Induction and augmentation of labour
The evolution of obstetrics in recent decades has meant that nowadays, the majority of births take place in hospitals with a rise in routine interventions. The reasons are often more related to hospital policies, the unfolding of events in the delivery room and the potential legal implications, than with each individual situation. Natural births, without medical intervention or medication, are becoming more and more rare.
“If you agree, we’ll induce you now” – a medical suggestion that a great number of women/couples are faced with at the end of pregnancy, even before the due date. An offer which, thanks to its ease, can often be enticing for future parents, especially when the pregnancy has begun to be particularly taxing or difficult. But, usually, the parents are not well enough informed about the medical risks of an artificial induction, or the potential risks.
The World Health Organisation (WHO) only recommends induction for medical reasons. In Luxembourg, 30% of births are induced, and of these, more than 41% are accelerated deliveries. Only in the minority of cases, was there any medical reason for intervention.
Nowadays, we are extremely lucky to have at our disposal doctors and hospital staff who are capable of saving our lives in emergency situations. Yet, pregnancy and childbirth are natural occurrences, and ideally, shouldn’t require any medical intervention unless absolutely necessary. According to scientific studies, it’s better to just let nature do its job.
In the mother’s belly, babies don’t have a calendar or a watch to tell them the doctor’s predicted due date. Labour is actually naturally induced by an interaction of fetal and maternal hormones, and it is the baby who signals the start, when his/her body is ready. However, a great number of labours are started either before, the day of, or only a few days after the due date; and yet, according to the WHO, spontaneous labour is likely to occur anywhere between 37 and 42 weeks. It is not until after the 43rd week that the baby is post term and that induction is necessary. Except of course, in cases of risk to either mother or child where intervention is necessary.
The due date – an unreliable date
To calculate the due date, a few things are taken into account; the 1st day of the woman’s last period (taking into consideration here the differing cycle lengths of each woman), the circumference of the mother’s womb, the diameter of the baby’s head and also the length of the baby’s femur bone – therefore, according to calculations, a baby with a larger than average head should be born before the due date.
Furthermore, pregnancy length varies from woman to woman to anywhere between 38 and 42 weeks; with around 40% of babies born after their due date.
Therefore, it is a real possibility that a child who is artificially forced out of the uterus is not yet physiologically ready to be born and that the child may have needed more days to become ready.
This is why it is important for the future mother to remain calm and wait patiently for birth, especially at the end of her pregnancy, and also that she remains self-confident and assured, without being fixated on the due date. Sometimes, it even seems that a baby can feel when their mother is not quite ready; the mother is stressed, and through her hormones, she signals to her baby that it’s not quite ‘the right time’ to be born.
How does induction work?
Often, when being induced, the cervix is prepared first, by introducing a gel. In the majority of cases, the mother will also receive an oxytocin drip. Then her waters are artificially broken, and we can no longer describe this process as a ‘natural’ birth.
What’s more, the breaking of the waters is hardly recommended – it can cause undue stress to the baby, increase the risk of infection and can cause contractions to be more intense and therefore much more painful for the mother.
What are the risks of induction and acceleration of labour?
The uterus can become overstimulated by the medication, there is a risk of more intense, prolonged contractions and less rest in between pressure waves and the baby can become stressed.
Often with inductions, the mother and baby are constantly monitored; therefore, reducing the mobility of the mother, which can in turn, reduce the efficiency of the contractions or disturb and even prevent relaxation. The birth process now, develops further away from the parents’ expectations and birth plan.
Lots of women say an induced birth is more painful than a natural birth; hence why they are generally given an epidural, which can also have further negative repercussions, as she can no longer move around freely. Furthermore, as the mother no longer feels the pressure waves, the production and release of endorphins (pain- reducing hormones) is greatly hindered, and the baby in turn is deprived of these hormones.
It’s possible that, in cases of induction, other medical interventions are triggered and become essential: help using forceps or a vacuum extractor (“ventouse”), episiotomy (cutting the perineum and vaginal wallto allow more space for the baby to pass through) or a cesarean, which is most common due to the slowing of the baby’s heart rate.
There is also the risk that a scar from a previous cesarean could rupture due to these more intense contractions.
Inductions, epidurals and other medical interventions could also have negative repercussions on breast-feeding.
French obstetrician Michel Odent, as well as other experts in the field, is against the induction of childbirth: the natural production of hormones, notably oxytocin and endorphins, are greatly disrupted, which could, from the very start, have a damaging effect on the mother-baby bond.
According to Odent, “industrialised” labours could have negative effects on future generations deprived of these love hormones at birth; he fears a rise in crime, a decrease of compassion and an increased tendency towards suicide.
According to a working group of German medical experts, doctors should only look at an induction after 41 weeks at the earliest (in the case of a normal pregnancy) and they only recommend it after 41 weeks + 3 days. It is not until 42 full weeks have passed that there is a real medical need for an induction or a cesarean.
So, if the question of an induction arises, you should carefully consider its necessity – because, after all, who would prematurely open the bud of a flower or a butterfly’s cocoon? Why then do the same to our babies?
Article Originally published in the Baby Info magazine 2/2015 by Initiativ Liewensufank
Author: Sandy Girotto-Weinzierl, Certified Hypnobirthing Teacher at Initiativ Liewensufank