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Avoiding induction - without eating pineapple!

by lizzi (follow)
Helping plant the seeds of positive birth. www.sproutbirthing.com.au
Birth (105)     
So we just looked at 2 (relatively extreme) examples of how the final weeks of pregnancy can go for a woman. Weeks of actively trying to avoid a medical induction vs weeks of relaxation and doing whatever you feel like.

I’d really like to look at just why so many women are finding themselves stuck in the first scenario rather than the second. Why are so many women finding that their final weeks of pregnancy are a miserable mush of pineapple, unwanted sex, curry, bouncing and rocking, squatting and doing various other they don't want to be doing? It’s all well and good if you actually WANT to do those things – for the pleasure of doing them, rather than as a means to induce your labour before baby is ready – but so many women are doing them because they feel they “have” to.



CTG
Courtesy of MorgueFile.


“My doctor won’t let me go past 39 / 40 / 41 / 40 and ¾ weeks”
This seems to be a super common reason for the flurry of activity to force the body to go into spontaneous labour (there’s that oxymoron again!) And in all honesty it’s also the most easy to avoid reason for induction around.

My top recommendation for avoiding this type of induction: Choose your care provider wisely. If you don’t want to be subject to an unnecessary induction simply because it’s care provider policy then choose a care provider who doesn’t induce women without a medical reason. Choose one who recognises that 40 weeks is an ESTIMATED due date not an expiry date. Choose a provider who recognises that the health of the baby and mother are not dependent on the calendar.

Easier said than done I know. We don't all have the option to choose a woman friendly care provider. So my second top recommendation for avoiding this type of induction is: Know your rights. You have a legal right to decline any medical procedure recommended to you. This right doesn’t just disappear because you are pregnant. Your care provider can make any recommendations that they like but they cannot “require” you to follow their policies. The AMA position statement on maternal decision making makes this clear. If your care provider is trying to force you into a procedure you don’t feel is necessary take along a copy of the position statement and let them know that you are aware of your rights.



CTG
Courtesy of Wikimedia Commons.


”I’m just not comfortable with the risks of going overdue.”
Now…I’m not going to rubbish anyone’s risk analysis. If you are not at all comfortable with going past a certain date that is entirely your decision to make. And we don’t make decisions in a vacuum – if you, or someone you know, has experienced an unexplained stillbirth at 42 weeks you would likely make a very different decision to someone who birthed their baby at 43 weeks with no signs of being overdue at all.

My top recommendation for the women who fall into this category is: Do a wide range of research and take responsibility for making an informed decision. Are YOU the one that’s not comfortable with going overdue (based on wide research) or is this a fear that has been passed to you by your care provider, your partner, your mother, your cousin’s best friend? Have you researched the actual risks associated with going overdue? And how are you defining “overdue”? Because “normal gestation” is considered to be 38 – 42 weeks, so you’re not actually overdue until you reach 42 weeks.

At 42weeks and 5days an OB gave me a research paper with the stats highlighted – at 43 weeks my risk of stillbirth was going to be 7 times higher (7 x higher than what I can’t remember). What he failed to highlight was the conclusion of the research paper which stated that the absolute risk of stillbirth remains so low that the risks of induction should be very carefully considered before making a decision. The moral of the story – Research widely before deciding what you are comfortable with!



CTG
Courtesy of Wikimedia Commons.


I’m also going to throw in: Choice of care provider again. Make sure that you have chosen a care provider who understands the actual risks of both going overdue AND induction. One who also understands your own fears and has the sensitivity and knowledge NOT to feed those fears. One who can help you to understand how you will know if bub is or isn’t okay and who trusts YOU and your instincts.

So let’s just assume that you have done all this research and have decided that you absolutely are not comfortable with going past a certain date. You book in the induction and start doing everything you can to force your body to go into spontaneous labour beforehand. For some women this “works” and they go into labour. However you have to remember that a percentage of women would have gone into labour before the induction date anyway so it is impossible to make a suggestion that it was the "induction method" that did the trick. For those women whose babies and bodies aren’t ready (because if they were ready you’d be in labour) they find themselves mentally, emotionally and physically exhausted by the time that induction date rolls around. Remember that first scenario?


"I have a medical condition which means it’s safer for bub to born at 38 /39 /40 weeks, but I don’t want a medical induction.”

This one is tricky. Because my personal thoughts are that if your baby or yourself are at such risk that you need to have an induction (remembering that every step of induction carries various risks) do you really want to add stress to yourself and bub by trying to force labour… especially at home where neither of you will be monitored?

My top tip for avoiding this type of induction is much the same as the other 2: Research widely. For example women are often frightened into inducing as early as 38 weeks for gestational diabetes, however a growing number of women are declining this and opting for additional monitoring and a personalised approach to their care. For example a woman with well controlled blood sugar levels has a much lower risk of problems (and therefore less need for induction) than a woman who’s BSLs are uncontrolled therefore your care provider should be looking at the entire picture.

My other tip for this is…you guessed it! Choice of care provider. Choose a care provider who bases their recommendations on YOU not your “label”. 2 women could have the exact same medical condition but still have 2 very different pregnancies and births and make 2 very different risk analyses.


So next time you are asked: How do I avoid an induction of labour? Here’s a few answers that don’t involve pineapple, sex, walking for 10 kilometres per day and turning yourself into a dairy cow:

Choose your care provider wisely;

Know your rights and feel free to “just say no”;

Research widely – NOTHING is risk free!

Remember that oxytocin hates adrenalin;

The final weeks of pregnancy can be either the most stressful or the most magical – no matter what your baby will be here soon. Why waste this precious time doing things that you don’t love?!

#Birth

Further reading:

Choosing a maternity care provider who works for you

Informed consent - we've been fighting for the wrong thing!

The illusion of choice in Australian Maternity Care

Dealing with adrenalin gremlins - Birthing in an unsupportive environment

Obstetric violence - Stop burying your head in the sand!
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Oxytocin does hate adrenalin it is so true. The reason for this are the receptor sites on the cervix for adrenalin, it sticks to them and makes the cervix rigid, harder to open. If the body senses a rigid cervix full of adrenalin then no way is it going into labour. Lovely picture of relaxation, and that is the key. Relaxation techniques practiced in the last 6 weeks of pregnancy will reduce stress levels ready for labour. www.painfreelabour.blogspot.co.uk
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