Modern women believe that they have a very narrow window within which labour must begin to be safe. Many believe that induction is compulsory after that window closes. Women will try just about anything to fit inside the narrow parameters their care providers have given them, and often feel extremely anxious about it. But is it really necessary?
In short, any decision which is based on estimated gestation as opposed to the health of the woman and her baby is not always in their best interests. Care providers are frequently guilty of omitting information when they discuss inductions. In his renowned essay Technology in Birth: First Do No Harm, Marsden Wagner states:
”Studies of birth certificates show that birth is more common Monday through Friday, 9 a.m. to 5 p.m. The only explanation that can be given is that doctors and hospitals use the induction of labor for their own convenience.”
They fail to explain that their guidelines are there to standardise care, to ensure that all women are being given the same care. McDonalds does the same thing with their burgers. Guidelines are for care providers, not for women. The law states that care providers require informed consent – which they can not have without explaining the difference between protocol and evidence – but it does not state that women must undergo anything within the confines of the guidelines.
Protocol for induction is rarely based on evidence. This is extremely apparent when we look at the wide variation between different care providers, venues and their protocols. Some practices are pushing induction before the woman is even 40 weeks, others at 41 and still others not until after 42.
The result is that women spend weeks fearful of being induced, doing everything they can to cause labour to begin without the “need’ for synthetic hormone induction.
Women spend weeks tweaking their nipples, eating curry, driving down bumpy roads, having uncomfortable sex, eating pineapples, gulping down castor oil cocktails, seeing chiropractors or acupuncturists, and plenty more. However the induction rates stay the same, and tellingly, the rates of caesarean for those that are medically induced, also stay the same – very high. Maternal and fetal outcomes also stay the same, with the exception of the US of course, where poor outcomes are rising.
At the end of pregnancy there are a number of factors that need to be considered when making decisions. Healthy women are frequently told all about the risks of NOT acting, but they are very rarely told about the risks of acting. Induction is not the harmless procedure that we have come to perceive. Often is is simply the first step in the cascade of interventions.
Unless your body and your baby are ready for birth, there is nothing – except a scalpel – that will bring your baby out. Not curry and sex, not dates, not raspberry leaf tea (which is a uterine TONER not stimulant) not castor oil, and not even powerful artificial hormones.
It’s an odd premise that a body can conceive and carry a baby to term, but suddenly at 40 weeks that same body has no idea what to do anymore. Realistically speaking the only way this idea has come to be so widely accepted is because of obstetric culture, and the high rates of induction.
Care providers are known to make flippant remarks about how women are “never going to go into labour” which women then internalise, and recount to their friends. Whether this is a women’s misinterpretation of a flippant remark, or something more akin to a game of chinese whispers we can’t be certain. What we do know is that our society widely believes that large numbers of women simply can not go into labour.
Women do go into labour though, and babies are born quite effectively, and quite healthily, when they are given time to finish gestating. Of course there are medical reasons where induction becomes a good option, but routine induction needs to be clearly explained to women as OPTIONAL, rather than mandatory.
If an induction can be scheduled based on nothing more than a date, then it’s a safe bet that the induction is medically unnecessary. Although the risk of stillbirth does rise slightly as pregnancy progresses, by the time you induce, you introduce different risks and the woman starts the cascade of interventions.
Any time a woman is pressured to induce, or not given all the information about induction and the likely outcomes, it is unethical and illegal. As Ina May Gaskin states:
“It’s easy to scare women. It’s even profitable to scare women… But it’s not nice, so let’s stop it.”
If we have any hope of improving birth outcomes, lowering the caesarean rate, preventing birth trauma, and ensuring that women and babies get the best start in life together, the induction rate must be reduced significantly. It is likely that by placing pressure on hospitals and care providers to follow their own guidelines for true Informed Consent, rather than ignoring them, and favouring their induction guidelines, would create this decrease.
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