I want to talk about something that has been on my mind for a long time.
I want to talk about induction of labour.
More specifically I want to talk about IOL for “prolonged pregnancy”, where mum and baby are both healthy and well.
Particularly where the mum is less than keen on the idea. In some cases, where it risks her out of her choices for the sake of a box ticked or a line on a graph.
I’d like to talk about why it is slightly just a little bit rubbish.
Gonna include a content warning here for induction of labour, difficult birth. If you had a difficult birth and/or one where you didn’t feel listened to, proceed with caution.
This post is specifically NOT about severe or acute illness where baby needs to be born as soon as possible.
If a woman is perceived to be pregnant “too long” she is offered induction. Is it only me who sees that as wildly simplistic and below par?
We have all this amazing medicine and science. We have all this knowledge about how the body works. And that is really the best we can come up with?
What else could be offered or considered BEFORE induction?
All mums have heard of sex and pineapples (NB. not sex WITH pineapples: not recommended), or spicy curries, or bouncing on a birth ball.
What else could your midwife or doctor discuss with you before bringing up induction?
For example, if you are approaching your due date, has anyone talked with you about your family history? How long was your mother pregnant? Aunts, grandmothers? Did they look into why pregnancy appears prolonged – is this normal for you? How long were your previous pregnancies? Are the dates correct? Are you and baby well? In other words: Is this truly a high risk situation that warrants intervention?
My guess is no, you reached a date on the calendar and were told you “had to” (don’t, please! I know! But that is the language used) be induced.
My observation so far has been that there is usually no attempt to address the cause of the “problem”, except sometimes from the mother herself, depending on her own background knowledge.
Things like, is baby well positioned? I once heard a midwife tell a room full of expectant parents that scrubbing floors was helpful in late pregnancy. And sitting on a birth ball.
Hey, she is kind of right. But. There are so MANY ways we can encourage optimal foetal positioning without reinforcing tired gender stereotypes (“hey, women, you should do more housework – right at the time you feel exhausted and crabby and approximately the size of a hippo with a bladder the size of a pea.” Wow, thanks Janet, what a revelation, my life is changed.)
Is mother suffering anxiety, or stress? Knowing that how we feel has a direct impact on labor, does it not follow that it might also have an impact on its beginning? And this being the case, what is her mental health like? Is she struggling with depression? Isn’t it worth exploring that in light of how many women suffer from it?
More: does she have a good relationship with her spouse? Does she feel safe? Is she walking on eggshells daily? Does she have ANY decent support at home? Heck, how old is she? (I am thinking globally, here, and how many young girls have their first child early.) Is she a survivor of abuse? Domestic orotherwise? What might be inhibiting the onset of labour and how can we help her address this? (Might be – if this is even a “problem” at all, as above.)
How often are any of these elements considered? And how often are all of them ignored – you reach an arbitrary date on the calendar, and off you go. Time to try and make the body do something it is probably just not ready to do (because if it was, it would very likely already be doing it).
There are some people out there who see the harms from overuse of IOL. People wonder, Oh dear, why labour was long/traumatic? Oh dear, I wonder why baby got stuck? Oh dear, I wonder why she tore so spectacularly? Oh dear, I wonder why she is upset? How can we improve this? I applaud those people, because I agree it needs improving. But the answer I have is too boring to listen to and doesn’t involve research or drugs or instruments. Just skin. People showing up and caring. That is hardly going to gain traction anywhere.
For a long while, IOL has reminded me of a baby just given a shape sorter, banging the cube randomly on the hexagon shaped hole repeatedly. He doesn’t really know what he is doing. Just wants to get this lump through this hole. Oh, it’s not working? Ram a bit harder, see if that works.
We don’t really KNOW what causes the onset of labor. We have a rough idea that the baby releases a protein when the lungs are ready. But…. /shrug. We can’t mimic that hormone dance completely even if we did know it. This almost never factors in to the induction process, unless it’s known baby will be premature and need help. It is almost an inconvenient fact.. Take a seat and pipe down, science.
There is no finesse involved in the process. When all you have is a hammer, every problem looks like a nail.
Oh, this person isn’t responding to this drip as well as we hoped. Solution? Turn it up to eleven 😎 Don’t give her freedom of movement to utilise gravity and allow the baby to achieve better position, because we won’t get a decent trace. The recording of our doing of the things is, legally, more important than your doing of the thing. Just hop up on the bed for me.
The system often fails to see the person as a whole person. In fact, lots of women don’t feel that they are seen or treated as a person at all, whole or otherwise. Daily I see and hear women saying, “I just left my appointment at XX weeks, and I feel so upset because…. ”
Why is this happening? Why are so many women feeling so unhappy with their care?
The (pesky) science is there to support that a normal pregnancy can vary up to five weeks in length. But I don’t see this recognised in real terms at any level. Babies are still ubiquitously described as being “late”. It seems everyone treats a mother as overdue at 40w1d. Are we pathologising healthy pregnancies? That is what it feels like.
I sometimes think of pregnancy as like puberty, and waiting for baby to arrive a little bit like waiting for your first period. You might have curves and spots and greasy hair and rage and tender breasts…. And your period could be months away. Or you can be straight up and down with very few of the usual signs, and get your period tomorrow. Would we give a girl hormone tablets if she didn’t start bleeding by her fourteenth birthday?
We know (don’t we?) that women have a basic need to feel safe and cared for during labour. Does she not need this before labor begins? If she feels alienated from or coerced by or ignored by her HCPs, surely you might as well have a sodding great sabre tooth tiger prowling around her home. Well, will you look at that. She does not feel safe. I wonder why labor is not starting sooner rather than later? 🤔
The same holds true during labour, too, when things slow down. Mum is quite often given a time limit and threatened with The Drip or The Doctor. “We only let you do this for a certain amount of time, you know.” (Thanks, Janet, could you please email that to my uterus?)
How often does anyone ask, When did Lucy (a made up name, Labouring Lucy) last go to the toilet? When did Lucy last eat something? Is Lucy staying hydrated? Lucy, you are quite safe. I am here to care for you. How often are women forced to try to labour effectively in the same room as someone who is frightened, angry, exhausted or tense? How often are NONE of these things addressed, and then, a little later, a drip set up “to get things moving”. Tale as old as time.
I know there are people out there who do address those things. Those births will end up in the “easy” category, with very little intervention. It’s negative data. But I see you. I just wish there were more of you.
We know (don’t we??) that labor is as much mental as it is physical. Before induction is offered, does anyone build a rapport with that mum to be and ask her how she is feeling?
Just THAT – that one teensy tiny change – making a connection, asking how she feels, truly listening…. If NOTHING else changed in the way IOL was offered and managed, that alone would make a humungous difference to our experiences as we become mothers… and on our mental health, regardless of whether IOL was used or how our babies arrive.
We all just want to be listened to, and we all deserve to be able to access continuity of care as a starting point and a standard, not some lofty unsustainable goal.