The World Health Organization states: ‘Induction of labour should be performed only when there is a clear medical indication for it and the expected benefits outweigh its potential harms’.
Based on this recommendation, it’s believed induction is medically indicated no more than 10% of the time.
Yet in many high-income countries, labour induction is occurring at rates between 25-50% of all births. Up to half of those inductions are elective rather than medically necessary.
Do Babies Really Need To Be Induced To Ensure They Are Born?
This growing trend of elective induction is causing concern for many health experts, as we learn more about the way labour proceeds and how it can affect the long-term health and wellbeing of both mothers and babies.
What Is Labour Induction?
Induction is the process where labour is started artificially, before it begins on its own (spontaneously). The most common way to induce labour is to introduce a synthetic hormone into a woman’s bloodstream. This hormone mimics the action of oxytocin, the hormone responsible for uterine contractions.
Science is only just beginning to understand the way babies and their mothers’ bodies work together to initiate labour. A baby’s lungs must be ready for life outside the womb. A mother’s body needs to have the right amount of hormones flowing.
It is a complex process – one that has been happening in mammals for millennia. No one can see or pinpoint the exact time when labour begins; it evolves naturally as each factor is triggered.
You can read more about how labour starts in What Causes Labour To Start?
Why Is Labour Induced?
The aim of labour induction is to stimulate uterine contractions before labour has begun simultaneously. When labour is induced, however, there are increased risks, including further interventions and c-section. So why do we see ever increasing rates of this intervention?
There is a multitude of reasons given for why the rates are so high, including:
- Convenience – either for care provider or mother
- Lack of support for, and trust in, normal birth
- Concerns about potential complications, such as macrosomia and gestational diabetes
- A heavy reliance on technology for estimated due dates.
Many experts believe about 50% of inductions are elective rather than medically necessary.
Medically necessary inductions occur when the risk of continuing with pregnancy is too high – either for the baby or the mother.
Elective inductions make it easier to manage obstetric practices in hospitals. Private obstetricians are generally upfront about how much more efficient scheduled inductions are.
Will My Baby Ever Come Out Without Induction?
Scan enough birth stories on the risks of induction and you’re bound to find a few comments from women who claim they had to be induced, because they just couldn’t or didn’t go into labour.
What is difficult, or often impossible, to know in these situations is whether those women would have started labour on their own. There might be circumstances where a woman is made to believe her body isn’t ‘working’, her baby is not being engaged, she is going past her due date, or her baby is too big.
These reasons for induction are not based on best available evidence, and shouldn’t be used to excuse an induction which is probably unnecessary.
What most people tend to forget is there is a wide variation in how long it takes an individual baby to mature fully. Some babies are ready to be born at 37 weeks gestation; others need longer and will be born around or even after 42 weeks.
Estimated due dates are also simply guesses, and the size and estimated weight of a baby aren’t indications of how mature a baby is.
What Do We Need To Do?
It’s widely assumed that medically managing labour makes birth safer for women and babies. It’s generally accepted that interventions in pregnancy and labour are safe and effective. Yet there is little evidence to support these beliefs.
Obstetric interventions are created for specific medical reasons, and when used for those purposes can be life saving. But when medical interventions are used routinely, on healthy women and babies, it undermines the view that birth is a normal event.
Lack of patience is not a medical reason. Neither is fear of a big baby. A baby who is high and not engaged isn’t a medical reason for induction. A care provider’s absence around the estimated time of birth isn’t a medical reason to begin labour artificially, either.
If you are considering induction for any reason other than a medical one, before you give consent it’s important you know the risks compared with the benefits. An induction is often presented as a relatively straightforward process, but there are a number of factors that can increase the chances it will fail, and you will need an emergency c-section. This can have a huge impact on your recovery, your mental health, and future pregnancies.