When do you think induction is necessary?

[Pinkstuffs]

I’ve been seeing a lot of backlash lately around the rate of inductions and the subsequent ‘cascade of intervention’ that can follow. Lots of content creators who are midwives or doulas are encouraging women to decline induction.

They often imply that there are scenarios where induction is necessary which has got me thinking, when do you think an induction is a good idea? I know each women’s case will be slightly different, but in what scenario would you take induction if offered?

I have an induction at 39 weeks for a small baby and don’t regret it even though it led to a csection.

When the available evidence is that it's safer for the baby to come out than stay in. Biology, although a science, isn't exact, so you have to make the call based on the information you have.

Suggestion of a placenta not functioning as it should ie small baby, fall off in growth, oligohydramnios, reduced fetal movements. Maternal reasons (there are many) but for example PET, hypertension, ICP etc. But really I think it's very personal what's 'necessary' and what's not. A woman's anxiety and own mental health are very valid reasons imo, but aren't necessary in every scenario for every woman if that makes sense. I don't think there can be a blanket statement on what's necessary and what isn't, aside from the obvious ones meaning baby or mother's life could be at risk. As a HCW the discourse around induction is alarming. Seeing women outright refuse induction because they've read somewhere that they should decline, without fully engaging with their care team, is terrifying.

I think sometimes the healthcare team gives mixed messages. I was pregnant with twins and they were planning to move forward my induction date as the consultant was concerned about me, high blood pressure, protien in wee I was in for monitoring and steroid injections.

Midwife who was monitoring me who I’d never met before was very anti induction, lots of they have plenty of growing room, babies would come when they were ready, she’d known a 5 2” woman get to 40 weeks with her identical twins, consultants don’t know everything, you’re entitled to refuse an induction type stuff.

It was not my first pregnancy and tbh I thought she was a bit bonkers. I could easily see how someone who was a bit uncertain could be led astray by the mixed messaging.

From what I can gather, a lot of the information around induction is actually quite out of date. Recently there has been the ARRIVE study in the US and this study from the University of Melbourne in Australia, which shows that induction by choice (rather than any medical need) at 39 weeks has positive health outcomes for mothers and doesn’t increase c-section risks. https://www.unimelb.edu.au/newsroom/news/2023/may/mothers-choosing-to-induce-labour-at-39-weeks-have-better-health-outcomes

That is entirely bonkers! Sorry you were faced with opinion rather than balanced medical information. I'd hope not many HCWs would behave in that way, but unfortunately you do meet all sorts🤦🏼‍♀️ I'm more talking about the 'people on the Internet' from all sorts of walks of life spouting madness on social media. Even worse when it's coming from HCWs you're supposed to be able to trust though.

Obviously I can’t speak for everyone but I found that advice really differed depending on who you spoke to within the team. My twin pregnancy was tricky and because of the type of twins I had fortnightly scans at hospital and hospital midwife appointments and consultant appointments and community midwife appointments.

At my original booking in I found out it was twins and the sonographer said scans every fortnight from 16 weeks. I saw the midwife directly after and she said no just two extra growth scans. The sonographer was right but it set the tone and I was told completely different things about the way I could expect my care to go quite often.

I do think pregnancy is an area where the care isn’t standardised and a lot seems to depend on individual hcw opinions. It feeds into a narrative where they aren’t right or wrong answers.

Pregnancy and delivery advice also varies a lot depending on where you are. Standard practice in France or the U.S. could recommend something different.

I’m not against inductions, I had two, just needed the pessary, everything went really well. No cascade of interventions for me. Some people have a terrible time of it though. I do think it’s seen as a cheap option when perhaps a c-section would be better but need to try induction first.

I was induced at 40 weeks for low amniotic fluid and a dodgy fetal trace (though still think that was because they had me flat on my back with a 9lb baby in there - I nearly passed out). I'd not noticed any leaking of the fluids but when they broke my waters as part of the induction there wasn't a lot there really 🤷‍♀️

But I was happy enough to get things moving at that stage with the baby fully cooked.

If you get to about 41weeks and 4 days I think it’s justified. The stillbirth rates go up rapidly after 42 weeks.

Sorry, edited because I made a big mistake on the math!

The ARRIVE trial was high rates of induction with very high rates of induction so I'm not sure it's appropriate to use it to draw conclusions about the overall safety of induction.
Also it's the USA so around 20% of the spontaneous labour were probably "augmented" with the same drugs they used for induction. ARM rates are pretty high too.

Of 2502 in the expectant management group:

Born before 39 weeks: 229 induced or c section 735 spontaneous labour
Born in 40th week: 378 induced or c section 733 spontaneous labour
Born 41+ weeks: 343 induced or c section, 427 spontaneous labour

Overall induction/planned c section rate in the expectant management group is 37%, approx 2 in 5

Data from the following analysis: https://pmc.ncbi.nlm.nih.gov/articles/PMC8404416/

I'd be super wary of anything you read online as there is a lot of misinformation out there, some of it quite dangerous.

I’ve found the fear of induction and ‘cascade of interventions’ has the effect of making women feel guilty if they need one, as though they have failed or weren’t diligent enough to ‘know their body’ and they should ignore medical professionals and breathe out the baby.

I had an induction as growth was falling.

I still feel ‘bad’ about it because of all the messaging around it. Even though I know that logically, doctors and midwife’s don’t want to do inductions for the fun of it, and actually only recommend when it’s medically advised.

There was a very poignant article in the guardian today about a stillbirth, and I think a lot of people overlook the very worst case scenario, and really if an induction is suggested, it will be for a reason

Just in case that was a reference to my comment - I think the national institutes of health is a pretty good source.

I was induced twice and would happily ignore the online misinformation in exchange for a safe birth and a healthy baby. I wouldn’t risk an increase in stillbirth and I think anyone who does is selfish

No I was referring to the OP who mentioned content creators who aren't accountable oe regulated. You can easily fall down a rabbit hole on something like Instagram or TikTok that can lead to some dangerous places imo.

A healthy baby and a healthy mother is the most important thing. I've had one induction that failed, that was probably always going to fail. My body was nowhere near ready to go into labour, i was stressed, tired and hungry from having to fast all day "just in case" before the induction starting at 9pm. It was an emergency that ended up with a c-section 4 hours later anyway. I should have had a c-section much earlier in the day (i came in with bleeding and an infection at 10am), that was what would have been best for me and my baby. But they were busy, there was a queue and they had to try the cheapest option first.

Realistically they need to accept that an induction takes days. You need a well rested and relaxed mum. If they need to get the baby out quicker then it's better to go for a c-section. I was told that it would happen quickly because I'd had babies before but this time i was 36 weeks pregnant with no signs of labour. I got from 0-2cm in an hour relaxing in the bath and then i had the drip and everything slowed down. My baby ended up in the nicu with sepsis and has long term problems now aged 11.

I just don't believe that recommendations for intervention tend to be based on good evidence.

The turning point for me was realising that there's basically zero evidence that CTG is any better for babies than intermittent auscultation, but it massively increases rates of all sorts of intervention. In my daughter's birth, the midwives basically assaulted me because they weren't getting good enough CTG readings. Look up the most recent Cochrane review if you're interested. That's a good source, one if the best.

They used to do routine episiotomies. They used to do immediate cord clamping. They used to do routine sedation and augmentation. They used to separate babies immediately at birth. Why do they think that the currently recommended interventions are different from those? There's no good evidence for CTG, vaginal exams, directed pushing, giving birth in hospital, all sorts of things.

If there's a problem, then surgery and medication are life-saving, but there is no other field of medicine where the standards of evidence for intervention are so low. There's no other field of medicine where you're so likely to suffer unnecessary medical harm.

The assumption seems to be that doing something is always safer. I don't think that assumption is well founded.

I'm very wary of inductions, I have heard too many horror stories where women's bodies just weren't ready.

I was told at 8 weeks at my booking appointment that they will discuss induction with me because I'm having an IVF baby. 8 weeks, no family history of issues during birth. wtf.

I’ve had two inductions. They were both fine, just pessary , no cascade of intervention. One for a term baby and the other for identical twins at 36 weeks.

I think opinion is coloured by experience it was positive for me. I think the most important thing is patient centred care. With both of my pregnancies I felt listened to and my opinions taken into account. I could of opted for a c-section (twins) or waited abit for my full timer to make an appearance (he was already 9lbs 2 oz) but I felt ready and tbh I was moving house two weeks later which they also kindly took into account.

Just a note on this - some research shows a small increased risk of stillbirth if you go postdates with an IVF pregnancy. This is why induction is considered, among all the other factors at play. Things like this (risk factors etc.) are highlighted to you at your booking appointment so that you have ample time to research, ask questions, understand and plan. Nothing at all to do with family history.

I was induced with my first child because he was 10 days overdue and really big baby (he was 10.4 pounds). The induction itself did not work so the doctor went in and broke my water.