wasn't as the placenta had disintegrated and he weighed 3lb) so I'm always very positive about getting induced if there's any chance it's necessary. I had one booked for 37 weeks for DC2 but they arrived before that anyway.

Induction can be a sensible solution, but these are my reservations:

• It often seems to take forever, which can be very stressful for the mum and end up with a birth where she's exhausted which isn't the best thing for a productive labour.

• It taking forever can be because your body wasn't actually ready to go into labour yet. That might be for a good reason. It might also be for a bad reason - nature isn't always right. But induction for the sake of it, for convenience reasons (not done in the UK), or over concerns which might be overblown may actually increase risk over simply waiting. And if you do need to give birth imminently, but the chances are your body isn't going to react well, then an elective c-section might make more sense especially as a long/drawn out/unsuccessful induction may end in an emergency section anyway.

• It can sometimes take some really hardcore actions to get it to work such as breaking waters or use of a syntocinon drip. These things can cause labour to progress in an unnatural way, which means you don't get the benefits of the natural systems your body has to help you cope with it. It can be a very intense and painful experience.

• Because it's higher risk than spontaneous labour, there is often more monitoring, which restricts the use of some non-medical forms of pain relief such as environment (no home birth/midwife led unit), use of birthing pools or movement and positioning etc. Monitoring can also increase the mother's anxiety which again can lead to poorer outcomes.

• It tends to more often (not always) result in an instrumental delivery or emergency c-section, it can make more sense to simply elect for an ELCS in the first place.

It's not always a bad idea. Sometimes it might be the best choice for the situation. But if you're being offered induction, I'd always 100% want a discussion involving what methods they would suggest, where are you on the Bishop Scale, what happens if it doesn't work, is it worth having an epidural immediately, is there a time scale, is it possible/advisable to wait and if it is more risky to wait and see, is there anything that can be done to mitigate the risk, and finally does it make more sense to go for ELCS rather than induction? Or move to ELCS after a certain time frame?

I think sometimes people get caught up in vaginal birth being "better" (safer? More natural? Cheaper?) than c-section and therefore keep chugging away at any option which means an attempt at a vaginal birth, and at some point you're actually increasing the overall risk or potential for injuries/trauma by trying so hard to avoid a section.

I think part of the problem with getting a clear picture on this is that the word “induction” covers so many things. A sweep, the balloon, pessary, breaking waters, drip - they are all different but all can be part of an induction.

Personally, I was booked for an induction but went into labour naturally beforehand. However, after 3.5 days of labour with contractions every 3-5 minutes I had barely made any progress. Then my waters broke with meconium and baby started to struggle so I was put straight on the drip. I’d heard that the drip made it more painful and by that point I hadn’t slept in days so I went straight for the epidural. It did lead to the cascade of interventions that others have been talking about (epidural, ventouse, episiotomy) which was certainly not in my water birth and candles birth plan but because I wasn’t in pain I was calm and able to sleep from 2cm to 9cm dilation! It wasn’t what I’d chose if my body cooperated but after a long first part of labour I’d have done pretty much anything to speed things up and I ended up with a gorgeous healthy baby.

The fact that induction can take a while and that it can lead to a lot of interventions makes it unattractive. BUT it’s a hell of a lot more attractive than there being problems for the baby and mum that can come with being seriously overdue or not getting the baby out when it’s struggling.

@Marmite27 I've had a drip to restart my contractions that stopped when I was 10cm and one to start labour. They aren't comparable imho. I had zero pain relief for the first. You are already in active labour in the first scenario, you aren't in the second. If you end up with a syntocin drip to start labour get an epidural at the same time would be my advice. The pain and frequency of those contractions was 10 times worse than my spontaneous drug free labour

I had 3 induced.

One was just a sweep and pessary
Two was sweep pessary and drip
Three was pessary and drip and a different drip.

All were absolutely the same. ! All fine.
Don't let storied scare you.

why would you take the risk of a stillbirth to avoid a slightly less painful birth?

Well, I don't think it's quite that simple.

First of all, induction vs waiting (forever) isn't the only choice. You could also have an elective c-section.

Second, all induction techniques are not the same as has been pointed out a lot already by other people on the thread. Some aren't as immediate as others so if the goal is to get the baby out as close to 40 weeks as possible, you might choose something different compared to if you just want to jog things along a bit.

Third, dates can be incorrect and there is a natural tendency for spontaneous labour right up to 42 weeks, isn't there? In fact the average time for a first time mum to go into labour is naturally a little bit later - something like 40+6 I think. So it might well be premature to induce labour by or at 40 weeks for some women or even most first time mums. There is also monitoring you can do first of all to check how favourable a woman's body is likely to be towards the induction, and second to check on the health of the baby and the placenta. I don't know offhand how effective this is (actually I think this is what that review is looking at with "expectant management" - so perhaps not that effective).

Fourth, none of this is happening in a vacuum. Some of the stillbirths happening after 40 weeks might well be caused by the induction, as induction before 40 weeks is very rare so most pre-40 week labours are going to be spontaneous whereas more 41+ or 42+ week labours are going to be induced ones.

Fifth, an induced labour is riskier than a spontaneous one, which needs to be weighed up against the increased risk of stillbirth - this is as I understand it why the current recommendation is to wait 10-14 days after the due date before scheduling an induction, rather than inducing immediately at 40 weeks. There are also other risks such as injury and trauma to the mother, which aren't insignificant. It can be easy to say well I'd take any injury or trauma if it means my baby will live - and that might well be true, but if for example there is a 10x increased risk of injury vs a 0.2x increased risk of stillbirth this might not be a reasonable comparison to make. Or it might be. That's why the individual patient needs to have a conversation about risks with her midwife or consultant in the case where induction is being suggested.

Sixth, we're not talking "slightly more painful" - but quite significantly more painful (going by anecdotal evidence, anyway) with an increased risk of lasting injury (documented) or trauma (anecdotal? Possibly studied, I don't know). But in any case as earlier stated, it's not a choice between induction or waiting, but actually between induction, elective section or waiting. Elective section is not painful (apart from the recovery perhaps) and tends not to be traumatic, particularly compared to instrumental delivery or emergency c-section, both of which are higher likelihood with induction. Of course it's major surgery, so does involve recovery and does probably count as an injury in terms of scarring and potential damage, but it's usually something people recover from completely as opposed to some of the more catastrophic bladder, bowel or vaginal injuries which can be caused by instrumental delivery.

I had an induction the day before I would have been 42 weeks. I’d had two sweeps and there was no sign of baby coming on his own.
To be honest the induction was fine. The first day was kind of rubbish because I had the pessary and then they didn’t give me any decent painkillers so I was having contractions for a whole day with no gas and air. But then I got moved to the labour ward and got on the gas and air and had an epidural. Very straightforward and relatively easy birth.

I was a bit sad that I never got to go into labour naturally but I wasn’t willing to risk waiting and I wanted to avoid the long recovery of a c section.

I didn’t realise people were against inductions! I’ve heard they can be more painful than natural labour but I had nothing to compare it to.

I needed syntocin (sp?) as my waters had broken and after 48 hrs DS needed to be brought into the world!

I had gone into labour, but it wasn’t progressing quickly enough. I was very glad that I had the option for our safety, but it’s not pleasant.

Contractions increased rapidly without the natural build up, I tried all the pain relief options but had to have an epidural, despite not wanting to go down that route.

DS was born safely, I was fine so all worth it, but not what I’d hoped for.

I had a hyper reaction to the pessary. I was contracting constantly (another contraction had started before previous one subsided) which was mega pain. I'd dilated to 6cm within an hour but the midwives kept saying I couldn't have progressed that fast and I was overreacting, that it was a side effect of the pessary.

My mum was writing down my contraction times and insisted I was checked immediately and they all quickly rushed into action as baby was in distress.

I didn't enjoy it at all mainly because I had a high pain threshold and the midwives didn't believe me that I needed to push... fortunately it was a positive outcome but dread to think what would've happened if my mum wasn't advocating for me (husband was busy comforting me through the pain!)

I had an induction with the drip at 2cm with my dc5. Slowed my barely there labour down and put baby in distress. Hooked up to wires and not allowed to move. I ended up with an emergency section 5 hours later when I still wasn't in established labour. Never again.

I have just remembered something else I should have said as I do when people are looking (possibly fuelled by NCT as we all were) for only positive birth stories. Out of 8 in our group only one had that "natural" experience and even she was booked in for an induction a couple of days after her DS arrived by himself.
Being forewarned is definitely forearmed, I think, and if you get the lovely experience in the end, so much the better. I'm hoping I'll get it if I have another DC but I'm much happier knowing the mechanics of the alternatives now having experienced some of them. A positive birth story is one that doesn't lead to any long term impact on the mum or baby, for me.

My trouble was I had no faith in my allocated midwife. In the three months before due date she told me I had gestational diabetes (wrong), my baby was breach (wrong) and that I would need a C-Section (also wrong).

I'd been fine for months, stopped work at 38 weeks, cleaned the house, packed my bag, stocked the freezer and sat down at 9am on due date to put my feet up. Then she rang (9am!) and told me 'we needed to move things along' - I wasn't late, baby wasn't big, my blood pressure was normal.

When I said I would leave it a couple of days, she tried to pressure me at which point I'd had enough. I'm a human being, not a production line. I went into labour naturally at 40+4 without her involvement, slow, calm, DS arrived pink & healthy.

She was bossy, officious and ignorant, my hackles are rising just thinking about her. If she'd bothered to ask, she'd have known I'd rather not have interference or fuss until I actually need it.

God I dreaded giving birth, in fact I think I had some mental condition that put me off getting pregnant because I was to scared of birth. But at 38 I fell pregnant, but had colystasis, spelling not good. I ended up getting an induction at 37 weeks. Had first pestary at 12 then the next at 9pm. There was no build up just pain from 9.20 then he was born at midnight. I had an epidural. So I was only in labour for under three hours. Once I had the epidural it was amazing, I felt like kissing the doc when he brought it in. My daughter a year later, I was in labour for twenty minutes.

I had an induction with my second and it was absolutely fine