Induction of Labour, Guide and How to Have a Positive Experience

If you are offered induction of labour (IOL) it is helpful to explore the reason why and look at your individual circumstances to decide if this is the right choice for you and your baby. This piece will

• Discuss the common reasons for induction with reference to the supporting evidence.

• Consider ways to start labour prior to medical induction.

• Offer suggestions for a positive induction experience.

If you are told you need induction or you will be induced on a set date it may feel that you don’t have any options, this is not the case. Having an induction is always your choice although it may not be presented like this by your midwife or doctor. It is important to know that no one can force an intervention without consent.

Reasons Induction is Offered and the Supporting Research

Around 1/5 of pregnant women in the UK will have an induction, the more common reasons are considered below.

Postdates

Being ‘overdue’ is the most common reason that IOL is offered and the UK base their healthcare guidelines on the National Institute of Clinical Excellence (NICE) a summary of which can be found here. NICE suggest that induction is offered between 41 and 42 weeks of pregnancy so that the baby is born by 42 weeks, you can find the evidence to support this guideline here.

In summary, the research says that the rate of stillbirth is 0.4 per thousand for women who had induction prior to 42 weeks and 3 per thousand for those who went beyond 42 weeks of pregnancy. The data found no difference in the rate of birth by caesarean or forceps and ventouse (instrumental births) between the two groups. Consider these numbers, you may feel that it is a significant increase and a risk you would not feel happy to take OR you may think that the increase is small and would consider going beyond 42 weeks of pregnancy. This is a deeply personal decision and not a choice anyone else can or should make for you.

Maternal Age

In the UK you will be offered IOL if you are 40 years or more when your baby is born, this is because there is an increased chance of stillbirth if you are over 40 and go beyond 40 weeks of pregnancy. You can find the supporting research for this here. It is important to note that if you have had a previous baby your risk of stillbirth is lower and a summary of this data can be seen in the table below.

Stillbirth Rates for Women Giving Birth per 1000 Ongoing Pregnancies

Reddy, Ko et al, 2006 (Data taken 2001-2002 from US Birth Certificates)

IVF/ Articifical Reproductive Technology (ART) Pregnancies

There is no conclusive data or universal agreement if induction should be offered for ART pregnancies, so hospitals have varied guidelines some offering induction and some not. There is an increased risk for these pregnancies, but this is associated with maternal health factors (older age, obesity, uterine anomalies, multiple gestations etc) rather than the treatment itself.  You can read further research related to this here.

When deciding if IOL is right for you and your baby consider your individual circumstances and if you have other risk factors rather than simply the use of assisted conception.

Medical Reasons

If IOL is offered for medical reasons including diabetes, high blood pressure, pre-eclampsia or baby’s size you can ask to see the relevant research and data that these guidelines are based on. Looking at the numbers helps you make a balanced and informed decision.

It is interesting to note that NICE says in the absence of any other indications, induction of labour should not be carried out simply because a healthcare professional suspects a baby is large for gestational age (macrosomic) although this does occur often in practice.

Pros and Cons for Induction

Weigh up the pros and cons for IOL by looking at your own individual circumstances. The decision may feel easy and obvious or a more difficult one to make.

Possible Pros

• IOL feels like the safest choice for your baby.

• You may be able to start the induction process as an outpatient or on the midwifery-led unit.

• You may feel ready to give birth.

Possible Cons

• It may take a couple of days to get labour started in the hospital leaving you tired and more likely to choose an epidural.

• Induced labour can feel more intense and less manageable than spontaneous labour (NICE).

• If you require a syntocinon drip to trigger regular surges you will need to be on the doctor-led unit and the birth pool will no longer be an option.

• The induction may fail in which case the baby will be born by caesarean.

• You may feel unready to give birth.

You can choose to accept, postpone by a day or two or decline the induction. NICE suggest that from 42 weeks, women who decline induction of labour should be offered increased antenatal monitoring consisting of at least twice‑weekly cardiotocography (CTG) and ultrasound estimation of maximum amniotic pool depth.

Encourage Your Labour to Start before Induction

Trying to stay as relaxed as possible is important but many Mums become anxious as they go past their due date. Remember that the due date is just a 5-week due ‘window’ which stretches from 37-42 weeks.

If you a holding in pent up anxiety it can be helpful to feel the emotions deeply. Try to release them with a weepy movie and a good cry long. I have had many clients go into labour once they have allowed the feelings rather than suppressing them in their efforts to stay calm.

Sweeps

You will be offered a sweep by the midwife at some point after 40 weeks of pregnancy, you can learn more about sweeps and consider if you want one by watching this video. Sweeps can work if your body is already starting to change ready for labour and your cervix has softened moved forward and opened. Data suggests that sweeps work 50% of the time although you may need 2 or 3 over a few days.

NICE says that currently, available evidence does not support the following for induction of labour: herbal supplements, acupuncture, homoeopathy, castor oil, hot baths, enemas, sexual intercourse. However, some of my clients have had success with the following methods.

Acupuncture

Starting once-weekly treatment from 34-36 weeks of pregnancy to encourage the cervix to ripen and open. This can be combined with full body massage for maximum relaxation.

Nipple Stimulation

Stimulating your nipples by hand or with a breast pump releases oxytocin and there is some evidence that suggests this can increase the chance of spontaneous labour by up to 30%. These studies were based on mums doing this for at least an hour a day for 5 days.

Dates

There is limited evidence to suggest that eating 6 dates a day from 34 weeks of pregnancy reduced the chance of needing our labour augmented with the oxytocin drip.

Movement

If your hips will allow it, go for a vigorous long walk each day to encourage the baby’s head to put pressure onto the cervix to stretch and open it.

Baby’s Position

Sometimes labour does not start or starts and stops because your baby isn’t in an optimal position eg back to back/ posterior. You can learn more about this and encourage them into a better position by taking my online course Align Your Baby.

Reflexology/ Massage/ Deep Relaxation with Audio Tracks/ Orgasm

Any complementary therapy or activity which encourages a feeling of wellness, calm and oxytocin release may be beneficial. Plan your days to include things that you find deeply relaxing.

You can watch me talk more about other ways of encouraging labour to start here.

I Have Accepted Induction, How Do I Have a Positive Experience?

If you go into IOL feeling very anxious and that it is not your decision this can increase your adrenaline output and reduce your birthing hormones, potentially making the induction process longer and more challenging.  

Once you know you are going in for an induction, mindset and a little preparation is key for a positive experience. You can watch a video explaining the process of induction here. It is important to make peace with your decision even if you feel it isn’t your ideal situation and as labour will be starting in a more medical setting you need to lay on your relaxation techniques extra thick. The following suggestions can be helpful.

1. Write some mantras for a positive induction. Use these throughout the days in the lead up to induction and throughout the birth.

2. Read some positive induction stories here.

3. Set up your environment in the hospital with home comforts; pillows, aromatherapy, photos etc.

4. Listen to the hypnobirthing tracks before induction and during the early stages in the hospital to tap into your state of deep relaxation. Headphones and an eye mask can help you block out the hospital environment and travel inwards.

5. Use slow breathing to relax whenever needed.

6. Take yourself off for walks and lunch or dinner if you need a break from the hospital environment, the process can take a couple of days so it is good to have a change of scene if possible.

7. Gentle nipple stimulation to boost oxytocin! Kissing, cuddling and massage can all get the hormones flowing.

8. Focus on your gorgeous baby, holding them in your arms and taking them home, boost those loving feelings to help your body go into labour.

9. Visualise your cervix softening and opening.

10. Once you start the induction process in the hospital remember, you can still decline anything at any time if it does not feel right. If you are not sure about something ask lot’s of questions and for half an hour or an hour to consider it, so you don’t feel pressured or rushed into decision making on the spot.

Although it may not feel like it, it is possible to stop the induction process and move to a caesarean if this is the right choice for you and your baby at any time.