Just like me, I hope you found the title of this article utterly absurd.
However, this is what my client was told by an obstetrician just recently, while being pressured to have an induction.
Unfortunately, this was just the tip of the iceberg of challenges she faced, after she declined the induction.
There was no medical emergency.
Not even a slightly abnormal test result.
She was pressured simply because the maternity hospital wanted expectant women to be induced 10 days after their estimated due date.
As her doula, I could not, and would not, make any decisions for her.
However, I did provide her with evidence-based information, so she could make an informed decision.
Telling a woman her body does not know how to give birth for the first time, and saying she needs an induction for labour to start, is not evidence-based medicine.
It’s unfair that a doctor can get away with saying such things, and scaring women into interventions they do not need.
I won’t go into too much detail yet, because I’m going to share with you the original post I shared on my Facebook page, right after she gave birth.
It was posted on a Friday afternoon – usually the quietest time on Facebook.
I didn’t think there’d be much response, perhaps some understanding ‘likes’ and comments from fellow birth workers.
But on Saturday morning, I woke to hundreds of shares, reactions and comments, and people asking permission to use my post to create their own blog post.
Someone had even posted it on Instagram, where it attracted thousands of likes.
The irony is, initially, I wasn’t going to write about it.
Because we have such high intervention rates when it comes to giving birth in Australia – similar to those in the US and other developed countries – that it’s become the expected birth experience rather than the exception.
Many people believe they should always do what a doctor says, no matter what.
Some people feel that not having interventions is more dangerous.
Too Many Interventions
It’s well known, as stated by the World Health Organization, the number of interventions done in developed countries is far higher than is needed to save lives.
So we’re adding risk, without saving life.
It’s extremely hard for inexperienced expectant parents to navigate the system, or know how to discuss their options with their doctor, to find out what is, or isn’t, really needed.
Sometimes, of course, it’s really obvious that medical care is needed.
Mother-to-be has pre-eclampsia? Urgent medical attention is needed.
Unborn baby’s growth is slowing down significantly? Sounds like we need to help.
But what about those low risk births where mama-to-be and baby are happy and healthy?
When there’s a system where every woman is induced at a standard time, without any attention to what she wants, or the stage she and her baby have reached, there’s added risk.
We know first time pregnancies are statistically longer than subsequent ones.
We know genetics can come into play.
So why are we treating pregnant women like carbon cut-outs – and then blaming them for the outrageous intervention rates?
Women are often blamed for being:
- Too old
- Too fat
- Much ‘too posh to push’
- Too emotional
Why can’t the industry stop and take a good hard look at how it’s caring for women?
Around 50% of first-time mothers-to-be are being synthetically induced into labour.
We’re lining up roughly 1 out of 2 women to give birth with synthetic hormones, messing up their natural hormone systems.
Research is now discovering this could be a reason behind our 1 in 7 rate of postnatal depression, as well a cause of bonding problems, and more.
Women are told there is risk in continuing a pregnancy, but I rarely, if ever, hear of a woman being told the risks of induction of labour, so she can make a truly informed decision.
I get it – sometimes we need to save the life of a mama-to-be or a baby.
I’m not anti-intervention.
If testing produces some abnormal results, or if someone’s life is at risk – emotionally or physically – then intervention has its place.
But after 16 years of working in this industry, I feel heartbroken that things are getting worse, not better.
And I find it very hard to believe it’s because of women’s bodies.
My post is below.
The Challenges Of Giving Birth At 41-42 Weeks
I rarely RANT… 😇 but now I MUST.
This has been brewing for a while. It’s frustrating, after being in this industry for nearly two decades, to find stuff like this is still so rampant. It feels as though there aren’t enough of us to put this fire out. 😔
Although there was a happy outcome, it took A LOT of work and stress, and it shouldn’t be this way.
Most wouldn’t have known what to do or say and so wouldn’t have had the same outcome.
How the birth unfolded…
“My client has her 41 week visit at one of Melbourne’s public maternity hospitals.
Obstetrician tells her he’s booking her in for an induction in 3 days, as it’s the policy to induce at 41+3 (10 days post-dates).
She says, ‘No, thank you’.
He pulls out all the stops, telling her how risky it is and that the baby could die, as there are poor outcomes at 42 weeks.
He says he can’t help her at 42 weeks of pregnancy anyway, andthere’s nothing more to do here, because there are no more appointments with him. The only thing left to do is to induce.
He continues: ‘This is the public health system’, as if she shouldn’t have any choices, but just lock in the induction.
Mum-to-be agrees to be booked in for an induction… at 41+6 (a day before 42 weeks).
She’s told it might not happen on that day, because it’s a busy time. Everyone will be prioritised according to need, so it could actually happen the next day. But she can’t leave once they start the induction process.
Before she hits 41+6, I do lots of work with her – to help get labour going and to help her process all that has horrified her and freaked her out.
She’s anxious every day that the baby could die if she doesn’t induce. It’s a heavy burden for any expectant parent.
This is despite there being NO problems during the whole pregnancy, and scans showing the baby is perfectly fine – water levels, placenta … all fine.
She arrives at the hospital at 41+6, after we’ve had some really good chats, and she asks for one more day.
The doctor on duty declares herself pro-induction and wants the induction done now. She performs an internal and announces that the cervix is completely closed and there are no signs of readiness for labour.
The doctor then tells mum-to-be that because she’s a first-time mum her body doesn’t know what it’s doing. After all, she’s almost 42 weeks and there are no signs of labour, so she needs an induction (with gels to ripen the cervix) to get labour going.
After she almost buckles to start the induction right then and there, I suggest she ask what will happen if the gels don’t manage to get her into labour. The doctor tells her it would mean a c-section, which is a big fat ‘NO’ for mum-to-be.
Mum-to-be manages to leave and has a crisis of confidence. I ask her how she feels about it all. She feels really good and well, but she feels too good – as though she’s never going to go into labour. She confesses the doctor has really got it into her head that her baby could die. It has really shaken her up.
She heads straight off to see the amazing Christopher Tang of Eastern Vitality, whom I always recommend to my clients in a tough spot. She has a strong acupuncture session (she’d had two sessions prior to this, trying to beat the induction deadline), and later that night tells me she’s been having what felt like period pain cramps, which ended up waking her in the night, but she gets back to sleep.
Smack bang on 42 weeks, I get a call saying she has had early labour contractions, and they seem to be ramping up. It’s not long until she’s in hospital.
It’s a huge victory that she’s gone into labour on her own.
But The Battle Goes On…
Because she is 42 weeks (exactly!) she is now classed as high risk in the hospital’s view, and they want continuous electronic fetal monitoring (CFM). But we know that CFM results in more c-sections, without improving outcomes. As well as that, she’ll be stuck in bed for her entire labour, meaning baby will have a harder time rotating. This is how some babies get ‘stuck’ and eventually need an emergency c-section; position and movement make a big difference.
By now, both mum-to-be and dad-to-be have a lot more confidence. As it happens, her first time mum-to-be body DID know what to do. Then an entourage of staff, of escalating authority, come in to tell her how risky things are now. They need to know what’s going on with the baby, but they eventually accept mum’s preference to have intermittent Doppler listening.
She also refuses all internals. I stand back and watch her overflow with new-found confidence, and her trust in her own body and her baby blossom. It’s beautiful to watch.
Labour is kicking along nicely.
She has done an amazing job, actively labouring and definitely making great progress. It was wonderful to watch her drift away from her thinking brain into her birthing brain. Now, mum-to-be wants to jump into the bath to get some pain relief.
Nope. Too dangerous at 42 weeks.
Again, doctors and other staff come in and say she can’t be monitored so she can’t have a bath. The shower is ok though. (That doesn’t make sense, right?). Mum-to-be is upset. She was really looking forward to the bath. But she can’t, because “They don’t know what the baby is doing without CFM”.
When they all leave, dad runs the bath anyway, to help his wife relax and to ease her pain. When the bath’s half full, the midwife walks in and dad cops it BIG TIME for going behind her back. She calls in the doctor and takes the plug away.
A Last Word…
I could go on for much longer, but what this willing, hardworking first-time mama had to go through was an absolute joke. Her support team (her husband and I) had to be completely on the ball, and we were exhausted trying to hold space for mum-to-be. She was doing beautifully! It’s not fair she had to put up with all of this.
I will say that the midwives on the final shift were the most woman-friendly. They tried to facilitate as much of the breastfeeding, bonding and skin-to-skin as possible. It wasn’t all bad, but it was a shocking and unnecessarily stressful lead-up and start to labour.
It’s so clear that this is the very reason we have such highly medicalised outcomes for birth in Victoria, let alone Australia.
How many women would have come up against those doctors and understood that policy is not law? How many would realise they can say no? And how many would hear the words: ‘There are poor outcomes – your baby could die’, and still say, ‘No, thank you’?
I wonder how many are aware of research showing us that CFM increases the risk of c-section without improving outcomes.
You have choices and options.
Until this mess is fixed, please get independent birth education. Find out why, here.
Please get yourself a doula. Find out more about doulas here.
And please read the right books about birth. Choose any number of these.
The maternity system is a mess.
And our mothers and babies are paying the price.
End of rant.
❤️ BellyBelly Kelly
ETA: The most frustrating thing, is when you’re in that new mama bliss bubble, the last thing you want to do is re-live this, or go through any more stress. New mothers do not have the physical or mental energy for it, which is completely understandable. So these events often go unreported and nothing comes of it. But because there are no angry mothers asking WTF is going on, there is no change – only acceptance that this is what birth is.
If you want to make a complaint or report a birth, you should write to the head of the hospital and CC the health minister to make sure something gets done fast.”
Reactions To The Rant
In the days after I posted the rant, a lot of birth workers replied saying this is EXACTLY what they see, over and over again, just as I did.
“I find this is the battle with almost every first-time pregnancy/birth or any client that is outside what the hospital deems normal. So incredibly exhausting. What I find hard is listening to Mums who have gone along with all the inductions and end up in c-section and now believe their bodies can’t birth and that perpetuates onto the next generations. Sigh. The battle is real”. (Rebecca Possamai)
“I hear you. No kidding, it was every hospital I attended a birth at and every single birth. They were either pushing intervention to speed things up or freaking out because things were happening faster than they anticipated”. (Kate Bentick)
“It’s the wearing down that’s difficult to watch, the coercion and grinding over hours or days so the woman eventually does as she is told. She is then told it is up to her and she doesn’t have to consent”. (Melissa Russell)
“Oh sigh . I wish your story was a one off, but unfortunately it’s nearly every second story I hear”. (Lael Stone)
And from mothers:
“OMG, this is almost exactly what happened to us. I let them induce me out of fear, though. If I could have just had a bath I’m sure the birth would have been uncomplicated. My body was screaming for that water!” (Kate)
“I faced this with both my pregnancies. I was constantly told I was risking my baby’s health, to the point I was also refused a bath when we booked in, when I was in labour (naturally) at 42 weeks. When I pushed it, they sent in the head of obstetrics. He was very rude to my husband and private midwife, who was there as birth support. I got very vocal when I was told by him, “Why are you here – you should just have a home birth!” And I was too exhausted to fight another battle once the baby was born. I wanted to, but just didn’t have the fight. I’m always surprised too when I tell women how many weeks I was when both my kids were born (42+4 weeks and 42 weeks). They’ll say, ‘I cant believe they LET you go that far!’ It’s my body, it’s not up to somebody to let me! We’ve taught women to think we have no control over what happens once we are pregnant. It’s so disappointing!” (Renee)
“My eldest three were all born at (what doctors considered) 43 weeks! All three! Those dates also happened to be exactly 9 months from when I conceived (yay hubby’s military deployments for making that easy to track, lol). The doctors tried to scare me in so many ways – even said ultrasounds had them measuring at 10lbs. My 3 boys were all between 6.5 – 7.5lbs. The midwife I had for #4 didn’t believe me when I said I don’t calendar correctly. She stripped my membranes (without my consent) at what she considered to be 40 weeks. My daughter was clearly at least 2, maybe 3 weeks early when she was born. It’s crazy how doctors can believe we don’t know our own bodies!” (Michelle)
But Doesn’t The Placenta Shut Down?
When a woman passes the estimated due date, usually there is concern about the placenta.
In Dr Rachel Reed’s article about balancing risks and inducing labour (a MUST read), she talks about how there is actually no evidence about placentas ‘shutting down’.
Dr Reed states:
“In theory, after term (i.e. 42 weeks) the placenta starts to shut down. There is no evidence to support this notion. There is also a good physiological explanation of the development and ageing of the placenta here, which concludes that: “There is, in fact, no logical reason for believing that the placenta, which is a fetal organ, should age while the other fetal organs do not…” I have seen signs of placental shut down (i.e. calcification) in placentas at 37 weeks, and I have seen big juicy healthy placentas at 43 weeks”.
But Doesn’t The Research Say It’s Safer To Induce Earlier?
Recently there has been a study in the media about inducing women earlier to avoid the risk of c-sections.
You might know it as the ARRIVE study, which suggested inducing women at 39 weeks of pregnancy.
However like most studies, the ARRIVE study has its flaws. It’s hard to make sense of research when you don’t have a research background.
Thankfully Henci Goer, an academic maternity researcher, broke the study down for us to understand.
I highly recommend you read it here so you can see, in simple terms, that the research is not what you might think.
But What About Stillbirth?
The image and quote below are from the above article by Henci Goer.
“The odds of fetal death with ongoing pregnancy in any given week at term are very low, and the change from week to week is clinically insignificant until 42 weeks, when the odds are still quite low (Alimena 2017 [U.S.]; MacDorman 2015 [U.S.]; Morken 2014 [Norway]; Weiss 2014 [Germany]). Moreover, the risk of fetal death varies according to factors such as race, marital status, and extremes of maternal age (Flenady 2011; Getahun 2007; MacDorman 2015; Reddy 2010), characteristics that may be markers for other factors such as poverty, substandard care, or prior cesarean (Moraitis 2015).”
At The End Of The Day…
If you have a low risk pregnancy, obviously you have more flexibility.
But it always pays to ask for more information when you’re told the risk is doubled or whatever.
In fact, the risk might increase from 0.2% to 0.4%, which still means you have a 99.6% or 99.8% chance of being okay.
This is especially true if you don’t have any other risk factors.
It’s completely up to you if you’re willing to accept that risk or not. It’s your decision to make and yours alone.
Just remember, even obstetric procedures like amniocentesis (where they extract a sample of amniotic fluid with a needle, to test for genetic abnormalities) have risks too; in this case, a 1% chance of miscarriage. But it’s perfectly acceptable to choose whether or not you want an amniocentesis, without coercion or bullying.
An induction of labour has its risks too.
Before you head into the birth suite, make sure you discover the The Truth About Natural Birth.