All in Good Time

To induce or not to induce - is impatience the question?

I have heard some extraordinary reasons to justify induction, but this one takes the cake:

"we can't be sure of the conception date, so it would be dangerous to go past your due date"

err...then how do you know the 'due date'? and why would not knowing this make a random date passing dangerous?

Your due date approaches, you are tired and possibly even 'over it'...your care providers offer a 'stretch and sweep' or 'membrane sweep'..a simple procedure, they will place a finger in your cervix and sweep around it, the idea being that the membranes will come away and release 'go into labour' hormones.  Evidence suggests that it works 50% of the time within 48 hours...seems to me that labour post this procedure probably would have happened anyway, so really, all this procedure does is introduce a seed of self doubt and possibly increased risk of infection.  At the same time as this is done, a 'cervical exam' will provide you with information such as 'softening' or '2cm dilated'...

"...if you know that you are pregnant and if you know when you conceived your baby and you think that everything's okay, doctors can probably do nothing for you. Women need to realize that the role of medicine in pregnancy is very limited..."  Michel Odent MD (in Optimal Birth)

You are now past your due date, and induction is being discussed: gels, syntocinin/pitocin, breaking waters/membranes...to speed thing along....seems like a good idea..I mean really...you're over it, everyone is asking "haven't you had that baby yet"?

It is important to understand the induction methods being offered, and why. 
What risks are involved?  
Have you heard about the 'intervention cascade'? 
​If you are induced you are more likely to end up with an epidural, and assisted delivery (forceps, vacuum, episiotomy) or c-section, and post-natal depression (PND). Whether or not the increased risk of PND is due to a sense of failure or dissatisfaction with the birth or hormones being interrupted and inhibiting bonding, or genetic predisposition, is the topic for another post.
​See: Slippery Slope of Modern Birthing

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So when do you induce and when do you politely refuse?  When is it truly medically indicated?

How late is late?
Many women are offer induction, or pressured into it, before the due date.  It is vital to ask why, and consider the context of the offer.  Induction is not without risk, it is not 'just a jump start', it is often offered due to convenience: and not always to you.  Is Christmas approaching?  Is your doctor about to go on holidays?  Is your work putting pressure on you to 'organise' you maternity leave?
or is the offer based on a 'medical' reason: baby too big, too small, uncertainty of dates (see above). mum is too fat, too old, has diabetes, is growing multiples, is too young, is too small, is tired...none of these are indicative of a need to induce.  

Let's consider the 'over-cooked' scenario, where you are being offered induction because you are past your due date.  If you are 10 day past the due date, you will be considered to be approaching 'post-dates', after 42 weeks the pressure to induce is very high. Is baby well? Are you well? How certain are you of your dates?

Some of the pressures surrounding induction are dictated by hospital policies - 'low risk' status may be lost, and your birth location may be changed due to one factor (e.g. BMI, gestation diabetes, and due date passing).  

It is well known that continuity of care, and in particular continuity of carer (ie having a known midwife through out your pregnancy, the birth and several weeks beyond birth), has the best outcomes for mothers and babies.  Unfortunately, modern maternity practice rarely offers this model of care. Most maternity policies are based on insurance-drive limitations or staff management protocols, they are not woman-centred and not supportive of informed decision making.

 Keep this in mind as you prepare your Birth Map, and the consider the potential induction pathway. DON NOT LEAVE THE INDUCTION DISCUSSION TO THE LAST MINUTE!  Birth should not be on a 'need to know basis'.  Take time through out your pregnancy to understand the modern maternity landscape, and make informed decisions in advance for various scenarios: and considering the 'induction based on due date' scenario is sensible given how common it is.

See: The Bun in the Oven

What follows are links to help build your understanding of normal, and find your comfort zone.  

Smart babies stay in the womb longer; Study shows improved brain development in full-term infants 
www.nydailynews.com/life-style/smart-babies-stay-womb-longer-study-shows-improved-brain-development-full-term-infants-article-1.1106249#ixzz2B9r9DTWp


The surprising lack of evidence for Post Date Birth Induction
http://www.greenmedinfo.com/blog/surprising-lack-evidence-postdate-birth-induction

Induction - a step by step guide (Midwife Thinking)
http://midwifethinking.com/2011/07/17/induction-a-step-by-step-guide/


Induction Of Labour - To Induce Or Not Induce?
www.bellybelly.com.au/birth/induction-of-labour-to-induce-or-not-induce


Length of pregnancy can vary by up to 5 weeks, scientists discover
http://www.independent.co.uk/news/science/length-of-pregnancy-can-vary-by-up-to-five-weeks-scientists-discover-8749081.html

Induction, labour and autism:
http://sarawickham.com/2014/01/06/induction-augmentation-and-autism/