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Forget everything you’ve heard about ‘inductions’; an OB shares the one thing you need to know

induction

If there’s one topic that’s ‘hot’ right now in the world of pregnancy and birth - it’s induction.

Odds are you know at least one person who has experienced an induced birth, and perhaps didn’t have the nicest things to say about it. I know I certainly do. There is just something about ‘forcing’ the body into labour before it’s ready that seems kind of, I don’t know… against nature, perhaps?

At least, that’s how I used to feel. With one naturally occurring labour and an elected c-section under my belt, I wasn’t at all familiar with induction in the vaginal birthing sense, but after talking to OBG-YN Dr. Hugh Porter of Sydney Babies, on the Cold Coffee, Hot Mess Podcast this week, my tune has been entirely changed.

There’s a bit of a stigma around induction, what are the choices around induction, and what warrants an induction?

Dr Porter: Look, induction is a hot topic. It’s such a fascinating word in the community because everyone views it in a different way. I think the first thing to realise with induction is that sometimes we need to induce someone. So induction is taking someone who is not in labour and starting the labour process before their body is really ready essentially. 

The very first inductions would have started because there was some medical reason why it was safer to have the baby today than to wait until tomorrow when you might go into labour.

Sometimes there is a genuine medical reason for induction, and I don’t think anyone worries about those inductions. If your baby is really small, or compromised, or the placenta’s not really working, or you’ve got gestational diabetes on hundreds of units of insulin, you’re really sick, those kind of reasons would make it genuinely unsafe to go another 24 hours before giving birth. Mum could crash, or baby could crash.

When is an induction beneficial for mother and baby?

Dr Porter: A few years ago a study came out, it was really interesting - they basically took thousands of women, they were low risk women that would normally go on and labour naturally. They said, ‘what would happen if we randomly took women out of this group and we induce them at 39 weeks, or just let them labour - and we just compare the two groups and see what happens.’

It answers the question, is an induction a good thing or not? It was a well designed study, there are certainly people out there who have issues with is, there are people who have issues with every study. This one is called the ‘Arrive Trial’ - and what it showed, which I think surprised everybody - the obstetricians, the patients, everybody - was that it seems to be the safest time to have a baby at 39 weeks.

What this study showed from a medical point of view, in terms of outcomes for the mum and baby, taking experience out of the mix, babies did better if mums were induced at 39 weeks; there were less babies in the nursery. 

Mums had less vaginal tearing, the cesarean rate was actually lower if you were induced. Mums did really well and so did babies, as less babies were sick and in the NICU if birthed by induction at 39 weeks.

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So, why doesn’t everyone just get induced at 39 weeks, then?

Dr Porter: The big thing about the ‘Arrive Trial’ is that it’s like it’s so much safer to give birth at 39 weeks, than to wait until 40 or 41 weeks. The way I read that data is, if you’re a low risk person, if you want to have an induction at 39 weeks to be the safest time, or whatever the reason is, then there’s no reason not to do that, but if you want to wait it out the risk doesn’t go up dramatically. It certainly does say 10 days after your due date, but for the next couple of weeks, anytime is a good time to have a baby.

It comes down to your reasoning for induction. I have patients who want a low intervention birth and then they get to 38 weeks and it’s a 40-degree day and they call me to say ‘get this baby out of me right now!’ Now this is certainly something we can help with, but at the end of the day, everything is a conversation. There are always going to be pros and cons with any approach.

So why does induction get such a bad wrap?

Dr Porter: The key thing with induction is, it has to be done right. And I think the problem is it’s often not done right, and that’s what gives it a bad name. And when I say doing it right, I mean making sure someone is essentially close to going into labour on their own before you start. We have a way of telling when we examine the cervix to tell how close you are to going into labour. We do this using a ‘Bishop’s score’, which gives us the markers to how close you are to labour. Is the cervix opening or softening? Does it feel hard like the tip of your nose, or soft like your cheek? 

When does induction result in c-section and intervention?

Dr Porter: In qualifying you for an induction, we would score your cervix, to say how close you were to labour, and for all of those studies (like the ‘Arrive study’) you had to score a 7, which means you’re well and truly on the way. If I started induction on someone who was a 3, the chance of c-section and all of those interventions are much, much higher. 

If I was to take someone off the street who was nowhere near labour - it wasn’t even on the horizon and I induce them, they’re definitely going to have an emergency C-section, 100 per cent! Because they’re going to have to be labour for 24 hours before the cervix even starts to change, in which time baby gets distressed and you have to have an emergency c-section. 

So overall, a poorly done induction gets the result that everyone expects in the community - and a well done induction can be incredibly beneficial for mum and baby.

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