Updated: Jun 10
Geraldton unfortunately has a culture of induction of labour at 39 weeks and onwards that has been steadily growing. It’s not supported in any midwifery evidence (if you know of some, I’d be interested to read it), but there is some obstetric evidence (ARRIVE trial). Although that evidence has been heavily critiqued and the authors even conclude themselves that it should not be influencing practice.
UPDATE 10/6/21 - there is now good evidence that contradicts the ARRIVE trial. See here for a discussion of the findings of the latest research and a link to the publication.
I believe this pro-induction evidence doesn’t look at a woman’s experience of labour or consider how it affects her confidence in herself and her abilities as she learns to parent. Nor does it take into account the baby’s experience of labour or the way artificially forcing labour upon a baby affects him/her before they choose to be born.
For the mother, it subtly (and not so subtly) undermines her innate capability to labour when the time is right. ‘If my body didn’t know when to birth, how can I trust it? How can I trust myself as a parent if I didn’t even know when to birth?’ Etcetera.
It’s a big loss of trust in self, and a loss of opportunity for her to step into her power even more fully. She enters motherhood filled with self-doubt, whether she consciously acknowledges it or not. The same for the partner/father. What is reinforced, is not that they are the experts in this experience and in their own bodies, but rather, that the medical team are the experts and that they are disconnected from their bodies’ intelligence, and must furthermore rely on an outsider to tell them what to do and what is right for them.
“It makes me furious, the arrogance of a practice that assumes superiority over a woman and her body, that it knows better - the pathologising of normal variation and direct undermining of women and their bodies.”
This has been going on for too long. Should those that mistrust birth and women’s bodies really be working in the birth field?
Furthermore, the stress that is placed on parents to decide whether to accept the induction or not entirely affects the final weeks of pregnancy. Many are being told at 10 weeks of pregnancy that they will be induced. When did this start becoming normal and OK? To plant seeds of doubt and mistrust.
During pregnancy and particularly in those last few weeks, letting go of control, surrendering to the great unknown, feeling as relaxed and open as possible, is vital to the hormonal birthing processes (ie oxytocin!). The great anxiety caused by pressure to accept an induction before 40 weeks cannot be underestimated. We used to trust our bodies to go into labour when our babies were ready. Inductions were not even put on the table until 41 weeks. I am seeing couple after couple being ripped off of their final pregnancy weeks, wracked with anxiety over this induction decision (which should not even be a decision needing to be made yet). It is disrespectful, and intrusive. It wrecks havoc on the complex process of going into physiological labour, reducing the chance of spontaneous labour occurring and affecting the safety of birth. Those final weeks of pregnancy must be safe guarded against unnecessary stress and anxiety.
I’m not talking about medically necessary inductions here, or those made in conscious choice, out of intention and intuition not driven by fear. They’re another story. I’m talking about the pressure to be induced because you’re almost at or just past the magical due date. Or you’re GDM diet controlled - is that even GDM? Or your baby measures large or small or you’re over a certain age or BMI or some other non-sensical reason, which really is just about a profession having power over women and their bodes. (Please read ‘Why Induction Matters’ by Rachel Reed if you’re not sure what I mean.)
The way our health system works, there is more money for an induction than a spontaneous birth. Inductions occur during the day time, spontaneous birth often occurs at night. It makes sense to push for scheduled inductions - more money at convenient hours. Hospitals can plan for staffing. Inductions work for industrialised birth. Natural birth is an uncontrollable inconvenience - (I’m sure women have been accused of that too!) In our current model of care, there simply is no incentive to support spontaneous physiological birth.
Inductions are a 3 step process: 1. Ripen the cervix mechanically by placing a catheter through the cervix and filling two balloons which place pressure on the cervix, forcing it to soften and open enough for step 2 2. Break the membranes, release the amniotic fluid 3. Start the oxytocin drip - aim to get the baby out within working hours
Will there be repercussions to this? Most definitely. Do I care? Most deeply. Should this be less emotional, more researched to be more effective/helpful? Most probably. Then why? Because we’ve been too quiet (too nice, too well behaved, too afraid of persecution) to speak out. But I am seeing too much stress, too much anxiety, too much mistrust of themselves and starting out parenthood with so little faith, that it’s time to call it out (well way past time, but better late than never).
Photo: Beautiful at 42 weeks @wild.pregnancy_free.birth