What Is Induction Of Labour?
I have decided that the first thing to discuss when exploring induction of labour is length of pregnancy and the famous due date. I believe this is especially important when it comes to an all healthy, good and well pregnancy, and often its careful consideration is overlooked even more so in this case. Almost as if we are ‘out the woods’ now or they are ‘well cooked’ now’, and the baby coming sooner than not would not be such a bad thing and especially when the idea of the ‘failing placenta’ starts to get readily thrown about but that is another blog post on its own.
What Is An Estimated Due Date?
An estimated due date is literally an estimation of when a baby may be born, w ith the value lying in standardising everyone’s pregnancy length to in turn standardise care and timings of care, especially when maternity care has a duty of care and to so very many. Outside of this and with healthy, all good and well pregnancies, I often see no benefit of dating a pregnancy other than helping someone decide when to engage with maternity services.
How Is An Estimated Due Date Calculated?
Most commonly an estimated due date is calculated in one of two different ways and most likely both ways will estimate different due date dates. The first way people are most likely to have their estimated due date calculated is by using a due date calculator, which involves knowing the first day of the last menstrual period and then adding 280 days onto this date. This does not take into consideration any of the many variables in menstrual cycle length, ovulation timing, let alone the natural variations in length of pregnancy.
The next way estimated due dates are calculated is through measuring babies size during an ultrasound scan. This is usually performed at a ‘dating scan’ around 10-14 weeks (by this means it is estimated well after calculating it using the above method, and it usually gives a different estimated due date). There is also a tendency for health professionals to go by estimated due date calculated by the ultrasound method over the above method and this is even if some are sure of all important variables.
When Might An Estimated Due Date Be Relied Upon For Decision Making?
Estimated due dates are commonly factored into decision making around induction of labour for whatever reason. And what is induction of labour? Induction in the simplest of ways, means to give rise to or start something. The next important word in the term induction of labour, is obviously ‘labour’ and this we can summarise appropriately as the process of childbirth.
What Consists Of Induction Of Labour?
The first thing to appreciate here is the when and how childbirth initiates naturally and therefore in the absence of induction. Evidence indicates that some key physiological changes occur coming up to and as late as the last 24 hours before labour begins. Let’s look at what some of these key changes are.
What Are Some Of The Changes That Occur Before Labour Begins?
Firstly, we should explore the baby’s role in the onset of labour. Towards the end of pregnancy the baby’s adrenal glands (the glands that sit on top of the kidneys) start to release cortisol (the stress hormone). The purpose of this is to prepare the baby for the process of labour but also its adaptations to life earthside in the absence of the placenta. It does this by encouraging maturation of many major organs. For example cortisol helps to mature the baby’s lungs, something the placenta has been playing the role of throughout the baby’s time in the womb.
Once the organ maturation part of the process is complete the baby then sends a building block for oestrogen to the placenta. The placenta uses this to release oestrogen into the mother’s body, preparing her brain and body for labour. The really high levels of oestrogen in the mother help prepare her uterus for contractions, and increase the number of oxytocin receptors in the uterus, brain and breasts. All this contributes towards a well coordinated labour, birth and beyond. It also helps the mother’s body prepare for the physiological pain of labour and birth by priming pain relieving pathways and mechanisms within the spinal cord and brain.
Have You Noticed That The Cervix Is Often The Focus Point When Talking About Induction Of Labour?
Did you know that as explained above, the mother and baby both have equally important roles in creating the optimum conditions for labour to begin? And, that the cervix has no initiating roles in any of these? I am sure that the only reason why the cervix is the focus point for induction of labour within maternity care, is because it is more easily accessible and meddled with than, for example, the safely incubated baby.
The cervix undergoes important changes around the same time as the above mentioned, and all as a result of the higher oestrogen levels within the mothers body. The key factor in this being that the oestrogen levels in the mothers body are now higher than progesterone levels. Collagen within the cervix which is responsible for keeping the cervix firm and closed to serve as a protective barrier for baby, is now broken down by relaxin and prostaglandin also promotes softening and ripening of the cervix ready for labour.
What Are The More Readily Encountered Forms Of Induction Of Labour?
Membrane sweep or stretch and sweep
Artificially breaking of membranes releasing waters or amniotomy – Actually quite likely to occur during the above procedure
Prostaglandin pessary or gel to ripen cervix
Balloon catheter in cervix to mechanically stretch cervix open
Syntocinon drip to stimulate contractions usually following procedure number 2
Whilst the above are the more commonly encountered methods of induction. Have you ever considered the fact that anything suggested as a way of bringing on labour, even if it is a more natural and potentially safer way of bringing forward labour and birth, it is still technically a form of induction of labour?… Not only does this undermine womens and babies innate abilities to know when the time to labour is right for them, but also all these options or things women could do to try and bring forward their labour and birth, sadly creates a feel that women should be doing something, or something more. That they are not quite enough or not doing things right, if they are not successfully interfering or acting to control things themselves and that just being, or just trusting is not enough.
What Are Some Of The More Natural Forms Of Induction Of Labour?
I have listed below some of the more natural forms of induction of labour. Be warned once you have accepted this idea or grasped this different view of induction of labour there will likely be no going back for you. I am not ignoring the fact that induction of labour has a place within obstetrics, here I am talking about pregnancy and beyond when it is all healthy and well.
Here is that list of more natural forms of induction…
Exercise i.e brisk walking
Acupuncture or Acupressure
I will not be going into any specific detail about any of the above forms of induction of labour whether medical or more natural in this blog post. This post is more about induction of labour as a whole and as a decision that many people need to consider.
How Can Women Best Consider Induction Of Labour?
The first thing to remember is something that remains true in any decision making situation, that is that no one can know what the best decision is for anyone, before they have decided for themselves and informed said person. And so very importantly in the case of induction of labour, anyone in a position where they wish to access support for their decision making around this, they should remember that they would be best supported by someone pointing them in the direction of well balanced, safe and appropriate evidence based information. Furthermore, they would be best supported by someone who helps them navigate all this important information. Lastly, a supportive and empowering environment is fundamental to holding safe and sturdy mother-centred space, and anyone can best encourage a truly autonomous and informed decision to be made by the person at the centre of this decision.
Learn more about antenatal midwifery care and support and what is available to you through
The Nurture Mama Ltd, by clicking on the following link https://thenurturemama.co.uk/antenatal/.
I shall leave you with a quote by Rachel Reed during an interview with the Positive Birth Movement. If there is one thing that not only service users but also health professionals need to remember during induction of labour talks – it is this!
‘We need to start considering the woman as the expert regarding her body and her baby. Health professionals need to share information and support decisions without judgement, and respect the woman’s expertise’.
– Rachel Reed
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