Many Healthy Women are Choosing to have Induced Labour.

 

In some cases, induction of labour can save a person's life. In this article, we explained everything about women being induced for non-medical reasons and earlier in their pregnancies.
 
Pregnant women in Australia are increasingly having their labours induced rather than giving birth naturally – and not always for good reason.
 
According to the most recent national data, a large proportion of first-time mothers (41.6 per cent) were induced in 2018, compared to 30.6 per cent in 2010.
 
In the 16 years leading up to 2016, induction rates for women 37 and 39 weeks pregnant in New South Wales tripled, according to one recent study, which was published in BMJ Open. In addition, 15% of new mothers were induced without a medical reason.
 
In some cases, induction of labour can save a person's life. When it is not medically indicated, however, it may place women and babies at unnecessarily increased risk of complications.
 

Remind me, what is induction?

Induction of labour is the medical start of labour. This can be accomplished through the use of hormones, a balloon-shaped catheter placed in the woman's cervix to open it up, or by breaking the bag of water around the baby.
 

Induction is often recommended when:

• According to one of the findings, inductions are sometimes performed for no apparent medical reason. This is especially true in private hospitals, according to previous research.

• Women are sometimes told that their baby is larger or smaller than normal. Larger babies may cause more complications during birth, while smaller babies may not grow well. However, ultrasound can be very inaccurate, and babies that are thought to be small or large at birth are often very average in size.

• Sometimes women are sick of being pregnant and are (understandably) uncomfortable, so they request or are offered an induction.

Greater intervention

Between 2001 and 2016, our BMJ Open study tracked nearly 475,000 births in New South Wales.
 
Of these, 69,397 (15%) had an induction of labour for no medical reason. These women were between the ages of 20 and 35, had a healthy pregnancy, and did not smoke, have high blood pressure, or diabetes.
 
In comparison to first-time mothers who gave birth naturally, those who were induced were more likely to have:
 
In one area, induced mothers benefited: severe perineal tears were slightly lower for first-time mothers (4.2 per cent vs 4.9 per cent) and those who had previously given birth (0.7 per cent vs 1.2 per cent).
 
Mothers who had subsequent children did not have the same high rates of intervention as first-time mothers.
 
Another recently published study found that first-time mothers had higher rates of caesarean section.
 

Inductions early in pregnancy period.

Over 16 years, we discovered a significant increase in NSW babies being induced at "early term" (37 and 38 weeks).
 
The number of babies born at 37 weeks' gestation tripled, while those born at 38 weeks' gestation doubled.
 
Those last few weeks in their mother's uterus, however, are critical for the development of the child's brain and other body systems such as the lungs, as well as the ability to control blood sugar and body temperature.

Long-term outcomes

Previous research has shown that inducing healthy pregnant mothers after 41 weeks of pregnancy reduces stillbirth, and the World Health Organization recommends this practice (we previously recommended induction after 42 weeks).
 
While our study did not look at stillbirth because all of our mothers and babies were healthy when labour began, we found no difference in neonatal, infant, and child death rates between the two groups.
 
Our study is one of the first to look at the long-term effects of labour induction.
 
Babies who had induction of labour experienced more trauma during birth and were more likely to require resuscitation. This is most likely due to being born prematurely and/or requiring more surgical intervention.
 
Babies born after induction were more likely to be admitted to the hospital with breathing problems and infections (ear, nose, throat, respiratory, and sepsis) at a range of ages, up to 16 years.
 
We were only able to examine hospital admissions, which occur when there are more serious health issues, so this does not include visits to a GP or other community services.

Loss of control

Most women prefer to go into labour naturally because induction is more painful (hence the increased use of epidurals) and they feel they have less control during labour.
 
Women who are induced find it difficult to move around because the baby must be constantly monitored for signs of distress. The induction drugs can cause very strong contractions, reducing oxygen to the baby. Most women have intravenous fluids running, which restricts movement even more.
 
Because of this lack of control, women may be dissatisfied with their births, and some may even be traumatised.
 
A recent evidence review discovered that decisions about induction were mostly made by clinicians rather than women, whose expectations and preferences were frequently unmet.

Time for a change

Clinical practice guidelines differ widely in terms of when women should be induced.
 
The World Health Organization has advised against inducing labour without a medical reason before 41 weeks of pregnancy.
 
The National Institute for Health and Care Excellence in the United Kingdom also released draught guidance for consultation this month, recommending that women be offered induction at 41 weeks but leaving the issue of induction open to debate.
 
 
There is no doubt that if used wisely, induction of labour can save lives. However, because it is a major medical intervention, it should not be routinely offered before 41 weeks without first discussing the risks and the potential increase in other interventions that women may not anticipate.
 
This discussion should also include the fact that we do not yet know all of the potential long-term effects of inductions.
 
Most importantly, women must be aware that they have the right to refuse or accept any intervention or treatment offered or recommended by health providers, and that the information provided to them must be balanced, evidence-based, and free of coercion. 

• The pregnancy has been extended beyond 41 weeks to reduce the risk of stillbirth; 

• The mother has high blood pressure or diabetes; 

• And there is another significant issue endangering the mother's or baby's health. 

• An assisted birth using forceps or a vacuum (28 per cent for women who were induced vs 24 per cent for women who gave birth spontaneously) 

• A caesarean delivery (29 per cent vs 14 per cent)epidural anaesthesia (71 per cent vs 41 per cent)an episiotomy, which is a surgical cut to the perineum, which is the area between the vaginal opening and the skin leading to the anus (41 per cent vs 30 per cent).