Induction - does baby's position matter?

[Julie Doula]

I've got a question about inductions. I noticed in the 2006 stats that 99% of women are having their babies in hospitals, and only 1% of women had their babies after 42 weeks. So I get the impression pretty much all women who birth in the system are induced before they get to 43 weeks. In the midwifery model, there are some women who don't get routinely induced at 42 weeks just because they're 42 weeks, I know homebirthers who've gone to 43, 44, even 45 weeks (yes I know them personally). But they only make up 1% of the population, and obviously only a small proportion of the 1% of homebirthers in Australia gestate longer than 42 weeks naturally.

These 2006 stats said that 25% of Australian women are induced, and that the most common reason was "prolonged pregnancy" (i.e., no medical reason). When the stats show that hardly any women have their babies at 43 weeks or beyond, I get the impression that a lot of women are getting induced just because they are 42 weeks. So the bell-curve of what is normal gestation for women is getting skewed by this 25% induction rate.

The Midwifery Model goes by evidence that shows expectant management is just as safe and yields as good if not better results than inducing. But only 1% of women in Australia are accessing the Midwifery Model - and they're trying to eliminate that!

So we end up with a LOT of inductions.

My question is, given that so many women are going to be experiencing induction, does it matter what position the baby is in, when you induce? I'm especially interested in first time mothers. So if you are a first time mama, and you're 42 weeks, the head is still high perhaps not yet engaged, and the baby is posterior or round to the right, does this have any implications for the induction?

The usual wisdom in the Midwifery Model is that sometimes a labour will start later in the pregnancy because the baby is spending time getting into a more optimal position for birth. When a woman is induced, will this process of the baby negotiating with the mother's body the ideal & unique route through her pelvis simply be accelerated? Is there any risk that the baby will be forced to descend before optimal rotation has occured, or will the induction hasten both the rotation and descent of the baby?

I am wondering if there is any value in taking measures to optimise the baby's position prior to the induction beginning, or whether the uterine contractions will pretty much take care of that.

Your thoughts? and experience?

TIA

[fi1980]

Hi

I'm not too sure if I can answer your question or not but thought I'd share my recent experience with you. I recently had my first baby and was induced due to being 'overdue'. At 12 days overdue they inserted cervadil to get my cervix ready. At the time it was inserted baby was engaged but cervix was tightly closed, also they didn't realise at the time but baby was posterior (didn't realise until she was born). The cervadil triggered labour which was awful as due to baby's position it was simply a constant and severe back ache that seriously intensified during contractions leaving me virtually unable to move due to the pain... so I was loaded up on drugs. My body still did not want to cooperate, with contractions virtually on top of each other I was only 2cm dialated so I had my waters broken but still nothing and bubs became very distressed with her heart rate dropping quite dramatically - I was quickly wisked away for an emergency c-section.

Looking back I honestly think that my baby was simply not ready to be born and all of this may have been avoided if I had been allowed to wait a few more days to allow her time to ready herself for birth rather than being forced out. Whether or not her position impacted on the outcome I can't really say.

I hope this helps

Fi

[Julie Doula]

Hi Fi, thanks for your response to this question. I'm sorry the induction did not end well in your case. It sounds like you are tuning in to your instinct well and this will serve you in the future.

I'm exploring some studies at the moment, some say "induction reduces c/s and does not increase the c/s rate" - some say the total opposite, that induction increases the chances of further intevention and eventual c/s. Whew. Talk about duelling research papers!

I also noticed this (below) on Spinning Babies, on the subject of shoulder dystocia (stuck shoulders after the head is born). Midwife Gail Tully who hosts Spinning Babies notices a correlation between medical induction and stuck shoulders because of incomplete rotation.

Inducing labor to prevent the baby having time to grow big is not statistically found to reduce the incidence of shoulder dystocia. That may be because the powerful effect of syntocinon, the articial hormone to make strong uterine contractions to induce labor, moves the baby down fast enough that a few of these babies, though smaller, don't have time to rotate their shoulders for birth.

Resolving Shoulder Dystocia

Gail also warns against disturbing a mother (as in suggesting a change of position) while she is crowning (such as "let's get you off the toilet now!") because it could interrupt the complete rotation of the shoulders.

Well, there are so many variables to consider, especially taking into account the different approaches used in the obstetric model and the midwifery model, I think it is very helpful that mothers and midwives and support people can discuss such things and share collective wisdom. Hoping a few others might come along and add their thoughts.

[Sagres]

This is a really interesting area, something that I certainly thought about before my induction. I guess I have thought quietly to myself that position does have an influence on how successful an induction will be but don't have anything to back that up.

I'm not sure if my situation will help you at all but here it is anyway. I was developing PE so was induced but at 40+3, not early and not 42 weeks. At my last appointment we discovered my girl had switched to posterior since my previous appointment a few days earlier. My ob set out that I'd have 2 lots of gels 8 hours apart (2 lots to give us every opportunity to get things going ourselves), then my waters broken 3 hours later. Between this appointment and my induction date I had some accupuncture to try and get my little miss to flip over again and to prepare my cervix. I have no idea whether that flipped her or she was on her way anyway but when I presented at the hospital for the induction she had flipped back. So this is why my story is probably no help to you, she was in a favourable position when I was induced and I never made my second lot of gels as my girl was already a few hours old at the time they were scheduled (vaginal delivery).

I noticed in the 2006 stats that 99% of women are having their babies in hospitals, and only 1% of women had their babies after 42 weeks. So I get the impression pretty much all women who birth in the system are induced before they get to 43 weeks.

This is an interesting one, and it depends a bit how you look at the stats. I think you would need to know what percent of women would have actually got to 43 weeks without any intervention. If it was like 2% then that makes the 1% almost too small to be significant. If however it was 12% you would say that yes, women in the hospital system are not going over 42 weeks. Also I guess you have to take into consideration that many women are quite happy to elect for an induction at 42 weeks, so not necessarily a hospital imposed situation but individuals choices.

I'm exploring some studies at the moment, some say "induction reduces c/s and does not increase the c/s rate" - some say the total opposite, that induction increases the chances of further intevention and eventual c/s. Whew. Talk about duelling research papers!

Oh this is a really interesting one. I think that both are true - but in different situations! Like my SIL who was induced at 37 weeks (due to babies size) and had a pretty unpleasant vaginal delivery, baby got very stuck, was eventually delivered, suffered a punctured lung and some other minor issues. I think had she gone to full term a vaginal delivery may have been out of the question. So induction very likely did prevent a c/s. But then with the previous poster you could easily argue the induction caused the c/s. So my very uneducated guess would be that both are correct, the very very hard part is knowing which basket a woman falls into!

[julie_ann_jules]

not sure if this helps as I wasn't overdue (i was induced due to gestational diabetes, although it was well controlled) anyway I was induced at 38 weeks, had the prostaglandin, my waters ruptured themselves and my body went straight into labour. 40 sec contrations 1.5 min apart. Terribul back pain so I had an epi. I laboured to 9cms then bubs went into distress so I was whisked into an emergency c-section. They said that bubs was prosterior.

oh when I was indued bubs wasn't engaged.

[Traveller]

My gut tells me that position matters a lot to the success of an induction, as the clock starts ticking from the first contraction which will be doing what would normally happen at home prior to labour, ie baby rotating into a nice position. This leads to more c/s for "failure to progress" and "maternal exhaustion" that IMHO could be otherwise avoided by waiting a few more weeks. I would love to see the stats on what gestation women are when they are inducted for non medical reasons as I suspect that there are a lot of inductions between 38 and 41+6 weeks which is of course term. This will skew the statistics on average gestation for Australian women.

To be honest I would like to see induction for "overdue" to be properly studied and hopefully the whole practice stopped. Induction for PET or diabetes is another matter entirely but I feel that inductions are being offered for so many reasons (maternal exhaustion, partner's holidays, childcare) without any consideration of the medical implications of this. And I do not feel women are giving informed consent, because they are not told of the likely implications of an induction.

[YoYo]

My experience with induction 2 years ago is all I can contribute to this thread!

I was induced because I was 9 days overdue, DS was posterior.....but didn't know till I was actually in labour (possibly a reason he wasn't ready to come out when I was ready for him to ). I was given gels on a Thursday night, which didn't work on me, and was induced with the drip on the Friday morning at 7am.

I went into labour hard and fast and had an epi. After they'd checked me, they knew that DS was posterior, but that didn't mean anything to me at the time (no BB wisdom!) I sat on a chair labouring which I think helped him to drop and I was quite relaxed after I'd had the epi which helped too.

The doctors thought that I wouldn't have him till six pm, but I wanted to prove them wrong. They also thought that I'd need help to get him out, either with suction or forceps. I didn't need any of that, at 3pm I was 10cm and ready to push and at 3:55pm DS was born. I had managed to turn him (well maybe he did that himself I'm not sure) and have him with his hand up against his face. The doctor was well impressed!

I'm not sure whether being a public or private patient would contribute. Had I of had a scan and seen that DS was posterior, whether that would have changed their reason to induce me, or leave me a bit longer to see if he changed position?

[onthefly]

This is my experience:

Induced at 42 weeks because...42 weeks.
Cervix was 90% thinned but not low or ripe when folley catheter thingy put in night before induction. Baby still not engaged
On morning of induction, cervix thinned, cervix still high but somewhat ripened. Baby not engaged. But still in left/anterior position.
DR says: Very high chance of ceasar (but continues anyway - never occurred to me to say, ok, we'll come back later then!)
Waters broken. 3.5 hours later, synto started. 1.5 hrs after that 8cm. 3 hrs after that 10cm, but baby in distress (and so was mum!) = forceps delivery.

Narrowly avoided caesar.
Mum regrets induction.