Most of us would like to think that labour gets underway spontaneously around our due dates, and that everything will go smoothly after that first twinge of a real contraction hits. But for many women the reality is far different, with one in four facing induction of labour.
That statistic has remained greatly unchanged over the last decade, and the most common reason for needing an induction is when a pregnancy goes well past the expected due date. According to Dr Christine Catling, lecturer at the University of Technology Sydney, many babies need to be induced “when a woman has a prolonged pregnancy beyond her due date (beyond 41 weeks)”, or they can risk endangering the life of the baby.
This was the case with Julia*, a mum of two. “I was induced with my first son when I was 14 days overdue, which happened to be a Saturday night,” she says. “All we could find on the hospital TV was football, so I welcomed the distraction of pain when at last it started!”
“Thankfully I only needed the [Prostaglandin] gel to get the contractions going, and never needed the drip [of Oxytocin]. All's well that ends well though, and I enjoyed – and I don't use that word lightly – a very smooth seven-hour labour and easy birth.”
Passing the due date is only one reason for inducing labour, as Carolyn, a mum of three, learned. Her second child was induced as her first had been born at 4.5kg.
“My second was tracking to be even larger, so I was induced,” she says. “He was born at 39 weeks at ten pounds [4.5kg] as well. Then my third was induced for the same reason.”
Carolyn says she had a positive experience with both her induced labours.
“I really enjoyed the whole experience – I felt like I could mentally prepare,” she says. “Adding to the positive experience was that I had a great doctor I really trusted."
According to Dr Catling, women are induced when the risk to themselves or their babies outweigh the risk of continuing with the pregnancy.
“Other reasons can be maternal illness, foetal distress, foetal growth restriction, diabetes and in-utero foetal death, all of which often require induction in order to treat the disease and/or ensure the wellbeing of the baby,” she explains.
“Women with prolonged rupture of membranes – where the waters have broken but labour hasn’t followed – also need an induction of labour due to the higher risk."
There are four commonly used methods for getting the procedure underway, explains Dr. Catling: the artificial rupturing of the membranes (a ‘sweep’), a transcervical catheter, the insertion of Prostaglandin gel (a hormone gel used to ripen the cervix), and an IV infusion of Oxytocin, a synthetic hormone used to bring on contractions and labour.
When choosing which method will work best for each woman, the doctor will take into consideration the reason for induction, as well as the health of the mum-to-be and the baby.
As with all medical procedures, however, there are risks involved, and it’s important the mum-to-be is well informed. The best thing a woman can do is ask lots of questions so she fully understands what she’s facing, Dr Catling says.
“Women need to ensure they have a satisfying conversation with their obstetrician and midwife that covers all the reasons for having an induction of labour and the methods to be used,” she explains.
Some common risks can include infection and bleeding, while more serious complications include foetal distress and umbilical cord prolapse. Discussing these risks with your doctor or midwife is an important part of the preparation.
Dr Catling also points out that mothers need to understand that induction can lead to further intervention.
“Having labour ‘medicalised’ from the onset can lead to more intervention,” she says. “Labour may become intense sooner, which sometimes makes it harder for the woman to deal with her labour pains. She may then ask for [pain relief] sooner than she might have if the contractions had gradually strengthened. And pain relief in the form of an epidural, when given in early labour, is associated with higher rates of assisted vaginal birth, including forceps or vacuum.”
So what can be done to prevent the need for induction?
In some cases, for medical reasons, it can’t be avoided. But for those trying to induce labour when past their due date, there are a few suggestions.
“Some women will try other methods of natural induction, such as having sex, nipple stimulation, taking caster oil, and eating strong curries,” says Dr. Catling. “However, none of these have been shown to be clinically effective.”
Dr Catling also notes that it’s important that women who have gone past their due date know that they have a choice to induce – but they can also turn it down.
“If women decline an induction (in these circumstances), then this decision should be respected. Women are then offered increased foetal monitoring,” she says.
Questions to ask about your induction
• "What are the main reasons I need to be induced?"
• "What are the risks to me and my baby if I don’t get induced for (perhaps) another week?"
• "What other things could you do to help me go into natural labour?"
• "What’s the latest day/time I can safely be induced (so my body has the best chance of going into natural labour first)?"
• "What are the methods you will use to induce me?"